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When Does Oncology Innovation Become Too Expensive?
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Released: September 29, 2026

John Marshall
John Marshall, MD
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MedBuzz: When Does Oncology Innovation Become Too Expensive?

John Marshall, MD: Oncology Unscripted. A whole lot going on in the last week or two. Back to school it is. Traffic is back here in Washington, DC. Patients were late for clinic this morning. But a lot going on in the medical world out there. And I want to talk mostly about the cost of the medicines that we are out there prescribing.

You all know daraxonrasib, the new pan-RAS inhibitor, just got approval for pancreatic cancer and quite a buzz. I was in clinic today hearing nurses managing the toxicity, and we are learning quickly about how to manage this toxicity. But did you know, maybe you did, that the 1-month price that's being asked for out there for this drug is almost $40,000?

So, I went to look this up. A totally loaded, brand-new Toyota Camry costs 38,000 bucks. So, about the same as 1 month's supply of this drug. I do like a good Toyota as well, but you get the idea: if you were to pay for it yourself, there is no way that you would keep coming up with $40,000 every month in order to be on this medicine, even though it is our money that's going to pay for this.

And so, the question is, is that the right thing to be doing? We want to applaud the innovation and the breakthrough and the creation of a new therapeutic line, if you will. But we also need to decide: what's the value of that to us as individuals?

And in keeping with that, I saw this actually in The Washington Post, my very good place where I find medical information, and this was a disease that I had, frankly, embarrassingly, never heard of before called Alexander disease.

And it's actually quite a rare progressive neurologic disorder, and it's a mutation that produces, I'm going to read it, glial fibrillary acidic protein, or GFAP. And this protein, if you don't have the right enzyme, basically builds up and can cause problems over time.

Well, a new drug was just FDA approved. It's an antisense oligonucleotide that basically in the clinical trial showed improvement in gait speed using a 10-meter walk test. Well, this wasn't something I knew, but at 61 weeks people were walking better than if they hadn't had it, and the FDA approved it. What's this price tag? $285,000 for this treatment.

Yes, rare disease. It's got to find it, got to take the medicine. You'll do better, you will feel better, you will have less neurodegeneration over time, is the way I interpret this. How many patients and how many payers will actually agree to paying that price tag?

The company thinks a lot because they think their net worth just went up by, like, $100 million as a basis for this, but we will see. So, always remembering whose money it is and who decides who's spending it. Well, it's our money, and generally other people are deciding who's spending it.

Which leads me to my last news item, and this comes again from the lay press, where today, the Trump administration has now awarded $106 million to expand rural healthcare access in New York, Rhode Island, and Michigan.

And so, of course, these are places where the vote counts. And just how this money is going to be spent is less clear, but it's about, you know, getting access out there to healthcare when we know those of us in the city get more access than those out in rural world. So, it's how do we improve overall the median healthcare that's out there in the United States.

And so, we are making all of these advances at very, very expensive levels, much less expense being spent on access to rural health. There's a lot out there going on in the business world of oncology, which is why we decided to dedicate this entire episode to exactly that.

Join us again. John Marshall, Oncology Unscripted.

This transcript has been generated by AI and lightly edited.