[Christine MH-UK]

Hi Jeff,

I wasn't entirely happy with the editorial myself. In a way, it sort of undermines its own message by pointing out that three years ago NICE was criticised for delaying herceptin for secondary cancer. This point would really only be convincing if herceptin had later turned out not to be useful for secondary cancer.

It is not ideal that the researchers combined the results of two trials. I wonder if they did it to prove the thing that is really hard to prove with her-2 patients over such a short-time frame: that a new treatment can make a statistically significant differences in overall survival, not just recurrence. The irony with cancer treatments is that the better they get at keeping patients with secondaries alive, the harder they make it to prove that new treatments keep patients alive longer, yet that is what really matters. Perhaps the editors of the NEJM should have advised them to include some basic data from the two trials.

I suspect that the Lancet was having a go at the New England Journal of Medicine for allowing an editorial that went over the top. I agree that Dr. Hortobagyi's editorial may have done the drug an unintentional disservice. I know that a lot of people are very unhappy with herceptin being labelled a cure, as if it solved everybody's breast cancer problems by itself.

I am naturally skeptical about the drug companies myself, but in the NEJM it did make it seem like in the U.S. trials Genentech had only provided herceptin and a bit of funding. It does not seem to have been involved in the trial design.