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Old 09-24-2005, 11:50 AM   #1
Rich
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Moderate stance in Sydney..is it the $$$?

http://www.smh.com.au/news/national/...982233667.html
Patient advocates have called on doctors to be careful about the way they promote the benefits of a new drug for women with early breast cancer, saying its apparent benefits are unproven and may not be sustained in the long term.

The Breast Cancer Action Group said women might feel under pressure to buy Herceptin, which does not receive a taxpayer subsidy and costs up to $70,000 a patient, if specialists placed too much emphasis on interim evidence from recent clinical trials.

Three studies presented in May suggest the drug may prevent or delay recurrence in up to 15 per cent of women in the early stages of the disease - those who test positive to a gene-related protein called HER2. But Sue Lockwood, chairwoman of the patient group, said there was no proof that Herceptin increased life expectancy.

Side effects, including heart failure, were potentially more significant in women with early disease and a good prognosis, Ms Lockwood said, compared with women whose cancer had spread. The latter group already receives Herceptin for free under a special Federal Government scheme.

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AdvertisementMs Lockwood wrote in the group's newsletter: "We don't know what other symptoms might arise over time. It took quite a long time for all the side effects of Tamoxifen [such as lung clots] to appear. Presumably it will take a long time for the side effects of Herceptin to appear.

"We know from previous experience that new approaches are not necessarily good."

The group's NSW chairwoman, Sally Crossing, said it would write to oncologists urging them to place the benefits of Herceptin in the context of women's already high chance of beating breast cancer. About 90 per cent of women whose cancer is diagnosed early are still alive five years later, and the survival rate is increasing.

"Doctors need to take great care when discussing [treatment options] with women when they are at their most vulnerable and faced with substantial financial implications," Ms Crossing said.

The chief executive of the Cancer Institute NSW, Jim Bishop, said he was convinced Herceptin would improve survival but it was important to tell women the results were preliminary. Doctors needed to make information as easy as possible to understand while staying close to the truth, Professor Bishop said.

David Henry, professor of clinical pharmacology at the University of Newcastle, said it was unusual and encouraging that patients were urging restraint instead of lobbying for new drugs. "You really need a lot more information to know unambiguously that the benefits outweigh the cost when you're dealing with early-stage disease," he said. The director of cancer information and support services at the Cancer Council NSW, Gillian Batt, said the organisation's help line had received calls from women considering whether to try to raise the necessary money for Herceptin, or upset because they had no way of paying for it.

"It's a huge dilemma," she said. "We're trying to reassure women the current conventional treatment for breast cancer is actually very good. But it's human nature to be looking for the next thing."
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Old 09-24-2005, 12:59 PM   #2
Christine MH-UK
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Join Date: Sep 2005
Posts: 414
Thumbs down Maybe only partly

Hi Rich,

I think that there are genuine concerns in many countries about giving patients who are likely to survive a disease a drug before all of the data is in, particularly following the vioxx fiasco. In the UK, for example, women who can go on aromatase inhibitors seem to be finding it hard to get oncologists to agree to prescribe herceptin. Of course, there are problems with the herceptin/vioxx analogy since few people die of arthritis and women with her2 positive cancer end up on palliative herceptin anyway if the first treatment fails.

This groups statements are only somewhat true regarding herceptin following chemo, which has not yet been shown to increase life expectancy. This is due partly to a short follow up period, since her2 patients can live a while with secondaries. The statements are not true regarding the U.S. herceptin-based chemo trials, where the treatment was shown to increase survival.

I do find it appalling, though, that this group seems to be doing nothing for groups of Australian breast cancer patients (such as inflammatory breast cancer, ER-/PR-, pre-menopausal, stage III) for whom the odds are often poor. It makes it sound like all patients have a 90% survival chance, and this is not the case. I was also wondering about the 90% five-year survival figure, since five-year survival stats are something UK breast cancer patients love to hate because they do not mean disease-free survival. It sounds like this group is trying to calm patients down, but turning a blind eye to the plight of the least fortunate patients.
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