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Hey Christine,
Thanks for posting this--I hadn't seen it. And I can't get at the JAMA piece mentioned in it because that one you have to pay for.
I know how just about anything I read can make me uncomfortable about various treatment decisions we have made. But I think this editorial doesn't actually say a thing. It uses all kinds of weirdly indirect rhetorical formulations to cast doubt on the herceptin trials--even raising the specter of unethical drug company behavior in combining the data of two trials.
Now believe me I am first in line when it comes to distrusting the drug companies. And I know that loads of breast cancer activists are very suspicious of stopping trials early. And I am sympathetic to their concerns.
But these trials do not exist in a vacuum, as their editorial suggests. They build, first of all, from a well established precedent: every agent that has shown benefit in the treatment of metastatic breast cancer has gone on to have benefit in adjuvant treatment. In addition, these adjuvant trials build on data from a few smaller neoadjuvant trials with herceptin (at MD Anderson and Dana Farber) that showed remarkable activity for the drug.
It is true that we can't possibly have full overall survival data yet. We might never have true clear data here because of the crossover of so many women onto Herceptin from the non-Herceptin arm.
But this editorial does a real disservice. It is clear beyond a doubt, I think, that the women who will benefit from adjuvant herceptin far exceeds any number that will suffer permanent cardiac damage or death from the drug. I am sorry that Hortobagyi and others have thrown the other "c" word ("cure") around. Lord knows I hope it's true, but it certainly is premature to say that.
Thanks for posting--sorry if I sound grumpy. But I really hated that editorial
Jeff
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