"There is only moderate evidence that the newly approved prostate cancer httpshealth.nytimes.comhealthguidesdiseaseprostatecanceroverview.htmlinlinenytclassifier drug Provenge helps patients according to an analysis done for Medicare httpstopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicsmedicareindex.htmlinlinenytclassifier that was made public on Wednesday. The analysis https is part of a controversial review by the Centers for Medicare and Medicaid Services to determine whether to pay for Provenge which costs  per patient and extended lives by about four months in clinical trials. Medicare advisers will meet next Wednesday to discuss the drug which was developed by Dendreon a Seattlebased biotechnology company. Provenge is the first socalled therapeutic cancer httpshealth.nytimes.comhealthguidesdiseasecanceroverview.htmlinlinenytclassifier vaccine  meaning it works by training the patients immune system to attack the tumor httpshealth.nytimes.comhealthguidesdiseasetumoroverview.htmlinlinenytclassifier  to win F.D.A. approval. The treatment is made for each patient from his own blood. Sales have been small so far because Dendreons manufacturing capacity has been limited. While Medicare generally pays for drugs that are approved by the Food and Drug Administration httpstopics.nytimes.comtopreferencetimestopicsorganizationsffood_and_drug_administrationindex.htmlinlinenytorg its debate over paying for Provenge has raised concerns among some cancer patients doctors and investors who say the government is sending a warning shot that it will not automatically pay for highpriced medicines. Not only is C.M.S.s action contrary to Congresss intent to ensure beneficiary access to drugs and biologicals used in an anticancer chemotherapeutic regimen but it threatens to stifle future innovation and cancer research for years to come Dr. Al B. Benson III president of the Association of Community Cancer Centers said in a comment submitted to the Centers for Medicare and Medicaid Services. But others say the health care system cannot afford to continue paying high prices for all therapies particularly cancer drugs that extend lives by only a few months. With expensive medicines there is already a sort of dual approval system especially with private insurance companies. First a drug must get F.D.A. approval and then a manufacturer often must go through a lengthy process of persuading insurers to pay for the drug. Medicare is not supposed to consider price when determining whether to cover a drug however. Some analysts have assumed that Medicare will pay for Provenge when used for the patients specified in the drugs label  those with advanced prostate cancer that is resistant to hormonedeprivation therapy but who are experiencing no or minimal symptoms. The Medicare review might be more designed to limit offlabel use of the expensive drug such as for patients who already have symptoms. The review for Medicare said there was insufficient evidence to judge whether Provenge would work if used offlabel. The F.D.A. declined to approve Provenge in  setting off protests by patients and Dendreon investors. After Dendreon completed another trial which reaffirmed a survival advantage for the drug Provenge was approved this April. But the analysis for Medicare said that there were issues in how the trials were designed that made it difficult to assess how effective Provenge really was. One big issue was that the placebo used in the control arm was not really inert. Robyn Karnauskas a biotechnology analyst at Deutsche Bank said in a note to clients Wednesday that the assessment of moderate evidence in support of Provenge boded well for reimbursement. Historically moderate means that CMS will reimburse the product for its onlabel indication she wrote. Dendreons shares rose more than  percent in trading after the close of the market. The assessment was done by a technology evaluation group at the Blue Cross and Blue Shield Association under contract to the governments Agency for Healthcare Research and Quality."