Explanations welcome

[AlaskaAngel]

Can someone explain what the rationale is that is being used to hold up progress?

TEN years ago when I was diagnosed, it was possible to do comparison studies in other countries that showed the effectiveness of such treatment as ovarian ablation plus "X" drug, versus standard chemotherapy for early stage bc:


http://jncimonographs.oxfordjournals...001/30/67.full

and


http://jncimonographs.oxfordjournals...expansion.html

How long will it take for us to get a comparison of either ovarian ablation and trastuzumab alone (or possibly trastuzumab plus lapatinib) for premenopausal early stage bc patients, versus standard chemotherapy, in this country?

-AlaskaAngel

[Lani]

That is because EVERYONE got chemo if their tumor was invasive in the US for years and years (still today!) as it was the standard of care and trials could only ADD treatments onto the standard of care or the doctors could be sued for denying patients "their best hope"
Europeans tried to determine with yearly St. Gallen qualification modifications which ER+ tumors benefited from chemo and ADDED chemo onto the basic standard of care and were unencumbered by malpractice suit considerations.

Endocrine therapy is also cheaper than chemo in general and European countries' national health services had trouble paying for chemos like taxanes and platinum agents.

It was difficult to get US oncologists to look seriously into the possibility that the ONLY benefit premenopausal ER+ patients might be getting from the chemo was the early menopause they were put into ( a result which could be arrived at much more simply)

THere are different cultural attitudes towards oophorectomy, GNRH injections as well as different women's willingness to suffer with symptoms of lack of estrogens...many things come into play.

And this does not even entertain entering into the realm of paranoia about manipulation by/influece of " big pharma"

[tricia keegan]

Lani,

Just to clarify, up to '05 when I was dx chemo was always given if a tumour was over 1cm or had nodes positive or was her2+, usually the gold standard of that time a/c followed by Taxol/herceptin same as the U.S!

Most Onc's in Ireland would never suggest an ooph but when I suggested it myself my onc agreed it was a good idea

[Adriana Mangus]

Hi Angel,

What's a pink ribbon diet?

Love,

Adriana

[Rich66]

Not sure it matters which country a given study is done in so long as it is largely viewed to be valid and in a similar population. As long as the treatments are available/covered here at Dr. discretion.