What If I Risked Everything For Nothing?

Update: I spoke to the doctor a couple days after I wrote this post, and he said that of the three chemo meds I took, only the Adriamycin was in the class of drugs referred to in the study. An 8% effect is considered good. I had originally misunderstood some ambiguously stated information I had read, and thought that all three of the chemo meds I took were of the same class.

Robert Bazell reports for msnbc:

What if an estimated 100,000 breast cancer patients got drugs that did nothing to combat their cancer, but put them at risk for heart failure and leukemia?

That is the implication of new research that was presented in private session at this week's meeting of the American Society of Clinical Oncology(ASCO) in Chicago.

The research, from Dr. Dennis Slamon, chief of oncology at the University of California, Los Angeles, suggests that the most widely used chemotherapy drugs may not benefit most women. Although the research hasn't been published or peer-reviewed yet, it is expected to be soon.

The drugs are a common class of treatments called anthracyclines, including doxorubicin, epirubicin, and mitoxantrone. Since their introduction in the 1980s anthracyclines have replaced older chemotherapy drugs in the combination therapies given to women. Administered in the months after surgery and radiation, the chemotherapy is intended to reduce the chances of a life-threatening recurrence of cancer, especially in women at high risk for relapse.

Early on, researchers understood that anthracyclines could cause heart failure in some patients. Recently, evidence has accumulated about the additional risk of leukemia, which can strike years or decades after the treatment.

Evidence for the effectiveness of anthracyclines versus the older drugs remained murky. Then, a 1998 meta-analysis (a study of all the previous studies) found the anthracyclines did a 4 percent better job at preventing recurrence. Despite their side effects, that study elevated the drugs to the standard of care.

Treating many to help few
The UCLA research questions that treatment. View story here.

I realize that breast cancer research is moving fast, and that over time better treatment options will arise. I know that I'll have to get used to not second-guessing the treatment I received, and that will be really hard for me to do. But how on earth did this become the standard of care with apparently so little research to back it up?

I just learned of this this morning, and I have to say that I feel sorry for women presently undergoing chemo during the time it will take for peer-review and publication.



The National Breast Cancer Coalition urges the oncology community "to re-assess the use of anthracycline-based chemotherapy in the adjuvant treatment of breast cancer."

NBCCF believes it is time for the oncology community to incorporate the evidence that has accumulated on this issue. It may very well be time to do away with anthracycline drugs in all but the very small percentage of women whose breast cancers co-amplify the Her2 and TopoII genes. NBCCF urges the oncology community - regulators, researchers, providers, and advocates - to come together to look carefully at these data and revise adjuvant treatment guidelines accordingly. View story here.



I don't know what to think. It's great news to future patients who might not need to go through what I voluntarily chose to go through. But for me it's huge hit to my confidence in my treatment. Right now I just feel queasy thinking about it.