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Drug Treatment of Breast Cancer Questioned--British Study

Big PhARMA has us believing in the miracle of chemo therapy.  However, only about 10% of all cancer cures are attributable to chemotherapy.  Oncologists often choose the less effective chemotherapy  for combination of reason including the persuasion of drug reps, patient expectation, and that while they can prescribe drugs, they are not a surgeon or radiologist and thus profit less from these other treatments.  What should be decided through the academic process has been corrupted by Big PhARMA.   

  

 

British study:  $206 Million was spent to treat 500 patients.  For that amount, X-ray machines could have been bought and 30,000 patients treated.  Of all the cancers cured, 50% by surgery, 40% by radiotherapy, and only 10% by drugs.  Only a few cancers show dramatic improvement with chemo therapy.  And many such as lung, pancreatic, and prostate cancer at best there is a very modest prolongation of life—life of a terminally ill patient. 

 

Call to Redirect Cancer Drug Cash

By Simon Cox, BBC Radio, 4’s The Investigation, and at http://news.bbc.co.uk/2/hi/health/7115540.stm

The millions the NHS spends on breast cancer drug Herceptin could be used to treat thousands of people using other therapies, a top specialist has said.

 

Dr Peter Kirkbride, the chief spokesman on radiotherapy for the NHS, said the NHS spent 100m on the breast cancer drug Herceptin in 2006.  (Review of Herceptin below). 

But he told Radio 4's The Investigation only about 500 patients had benefited - at a cost of about 200,000 each.

If that was spent on radiotherapy, it could have a dramatic impact, he said.

Cancer survival in the UK is still below the European average, despite recent improvements.

Herceptin was approved for use in women with early stage breast cancer in 2006 after a fast-track assessment by the National Institute for Health and Clinical Excellence.

But now some cancer doctors are concerned this focus on new cancer drugs may not be a good thing.

Dr Kirkbride said: "There is a lot of publicity about the role of chemotherapy but the consensus is of all cancers that are cured, half are cured by surgeries, 40% by radiotherapy and only 10% by drugs.

"If I was to spend 100m on radiotherapy, I could buy something like 90 machines, I could buy 30 simulators and I could probably benefit about 30,000 patients for the same amount of money."  

Radiotherapy problems

Earlier this year, the National Radiotherapy Advisory Group published a report which called for a 91% increase in radiotherapy treatments in England in the next 10 years.

But the trade body for the manufacturers of radiotherapy machines has told the BBC that instead of seeing more business, it has all but dried up.

David Miles, the chairman of the radiotherapy specialist focus group of the Association of X-ray Equipment Manufacturers which formed to highlight the problem, says there has been a "collapse in critical investment".

He said: "We noticed after the government initiatives to improve the established stock of radiotherapy equipment, it actually ended in April last year. And the sales of machines then fell off drastically.

"One order has been placed in the last 20 months."

Because it takes around three years from when an order is first placed until it treats its first patient, the radiotherapy focus group at AXrEM says the NHS should have bought 20 replacements machines by now instead of just one.

'Not sexy enough'

Dr Kirkbride thinks part of the problem is raising the discipline's profile in the eyes of both the public and government.

He said: "We are not sexy enough. We don't have pharmaceutical companies backing us in the same way that some of the drugs companies support campaigns for the use of their drugs."

Professor Mike Richards, the National Cancer Director, said there should be room in the cancer budget for both.

He said: "There is no doubt that Herceptin is a good drug. There is no doubt that it has been looked at carefully by NICE and it has been deemed to be both effective and cost-effective.

"Radiotherapy is also effective and we need to make sure that it's not one or the other, but that we actually have a service that delivers both."

The Investigation - The Sick Man of Europe
Radio 4, 2000GMT, Thu 29 November
Online from Radio 4's
Listen again page
Podcast from the
File on 4 website

 

 

More on Machines

 

France for instance, which has some of the best cancer survival rates in Europe, has 336 machines compared to the UK's 279 - 20% more for the same population, and the staff to match.

And while targets for treatment are being met, they do not always give the true picture.

There may be a maximum 62 day wait from urgent GP referral to treatment, but this simply means the start of treatment.

There are instances where people are waiting as long as 16 weeks for post-operative radiotherapy, a key part of their treatment which can maximise their chances of being cured.

 

 

 

Logic reveals that this gene therapy cannot work.  The gene targeted is expressed only in a few of the cancer cell (those included for treatment have more than 10% of their cancer cells with this gene over expressed, and generally no more than 20%).  Thus most of the cancerous cells will not be affected.  The treatment at most modestly prolongs life, which is what the results show.

Herceptin Study

Journal of Clinical Oncology, Vol 17, Issue 9 (September), 1999: 2639

http://jco.ascopubs.org/cgi/content/full/17/9/2639

The reason for the failure of this treatment to affect a total remission is that the receptors targeted are over expressed in less than half of the cancer cells. 

Herceptin is a recombinant humanized HER2 antibody approved by the FDA in 1998.  These antibodies are effective in only 20-30% of the cases, those where the HER2 is over expressed.   HER2 is a growth factor; and its over expression is correlated with poor clinical outcome.  However, the term effective is misused.  In one study of 222 women with HER2 over expressed in metastatic breast cancer only 8 were identified has having a complete response and 26 a partial response, which means that only 15% benefited from the treatment.  Thus for 85% of the women the treatment was not at all effective. Moreover of those who responded the medium duration was 9.1 months, and their medium duration of survival was 13 months.  From Journal of Clinical Oncology, Vol 17, Issue 9 (September), 1999: 2639.   One problem with this approach is that even though there is an over expression in the metastatic cancer, most of the cancer cells did not over express this growth factor.  The criterior for inclusion in the study was a > 10% weak to strong response to staining for the HER2 growth factor.  Moreover, therapy was not limited to Herceptin, “Additional antitumor therapy was also permitted upon disease progression.  The numbers get worse. The cut off date for this study was set at December of 1997, which is as little as 14 months from the date therapy began to as great as 32.  Of the 222 patients enrolled, 43 were still receiving treatment at the cut off point.  Of those who responded (34 patients) the mean duration of response was 9.1 months (range 1.6 to 26 months).  The median time of the disease progression was 3.1 months, and the median time of treatment failure was 2.4 months. 

Adverse reaction rate was 99%, with 41% having a severe adverse event fever, chills, pain, asthenia, nausea, vomiting, and headache).  Subsequent treatment produced a much lower rate of adverse events. The study was done on patients with a very poor prognosis—most had undergone one or two bouts of chemotherapy prior.  Herceptin’s adverse events were, compared to other chemotherapies, less severe. 

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Disclaimer:  The information, facts, and opinions provided here is not a substitute for professional advice.  It only indicates what JK believes, does, or would do.  Always consult your primary care physician for medical advice, diagnosis, and treatment.