A MUST READ--get the word out--to governments, bean-counters, insurance companies,

[Lani]

friends and family!!

Cancer. 2010 Aug 23. [Epub ahead of print]
Estimating recurrences prevented from using trastuzumab in HER-2/neu-positive adjuvant breast cancer in the United States.
Danese MD, Lalla D, Brammer M, Doan Q, Knopf K.

Outcomes Insights, Inc., Newbury Park, California.

Abstract
BACKGROUND.: Breast cancer recurrence is associated with significant morbidity, mortality, and cost. Patients with early stage HER2+ tumors are at increased risk of recurrence. The use of trastuzumab for these patients has been shown to reduce recurrences and improve overall survival. METHODS.: A Monte Carlo simulation was conducted based on Surveillance, Epidemiology, and End Results incidence rates for 2005, United States Census data for 2005, and the results of key trials of the adjuvant use of trastuzumab. Patients included in this analysis had incident, HER2+, stage I to III breast cancer. The number of recurrences that could be prevented with trastuzumab, the cardiac adverse events that might occur, and the associated cost savings were estimated. RESULTS.: Approximately 31,200 women had HER2+ breast cancer in 2005, of whom 7298 would have had a recurrence over the subsequent 5 years despite standard of care adjuvant treatment. If trastuzumab were added to their regimen, 2791 women might have avoided recurrence, and 948 may have had an asymptomatic or symptomatic cardiac adverse event, for a ratio of expected recurrences to cardiac adverse events of 3.2 (95% confidence interval, 1.5-5.9). In economic terms, avoidance of future breast cancer recurrences was associated with lifetime reduction in future direct and indirect costs on the order of $240 million to $1.7 billion. CONCLUSIONS.: On the basis of the simulation results, targeting HER2+ tumors with trastuzumab in the adjuvant setting should prevent a significant number of women from recurrence events, with important outcomes for patients, physicians, payers, and society. Cancer 2010. (c) 2010 American Cancer Society.

PMID: 20734398

[Lani]

by the way, it turns out two of the authors are employees of Genentech

Wish that wasn't the case

[Jean]

Understand Lani, but we can also realize that the authors also have knoweldge since they do work for the company. For instance before the FDA approved Herceptin for early stage I would strongly think that the company was confident that early stage patients should be on the treatment...and that was years prior to the
approval. No matter who works where...it is my belief
that Herceptin saves many from recurrence. Certainly we do not have all the answers yet as to why some who are treated with herceptin fail - while others remain free of cancer...hopefully those answers will come in the near future. I met a women who was in the first trials of early stage patients who were lucky to have herceptin....she will be 10 yrs. out in a few months. and she is doing great. Was this due to the herceptin or would she never have recurred? We do know now that hercpetin does help (not all) but I will grab onto that for the time being.

[chrisy]

You know the saying there are lies, damned lies, and statistics!

I know that having the authors include Genentech employees gives some people cause for concern; my concern overall is that there is too little effort to balance all the sides of the equations - and all the statistics can be spun in different ways.

So I welcome this analysis - even if all it did was spur people to ask the questions "what is the cost of NOT doing this?"

[Lani]

my only disappointment that some authors were from Genentech, is that some would discount the paper due to that, whereas they probably would not if all of the authors came from an academic or clinical setting.

I was not implying that the paper was "spun" or "propaganda"

[Jean]

Oh Dear Lani,
What would we ever do without you?

I think we understood your position...that is one of the problems with internet - the words come thru - but the tone or meaning can not be heard. Often much can be lost or even misunderstood....anyhow...

I understood and I believe Chrisy did also what you were aiming at.....as Chrisy so well pointed out it is often difficult to have a balance.

For the most part the post is GOOD NEWS for all.
We also thank you.
jean

[karen z]

Thanks much for posting.
k

[Jackie07]

Let's do some case studies besides plain statistics.

If I had had a mastectomy in 2003 and had been treated with Herceptin (instead of only getting part of it during recurrence due to heart issues) for a year, I would have been working somewhere continuously.

The savings from the treatment for recurrence would have been at least $100,000.00. The wage saved (instead of lost) would have been another $100,000.00. Multiply $200,000.00 by 1000 patients, it amounts to $200,000,000.00 just for a period of
seven years not counting future wage losses and treatment cost for metastasis for many.

But, because breast cancer is not an 'infectious disease' - even though it affects a lot of people including care-givers - the people in charge of policies continue to take a 'tough luck' attitude and ignore our pleas. The result is even more money loss when more of us are forced to rely on the government for disability and/or Medicare benefit...