Evidence Mounts on Heart Failure After Trastuzumab in Breast Cancer Survivors

[phil]

I am not going to debate too long on the above issue. My focus is on reforming the present cancer drug approval process, and having it reflect the advances in cancer tx in the 21st century. Greg, I hope more effective " individual " cancer screening tests get tested and approved . Quickly. But i say it again, i feel your focus on that issue , your desire to see Rat. Ther. more widely used , is affecting your perspective on related cancer war issues. I dont think you are in the chemo room like we are. I think some of your generalizations about herceptin risks affect that . you are not the only one. FDA officials are similar. If i took your approach with issues , I would be questioning everything the FDA Oncology review division does . I am not. They have kept un-safe drugs off the market , at least gave quick partial appr. to pertuzumab. I am glad that the prevous FDA admin gave accelerated approval to tyk. in 07 ", even tho i feel it is a lesser drug to t dm-1.
These stats on herceptin have to be put in perspective. I am grateful for herceptin , it has saved countless lives . It helped get my wife to t dm-1. even tyk played a small role. My first wife never saw herceptin, in 88-"92. No testing for her2 genethen. Talk about progress , back then adria was the drug everyone pinned thier hope on ! No taxanes even. herceptin by itself cures 20 %, w/ chemo , more. Of course as we see yrs of use , problems become evident. cardiac issues in 30-40 %, doesnt cross bbb in 30-40 %. that stat becomes clearer only because herc has kept so many alive for so long. But we in the chemo room say : without herceptin , whats the percentage of survival , compared to pre-herc. To talk up tykerb, and talk down t dm-1 w/ minimal info on it, is biased on your part .

[gdpawel]

I was in the trenches Phil. I was in the infusion rooms with my wife to know what goes on. I experienced the inappropriate use of chemotherapy to control cancer in patients we met. And those that never showed up again because of it. And I experienced it with my wife. So there is no need to belittle me with that innuendo. Performing laboratory oncology deserves the same degree of professional time and attention as random selection of chemotherapy. In fact, instead of random selection of chemotherapy. There would be a huge advantage for patients to receive a positive/sensitive drug, compared to a negative/resistant drug. The time and energy required to conduct proper "individual" selection pales in comparison to the time, energy and lost opportunities associated with months of ineffective, toxic therapy. I feel your focus on pushing a pharmaceutical company's drug is a disservice to the many that will not be helped by it. The system is overloaded with drugs and underloaded with wisdom and expertise for using them. We are getting an expanding list of treatments which are partially effective in a minority of patients, ineffective in a majority, remarkably effective in a few, while being enormously expensive. Whatever clinical response that has resulted to the average number of patients in a randomized trial is no indication of what will happen to an individual at any particular time. The fastest way to improve things is to match treatment to the patient. Neither would I like to debate this issue too long, but I will defend misrepresentations of my cancer patient advocacy.

[michka]

I asked Hopeful to post on this forum to be sure that everyone watches their heart because it is not always our first priority.
But I don't mean we must stop Herceptin or TDM1 or other drugs because of that. For example we now know that ACs are toxic and sometimes we can avoid them. More and more but not always.
I would love to have tests telling me if a chemo will work for me without having the medical system pay for nothing and maybe having toxic side effects. But we don't have those tests yet.
So Phil and Greg you are both right. Your arguments are good. It is just an open discussion. You are two major contributors to our Group. We need you.
I am so grateful to both of you for sharing all your knowledge with us and fighting on our side. Michka