Efficacy, safety, and cost of new anticancer drugs

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7375.1302/a (Published 30 November 2002) Cite this as: BMJ 2002;325:1302

Pessimistic conclusion was not justified

  1. Hilary Calvert, professor of medical oncology (hilary.calvert@newcastle.ac.uk),
  2. Duncan I Jodrell, reader and honorary consultant in medical oncology,
  3. James Cassidy, professor of medical oncology,
  4. Adrian L Harris, professor of medical oncology
  1. University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH
  2. Western General Hospital, Edinburgh EH4 2XU
  3. Cancer Research UK Department of Medical Oncology, Glasgow G61 1BD
  4. Cancer Research UK Medical Oncology Unit, John Radcliffe Hospital, Oxford OX3 9DS
  5. Laboratorio SIFO di Farmacoeconomia, c/o Drug Information Centre, Azienda Ospedaliera Careggi, Viale Morgagni 85, I-50134 Florence, Italy md3439@mclink.it
  6. Mario Negri Institute for Pharmacological Research, via Eritrea 62, 20157 Milan, Italy

    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 …

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