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NEWS ROUNDUP: Susan Mayor Women with early breast cancer to be tested for trastuzumab treatment BMJ 2005; 331: 864 [Full text]

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Herceptin for early breast cancer

Edward CF Wilson   (17 October 2005)

More imponderables

Anne J Ward   (31 October 2005)

Herceptin for early breast cancer 17 October 2005
Edward CF Wilson, Research Associate, Health Economics Group School of Medicine, Health Policy & Practice, University of East Anglia, Norwich, NR4 7TJ Send response to journal: Re: Herceptin for early breast cancer	Editor, The government’s recent announcement that all early stage breast cancer patients are to be tested for HER2 overexpression with a view to receiving trastuzumab (Herceptin) will no doubt be a great relief to both patients and oncologists. However, this raises a number of important issues. Firstly, the government may be setting a dangerous precedent in effectively promoting off-license indications for a pharmaceutical (what oncologist, presented with a patient who could benefit from this drug, will not use his or her clinical discretion to prescribe it off-label?). Secondly, it is pre- empting the evaluations of both EMEA (the licensing agency) and NICE, the body set up to advise the government on value for money in the NHS. But most importantly, it highlights the terrible decisions necessary in any health system: the oncologist sees a sick patient and knows there is a therapy available that may help them. However, the Director of Public Health in the Primary Care Trust has limited funds (which in many cases are already overspent), and a duty to get the best possible healthcare for the entire population with those funds. Herceptin costs in the region of £20,000 per patient per year. A typical PCT (170,000 population) may have 23 eligible patients (1), so costing an additional £460,000. Without Herceptin, on average two of the patients may die each year (2). With it, one of them may survive (3). Therefore the stark decision faced by the PCT is whether it can withdraw £460,000 from other services at a ‘cost’ of less than 1 life elsewhere. To this there is no easy answer. (1) National Horizon Scanning Centre: Trastuzumab as adjuvant therapy for early stage breast cancer, University of Birmingham, January 2005 (2) Fritz P, Cabrera CM et al. c-erbB2 and topoisomerase IIá protein expression independently predict poor survival in primary human breast cancer: a retrospective study. Breast Cancer Research 2005;7:R374-R384 (3) Piccart-Gebhart MJ. First results of the HERA trial. ASCO Scientific Session, Orlando, FL, 16th May 2005 Competing interests: None declared
More imponderables 31 October 2005
Anne J Ward, Consultant Psychiatrist in Psychotherapy Maudsley Hospital, Denmark Hill, SE5 8AZ Send response to journal: Re: More imponderables	Dear Sir / Madam Has anyone considered those patients with early breast cancer who have completed adjuvant treatment a number of years ago, and who might be HER2 positive? Logically they too should be eligible for this treatment. Yours Dr Anne Ward Competing interests: None declared