Brut-al disparities.

Earlier this month we praised a pragmatic pub evaluating the cost-effectiveness of more aggressive treatment for extensive stage small cell lung cancer. Those who leave no hyperlink unclicked may have noticed the referenced Big Five of absolute cancer costs in 2016, including four you would expect and one you probably wouldn’t—lymphoma. Last year lymphoma ranked just above lung cancer in total national expenditures, while that same year it exacted a death toll that was 0.7% of the latter. (We want you to read that again.) This fall has ushered in major FDA approvals that will almost surely widen this disparity. The newest lymphoma blockbuster approval comes for acalabrutinib (knighted by the market as Calquence) based off a reported 80% objective response rate among 124 patients with mantle cell lymphoma refractory to at least one previous standard chemo regimen in the phase 2 ACE-LY-004 trial. Calquence is only the first of many second-generation inhibitors of Bruton tyrosine kinase (BTK) to potentially follow in ibrutinib’s footsteps. This is all good news for Astrazeneca, and probably for patients with MCL, but for now lung cancer will have to keep waiting for its payday.