Here is an example of a cancer trade group and its peer review venue. It is highlighted in a recent video by the Healthcare Channel, questioning a drug's use in breast cancer.
http://blogs.wsj.com/health/2007/12/11/avastin-for-breast-cancer-the-pre-history/
The idea that approving drugs based on population studies has its limits. What may or may not work for the average population may not apply to the individual. Avastin killed more patients than the control arm. Avastin doesn’t have to be used in every breast cancer patient. Taxol doesn’t have to be used in every breast cancer patient (it seems like they do).
The clinical trial was done using Avastin in combination with Taxol. Doctors are faced with a problem of whether to use Taxol and forgo Avastin, or to use some other conventional drug for initial therapy in order to use Avastin.
Avastin is a “large molecule” monoclonal antibody. It can be tested with a EGFR biomarker assay because the “target” of Avastin is not the cells themselves, but rather a hormone (VEGF) secreted by the tumor cells. Avastin complexes with free VEGF and blocks its action.
Having a good tumor-drug match not only would improve survival rates, it would be cost-effective, and the high cost of the newer cancer therapies reinforces the necessity of choosing the right therapy the first time around.
The tumors of different patients have different responses to chemotherapy. It requires individualized treatment based on testing the individual properties of each patients’ cancer.
http://www.cancermonthly.com/iNP/view.asp?ID=209