Adjuvant trastuzumab for breast cancer: Advent of pharmacogenetics raises many issues

doi:10.1136/bmj.331.7526.1202-a

BMJ 2005;331:1202 (19 November), doi:10.1136/bmj.331.7526.1202-a

Letter

Adjuvant trastuzumab for breast cancer

Advent of pharmacogenetics raises many issues

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

EDITOR—Kell and Power [previous letter] at last clarifyfor everyone that at least 20% of patients with positive immunochemicalresults will not benefit from trastuzumab.¹ These are expensivefalse positives at £20 000 yearly per patient, both forthe health system and for patients' quality of life—or,indeed, life at all, bearing in mind the death rate from thetreatment.

The advent of pharmacogenetics raises important issues. Fulland equitable access to treatment will be increasingly difficultto achieve as increasing numbers of expensive patient adaptedtreatments for pathological subclasses become identified andavailable. Only some people will be suitable for these targetedtreatments, and only a proportion of those targeted will benefit.Greater openness and debate, not just among health professionalsbut also with the wider public, would help to explore the legitimacyof these approaches.

The ethics and economics of blanket prescribing are intertwinedand difficult . . . [Full text of this article]

Hazel Thornton, honorary visiting fellow

Department of Health Sciences, University of Leicester "Saionara," Colchester CO5 7EA hazelcagct@keme.co.uk