Pessimistic conclusion was not justified

EDITOR—Garattini and Bertele' conclude that new anticancer drugs introduced during the past six years have not increased survival or quality of life in cancer patients.1 This is a surprising conclusion to be made at the end of a decade during which unprecedented advances have been made in the treatment of common tumours, in both survival and quality of life. Perhaps if they had examined the contemporary literature and taken account of oncology practice they might have reached a less pessimistic conclusion.

The authors rely heavily for their negative general comments on the value of cancer chemotherapy and chemotherapy trials on the population mortality based study of Bailar and Gornik, which used data collected between 1970 and 1994, pre-dating by many years the period being considered here.

Most of the drugs examined have been evaluated extensively in randomised trials, many with evaluations of quality of life. For example, the taxanes significantly enhance survival in both adjuvant treatment and treating metastatic breast cancer, as well as in lung cancer and ovarian cancer. 2 3 Recent results from randomised trials of irinotecan and oxaliplatin (not considered by this article) show extended survival in colon cancer, underlining the significant progress that is being made in the chemotherapy of common cancers.4

Although cost considerations are important, they should not affect our judgment of the utility of a new agent. The drugs chosen for cost comparison are mostly inappropriate because they are either not indicated or ineffective in the indication concerned. For example, taxanes are normally used in breast cancer that is refractory to hormones or negative for oestrogen receptors, where the use of tamoxifen would …