Trastuzumab for early breast cancer raises important issues

doi:10.1136/bmj.331.7523.1023-a

BMJ 2005;331:1023 (29 October), doi:10.1136/bmj.331.7523.1023-a

Letter

Trastuzumab for early breast cancer raises important issues

The first 150 words of the full text of this article appear below.

EDITOR—The government's recent announcement that all earlystage breast cancer patients are to be tested for HER2 overexpressionwith a view to receiving trastuzumab (Herceptin) will no doubtbe a great relief to both patients and oncologists.¹

However, this raises several important issues.

Firstly, the government may be setting a dangerous precedentin effectively promoting off-licence indications for a pharmaceutical(what oncologist, presented with a patient who could benefitfrom this drug, will not use his or her clinical discretionto prescribe it off-label?).

Secondly, it is pre-empting the evaluations of both the EuropeanAgency for the Evaluation of Medicinal Products (EMEA, the licensingagency) and the National Institute for Health and Clinical Excellence(NICE), the body set up to advise the government on value formoney in the NHS.

But most importantly, it highlights the terrible decisions necessaryin any health system: the oncologist sees a sick . . . [Full text of this article]

Edward C F Wilson, research associate

Health Economics Group, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ ed.wilson@uea.ac.uk