Meta Analysis: Anthracyclines only helped her2-positive patients

[Christine MH-UK]

I know that Slamon has suggested this, but Italian researchers performing a meta-analysis of 5,000 patients have also just found that only her2 positive benefit:

http://www.nlm.nih.gov/medlineplus/n...ory_59375.html

Ok, it might be topoIIa, but given how harmful anthracyclines are, can oncologists really continue to use them in good faith on her2-negative, topoIIa negative patients?

[Lani]

there was no improvement in survival by giving herceptin with anthracycline and a taxane vs giving anthracycline, taxane alone. Looked at backwards, that means giving TCH would be just as good as AC+T--now it becomes a problem of the shortsighted bean counters vs those who wish to "do no (unnecessary)harm"

It seems anthracyclines cost less than herceptin (although the antinausea meds and hospitalizations for complications cost more...and perhaps a lifetime of cardiac problems, if they develop, could be very costly)

If the two treatments are equivalent for those who are TOPOIIA+ and her2+, then by giving those patients TCH instead of AC+T (AC+TH did not seem to improve the lot of this subgroup of patients, which may make up to 30% or less of her2+s, which already make up 20-25% of breast cancer patients, hence 8% of patients overall) they will do just as well.

For the other 92% of patients, they are in Dr. Slamon's view, receiving a drug with significant side effects (you all can provide a view none of those
giving the talks can) which there is no evidence will improve their situation.

THIS paper only looked at her2+ vs her2- as TOPOII testing was not available .IF (note if) Dr. Slamon's results prove true, and are shown again and again with data from larger number of patients, perhaps the naysayers ("there is not enough data to change...") will change the standard of care, and insurance companies/government health services will hopefully recognize it (though it may end up costing them money).

I know it takes quite a while for a new and better treatment to get accepted--FDA approval and all that. What is always quoted is that "there is no data to support that"--well here there is data to support the view that the STANDARD of care is doing more harm than good when applied across the board to all Breast cancer patients. Will this speed up the day when treatment for SUBTYPES of breast cancer are delineated to avoid both over- and undertreatment?

Off my soapbox!