Chemotherapy Treatment Taxol Ineffective In Treating HER-2 Negative Breast Cancer, NEJM Study Says
The New England Journal of Medicine editorial comment made by Ann Moore of the Weill Cornell Medical College, could not have been stated with any more precision that the "one-size-fits-all" approach to breast cancer treatment is coming to an end, and should come to an end. Also, oncologists do have a responsibility to their patients to be aware of the University of Michigan report.
As we enter the era of "personalized" medicine, it is time to take a fresh look at how we evaluate treatments for cancer patients. More emphasis should be put on matching treatment to the patient. Patients would certainly have a better chance of success had their cancer been chemo-sensitive rather than chemo-resistant, where it is more apparent that chemotherapy improves the survival of patient, and where identifying the most effective chemotherapy would be more likely to improve survival.
The academic center-based oncologists are misguided in not recognizing that they continue to try and mate a notoriously heterogeneous disease into "one-size-fits-all" treatments. They predominately devote their clinical trial resources into trying to identify the best treatment for the "average" patient, in the face of evidence that this approach is non-productive. However, such unsuccessful experiments will never be viewed as such by the people whose careers are supported by these kinds of experiments.
The methods of cancer medicine during the last thirty some years are coming to haunt the "one-size-fits-all" establishment. Technologies, developed over the last twenty years by private researchers, hold the key to solving some of the problems confronting a healthcare system that is seeking ways to best allocate available resources while accomplishing the critical task of matching individual patients with the treatments most likely to benefit them.
Survival in metastatic breast cancer hasn't improved substantially in thirty years. Improvements in overall survival for all patients are owing largely to a marked trend for earlier diagnosis and surgical technique. Even this doesn't mean that many more patients are being cured. If you diagnose someone earlier in the course of disease, of course they'll live longer from the time of diagnosis. This is what's known as lead bias.
There have been truly minuscule improvements as a result of adjuvant chemotherapy and the net benefit to the community of breast cancer patients in the real world isn't all that clear. And the criticism remains: All of the clinical trials resources have gone toward driving a square peg (one size fits all chemotherapy) into a round hole (notoriously heterogeneous disease).
The most widely used chemo drug for breast cancer and it does not work for the most common form of breast cancer, and helps far fewer patients than has been believed? This would be roughly half of all breast cancer patients who get chemotherapy now.
MD Anderson's Donald Berry says that "we should have done this [study] a long time ago." He says that "tools" were lacking to do this, so they gave virtually every breast cancer patient Taxol, just in case? I'm sorry, the "tools" were there. They've kept them under a breadbox for the last fifteen years.
Taxol is an extremely potent drug, often producing a number of side effects in patients. Side effects can include severe allergic reactions, cardiovascular problems, infections developing from white blood cell deficiencies, apolecia, joint and muscle pain, irritation at the drugs injection site, low red blood cell count, mouth or lip sore, and numbness or burning in the hands and feet.
They say that for now, many doctors will be reluctant to skip Taxol for fear of lawsuits if the cancer recurs and Taxol wasn't given. It's just so much easier (and more money to be made) to give the Taxol and know you've been "super-aggressive."
Oncologists have the responsibility to their patients to be aware of this report and patients should be given the choice not to receive Taxol.
According to the National Cancer Institute's official cancer information website on "state of the art" chemotherapy, no data support the superiority of any particular regimen. It would appear that published reports of clinical trials provide precious little in the way of guidance.
I agree with University of Michigan's Dr. Hayes, we should use the biology of the cancer to decide whether the chemotherapy will work before subjecting women to it. The problem is that few drugs work the way oncologists think and few of them take the time to think through what it is they are using them for. More emphasis should be put on matching treatment to the patient (personalized medicine), through the use of individualized pre-testing.
http://content.nejm.org/cgi/content/short/357/15/1496
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