Treating Advanced Cancer
Today's blog is a thoughtful commentary from the Journal of Clinical Oncology about treatment for advanced cancer, balancing value vs. price. The example used, the treatment of metastatic breast cancer, is especially relevant for us. There are several broad perspectives of this theme: the explosion of new research and new treatments for metastatic cancer (some of which turn out to be useful and others turn out to be less so), the huge cost of some of these drugs, and the central importance of the patient/doctor relationship with individual decisions being carefully discussed.
It is one thing to talk about what we as a country can afford and another to think about care for a single person, either yourself or someone whom you love. This is a hot topic in the presidential election, one with a lot of rhetoric and suspicion being flung around with little regard for facts. The one thing we all, Republicans or Democrats or people who are relatively indifferent to politics, agree on is that we have a big problem and something has to be done.
Here is the beginning of this essay and then a link to read more:
Progress Against Solid Tumors in Danger: The Metastatic Breast Cancer Example
In 2012, the estimated number of cancer diagnoses in the United States will exceed 1.6 million, with more than a half-million deaths. In broad terms, the goals of treatment for patients with metastatic solid tumors are improving quality of life and overall survival (OS). From a regulatory standpoint, an improvement in OS is the gold standard for approval, but in some diseases and treatment settings, progression-free survival (PFS) is a valid surrogate end point. In fact, PFS has several important advantages: first, it is a timely end point that is reached before OS; second, it is well-known that disease control provides meaningful patient benefit; and third, it is not affected by subsequent therapies.
For example, for metastatic breast cancer (MBC), an increasing number of agents are available for use; thus, patients may receive multiple lines of therapy, and it is always possible that better and/or subsequent therapies will be administered to patients preferentially in one study arm, which creates imbalances that can affect OS but not PFS.
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