Pharmaceutical clashing with Dutch doctors over pricey cancer meds

Dutch doctors are clashing with the pharmaceutical company MSD about expensive cancer treatments. Doctors are trying to spend less on pricey medicines while still offering their patients the best possible treatment. MSD accused them of “experimenting on vulnerable patients,” NOS and Nieuwsuur report.

New cancer drugs are very expensive, and the effectiveness of these drugs is often still unclear. Partly for this reason, doctors regularly prescribe lower doses. That has fewer side effects and is also cheaper, according to the media.

For example, Dutch doctors use the immunotherapy Keytruda for nine different types of metastatic cancer. It is the best-selling drug in the world, and MSD sold 25 billion dollars worth of the treatment in 2023, including over 250 million euros in the Netherlands.

Dutch doctors don’t dispute that Keytruda is effective, but they aren’t convinced by the level of the effective dosage. MSD prescribes a standard dosage. But according to doctors and pharmacists, human bodies aren’t standard, and the dose required for a 120-kilogram man is different than that for a 50-kilogram woman, for example.

Michel van den Heuvel, a professor of pulmonary oncology at Radboud University Medical Center, started a study in 2020 to investigate two aspects of Keytruda—for which patients does the drug work, and at what dosage does it retain its effect. The Treatmeds Foundation, which funds effectiveness studies on behalf of health insurers, financed the research.

MSD was not happy, Van den Heuvel told NOS. The company sent a letter demanding clarification. “They had major problems with the statement that we could safely reduce the dosage,” Van den Heuvel said. MSD also had a sharp discussion with the hospital management. “We could not escape the impression that financial interests played an important role. If you reduce the dosage by 25 percent or more, this will have consequences for profits. It really concerns billions.”

Ultimately, MSD could not object because the research had already been approved by an independent medical ethics committee.

Separately, the Professional Association of Medical Oncologists (NVMO) issued advice in 2021 recommending lower Keytruda doses to doctors based on new scientific insights. MSD wrote another critical letter, this time Zorgverzerkaars Nederland, the umbrella organization for health insurers. The pharmaceutical accused the oncologists of “experimenting with vulnerable patients in the field” and said there was “no clinical evidence based on randomized research” that justifies lower doses.

The health insurers and oncologists saw no reason in the letter to change their advice. According to NOS and Nieuwsuur, 30 Dutch hospitals currently administer lower doses. The professional associations involved said that the chosen doses are scientifically substantiated, result in fewer side effects, and are much cheaper.

“Randomized research or comparative research with the same exact method is not always necessary,” Gabe Sonke, an internist-oncologist at the Antoni van Leeuwenhoek hospital and a pioneer in the field of effectiveness studies, told NOS. “Measuring in the blood whether a lower dose has the same effect as the original dose can be scientifically sound enough. This has been very carefully researched. As a professional group, we think this is a good and safe way to administer these drugs.”