Herceptin - Look Out, They're At It Again
Herceptin Press Hype Misleads Women AgainWell - here we are again, again, again ...... !
Only days after NICE - the UK National Institute for Clinical Excellence reviewed herceptin and ruled that it should be made widely available in the UK - and after my previous herceptin in the UK posts - I find that the press are at it again.
So its black marks and raspberries to Medical News Today who lead today with the headline:
"Herceptin Recommended For All Early Stage Breast Cancer Patients, UK"
They go on to say
"Basically, this means that all women will get treatment free - probably in England and Wales, and most definitely in Scotland"
Now - sorry guys - but that's just not true and can only cause distress and confusion to many women with breast cancer.
Much better journalism can be found at Politics.co.uk who take the same press release from NICE and get the story spot on. They say:
"Herceptin will now be available to everyone who could benefit from it, regardless of where they live."
"We must remember that Herceptin is only suitable in about one in five cases of breast cancer. So it’s essential not to create a climate of false hope for women, where Herceptin is seen as a miracle cure suitable for everyone with breast cancer."
So it's roses to Politics UK and raspberries to Medical News Today for some shockingly badly written journalism.
Come on guys - you know that you can do better than that.
Gordon
You can find more herceptin treatment information on our herceptin article archive page
Labels: a-lump-in-the-breast, cancer-support, herceptin, symptoms-of-breast-cancer
posted by Marjory @ 3:44 PM
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4 Comments:
In regards to Herceptin, you might want to note that past studies have suggested a potentially very serious weakness in the drug, the problem with central nervous system (CNS) metastasis. According to research done at Dana Farber Cancer Institute, and published in the May 2003 issue of the journal Cancer, a cohort study of 122 metastatic breast cancer patients with HER-2 overexpressing tumors found that 34% developed CNS metastasis in spite of the fact that their disease was responding to treatment elsewhere in the body.
In the abstract the researchers write that of the patients whose cancer spread to the central nervous system, Fifty percent were responding or had stable disease while receiving Herceptin at other disease sites at the time of diagnosis of CNS metastasis. The median survival period after CNS metastases was 13 months. Fifty percent of patients died of progressive CNS disease. Patients receiving Herceptin as first-line therapy for metastatic disease frequently developed brain metastases while responding to or stable on Herceptin at other disease sites.
The research doesn’t necessarily suggest that Herceptin causes breast cancer spread to the CNS, but instead that CNS mets are common to HER-2-positive patients and that more than likely, because Herceptin doesn’t cross the blood-brain barrier (the system in the human body that protects the brain from blood-borne pathogens, chemicals, etc,), the drug while effective outside the central nervous system, can not treat cancer in the CNS, or stop it from spreading there.
Monoclonal antibodies like Herceptin are enormous. Very large molecules don't have a convenient way of getting access to the large majority of cells. Plus, there is multicellular resistance, the drug affecting only the cells on the outside may not kill these cells if they are in contact with cells on the inside, which are protected from the drug. The cells may pass small molecules back and forth.
Herceptin combined with standard chemotherapy will have as many as 4% of women who take the regimen develop symptoms of congestive heart failure, compared with less than 1% of women given chemotherapy alone. It's one of those things that benefits a very few patients a whole lot, is neutral in most, and is bad in a few.
Overt congestive heart failure is a very late and serious manifestation of heart muscle damage. For every patient with frank congestive heart failure, there is probably another two, three, four or five patients with heart muscle damage short of congestive heart failure. The sort of heart muscle damage which can cause fatigue and/or shortness of breath with moderate or mild exertion, which otherwise wouldn't occur.
Herceptin has been in use only a few years. We don't know what will happen 10 or 20 years from now in women who didn't need any adjuvant therapy at all, who would have been cured by surgery alone. Only a minority of patients who receive adjuvant therapy benefit from it. Adjuvant therapy is worth it if the women have to suffer only short term, temporary toxicity, and if it even slightly reduces the probability that their cancers will come back. But if it produces permanent toxicity, whether "chemo brain" or "heart muscle damage," that is a whole different order of magnitude in terms of risk.
Herceptin proponents claim clinical trials show a 46% decrease in recurring breast cancer when the drug is prescribed to late-stage breast cancer patients. But consider the facts: One of the main studies being cited in support of Herceptin saw 34 deaths in the control group (2.0% of the participants) and 23 deaths (1.4% of the participants) in the group treated with Herceptin. This translates in a 0.6% absolute reduction in deaths. Hardly a miracle!
(Cancer 2003 Jun 15;97(12):2972-7)
Thanks
Thats a great comment - and both highlights and expands on some of the points I've been making elsewhere on this site.
I agree that we have a lot still to learn about how herceptin will shape up in the longer term but for now - and for the many thousands of patients like Marjory - it's a huge step forward from where we were previously.
Thanks again for your input
Just a further comment for those of you reading the above.
The studies referred to above were done on women with metastatic breast cancer - in other words, women whose cancer has already spread throughout the body.
The results of these studies of herceptin should not be generalised to all women with breast cancer - particularly those who only have early stage cancer with no spread beyond the lymph nodes.
Secondly - there is a concern about heart problems triggered by herceptin - but the most recently published HERA study suggested that the risk was much less than had previously been thought - and certainly much lower than 4%
Any cancer drug can cause potential heart damage, even death, and many doctors do not adequately monitor their patients or manage their care to minimize the health risk, according to a study by M.D. Anderson cardiologists.
They pointed out even the newest targeted therapies (like Herceptin), designed to attack only cancer cells, can cause cardiotoxicity (toxic effects on the heart). The monoclonal antibody Herceptin may be less toxic than generally believed, but it can cause chronic heart failure, dysfunction of the left ventricular, the main chamber of the heart that pumps blood to the body.
M.D. Anderson seems to have found a profile of cardiotoxicity for the most often used anticancer drugs, and it is important to know that every patient has different risk factors that will determine how their hearts handle the treatment. Monitoring and management is the key to surviving.
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