Breast Cancer Action’s (#100, congratulations!) covers why it’s so difficult to alter reliance on certain breast cancer treatments — even when there’s evidence to indicate the drug is not working.
Two factors cited by BCA Executive Director Barbara Brenner are longstanding attitudes about the best way to treat cancer (read: aggressively) and the pharmaceutical industry’s investment in particular drugs.
“Given this training, doctors probably fear giving up on a treatment that they think might help some patients,” writes Brenner. “Making a mistake could have big consequences if it turns out that the indications for nontreatment are wrong, or if a patient has a recurrence that might not have happened with treatment and sues for malpractice.”
“The other is that there is a huge investment in these drugs, and a lot of money being made in producing and administering them,” adds Brenner. “Financial interests stand in the way of many changes. They create a large ship that is very hard to turn in a new direction.”
The examples cited are Taxol and anthracyclines, the most common of which is Adriamycin (generic name doxorubicin). Here’s what’s happening with anthracyclines:
For several years, Dennis Slamon, the person credited with the development of Herceptin, has been reporting on research that shows that women whose breast tumors overexpress the Her2/neu protein (HER2-positive) benefit from anthracyclines, but those whose breast tumors are HER2-negative do not. , a number of studies now support this conclusion and lead inevitably to the observation that women who do not overexpress Her2/neu (and an additional gene known as Topoll-2–topoisomerase II alpha) should not receive anthracyline treatment, because they won’t derive any benefit from the drug.
Yet doctors, including many who attended the San Antonio Breast Cancer Symposium in December, are not ready to drop this very aggressive treatment from cases where it clearly doesn’t seem to work ().
So what can be done?
Brenner concludes: “[P]atients who are well informed can demand that treatments change as new information becomes available about who benefits and who doesn’t. It shouldn’t be up to us, but it is.”