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Personal Views

My cancer and the magic bullet

BMJ 1998; 317 doi: (Published 19 December 1998) Cite this as: BMJ 1998;317:1739
  1. Caroline Richmond
  1. London

    In June the first treatment for cancer that uses monoclonal antibodies was licensed. By a miracle of chance, it was designed for my particular subtype of cancer, and it has brought me complete remission. The odds against this happening are enormous. I'm as pleased as Punch, and so is my oncologist.

    Rituximab costs £6000 for a course, is for low grade B cell follicular relapsed or chemoresistant stage III or IV non-Hodgkin's lymphoma, halves the size of tumours in only 48% of patients given it, of whom only one in eight gets a complete remission. I was one of these patients. So, statistically, the chances of it being for my type of (incurable) cancer, and of me being given it (considering the cost to the NHS) and getting a full remission, are slender. Having just read Innumeracy by the mathematician John Allen Paulos (he uses his middle name to avoid being taken for the Pope) I feel I should quantify the odds. If, say, 7% of all cancer patients have a lymphoma, or to put it another way are lymphomaniacs, and 80% of those are non-Hodgkin's, and 85% of those are B cell, and 60% are low grade, and 40% of those are follicular, and 30% of those are chemoresistant or relapsed … the odds of getting a full remission are around 1 in 10 000.

    How antibodies work

    When you're a medical journalist, one of the first things you learn about cancer is that although there are regular “breakthroughs,” there is very little real progress. After my lymphoma was diagnosed, my interest in cancer “breakthroughs” increased, but only to the extent of collecting journal articles and press cuttings about lymphoma. I put them in a file to gather dust, and once in a while I leaf through and shake my head at the way …

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