Dissecting Chemotherapy 15: Couldn’t Afford Avastin, Gave Up Xeloda

Leo is a 51-year-old man. He was diagnosed with cancer of the rectum. But his cancer had spread to his liver. He underwent 6 cycles of chemotherapy and 25 sessions of radiotherapy. After the treatment he had a surgery to remove the tumour in his rectum. CT scan showed he was not cured, the tumour in his liver was still there. Leo was asked to undergo more chemotherapy.  He declined. He was prescribed Xeloda instead.  He took Xeloda for 3 cycles and gave it up. He turned to herbs.

Listen to what he said:


Why he declined the second round of chemotherapy – FOLFOX  + Avastin

Leo was asked to undergo chemotherapy using FOLFOX plus Avastin. The treatment is going to cost him RM 5,200 per cycle and he was to receive a total of 9 to 12 cycles. In total, that means spending around RM 50,000 to RM 60,000 for another round of chemo. To some patients, the response to such proposition is plain and simple. They cannot afford it! Period.

I remember Pak Jam who got his wife into a private hospital and had to spend RM 2,000 per day. After 15 days he was reduced to be a bankrupt!  He came to see us appearing like a “mad man.” His wife had leukemia. Perhaps today he still has to keep working to repay the borrowings from friends and relatives.

CPW was diagnosed with GIST and was asked to take Glivec for her condition. One tablet per day would cost RM 293.00. That is to say the family will have to fork out RM 8,790 per month for the medication. How long does she need to go on this medication? No one can tell.

HS from Indonesia came to see me. He was diagnosed with advanced kidney cancer that had spread extensively to his lungs. Since nothing much could be done, he was asked to take Sutent (sunitineb). According to his  wife, a month of Sutent would cost him 100 million rupiahs. I asked the wife, How much does an ordinary man get paid per month doing a normal job. She replied, Average earning per month in her home town (in Indonesia) is one and a half million rupiahs.

I have a lot more to say about the cost of chemo drugs nowadays. But suffice to say that the price of certain chemo drugs have gone crazy!

Why he stopped taking Xeloda after three cycles

Leo was not convinced that Xeloda would do him any good. He had fevers and diarrhea. In addition he vomit and had pains around the colostomy stoma after taking Xeloda.


I wonder what Leo would do if he has the money to pay for his FOLFOX + Avastin treatment – would he go ahead with it?

There are three important issues which patients need to bear in mind when deciding whether to undergo treatment or not.

One, don’t ever believe that money can buy your cure! Leo told us of what he saw. A man had spent more than a million ringgit trying to find a cure for his cancer. He went to Singapore for his treatment but found none. He ended up in a Johor government hospital – bed ridden and debt-ridden. He told his son that he had had enough and told his son not to go around and borrow any more money trying to cure him. One night, this frustrated man jumped out of the window of the 6th floor.  This is not the first time I hear such a story. Some time back, I received a similar e-mail from a lady in Singapore telling me that her father just jumped off the flat after failing to cure his cancer.

Two, ask these question: What is the aim of the treatment? Can this treatment cure me? Or is it just to prolong my life for a while more – if so, is it worth it? You should get these answers straight from your doctor. After getting your doctor’s answers, check them out with other experts as well.

Three, ask your doctor about the side effects of the treatment that he is going to give you. List them down. There is no argument about his – all poisonous drugs have side effects! And you know that chemo-drugs are poisonous. . So ask yourself, are you game with that? Some patients can tolerate the side effects but some patients prefer to die than go through it. Only you can decide. But at the same time, educate yourself about the side effects of these drugs.

Unfortunately some doctors are not forthcoming with such information. They would say, Oh, it is nothing. It is just like ant-bite! I remember one funny episode. A patient from India came to our center for help. She underwent chemotherapy and suffered side effects. She went to her oncologist complaining about a certain problem and was told, That is expected because of your chemo. When another problem cropped up, she was again told, That is expect because you had chemotherapy. This woman was clueless about the possible side effects of chemotherapy. Unfortunately for such patients they have to learn the hard way.

Let me end with one final question. What do you think are the benefits of Avastin?

Do you expect Avastin to cure you – after spending a good sum of your life’s saving? Read what the medical literature has got to say. Be ready for a rude shock!  Are you told of this – or do you ever ask your doctor?

The Phase III study involved 820 patients with metastatic, inoperable colorectal cancer who had been treated with standard first-line chemotherapy and Avastin. The results showed that:

In advanced colorectal cancer, continuing bevacizumab (Avastin) without interruption after tumor progression improves survival modestly.

In another report, it says – patients who received chemotherapy and Avastin did better than patients who received chemotherapy alone.

  • The patients receiving Avastin were likely to have longer tumor control and live longer than patients who did not receive Avastin. On average, they lived about five months longer (Note: this is probably a mistake found in this posting. It is not five months! Five weeks is probably the right number!).  http://www.medicinenet.com/script/main/art.asp?articlekey=54679

In this article, Avastin prolongs life but drug is too expensive for NHS patients, says Nice, http://www.guardian.co.uk/society/2010/aug/24/avastin-too-expensive-for-patients

  • Avastin (bevacizumab) can help patients with advanced bowel cancer which has spread to other organs, usually the liver and lungs.
  • The National Institute for Health and Clinical Excellence (Nice) said it had considered the drug …, but still considered the price too high for the extra benefit it gives patients.
  • Avastin costs almost £21,000 per patient (Note: This is equivalent to RM 102,302.73).
  • Clinical data submitted by Roche to the watchdog shows it can typically offer patients an extra six weeks of life when added to the chemotherapy drugs  capecitabine and oxaliplatin.

The expected benefit (or you call that benefit at all?) is surely miserable compared to the cost that an ordinary patient in Malaysia or Indonesia has got to pay. But that is not all. What about the side effects of Avastin? Click this link, http://www.avastin.com/patient/overview/side-effects/index.html

The most serious side effects (not common, but sometimes fatal) are: gastrointestinal perforation, i.e. developing a HOLE in your stomach or intestine; wound would not heal, serious bleeding including vomiting or coughing up blood; bleeding in the stomach, brain, or spinal cord; and vaginal bleeding, stroke or heart problems, severe high blood pressure, nervous system and vision problems such as high blood pressure, headache, seizure, sluggishness, confusion, and blindness; kidney problems, etc.

The most common side effects are: nosebleeds, headache, high blood pressure, inflammation of the nose and skin, too much protein in the urine, taste change, dry skin, rectal bleeding and back pain.

Worse of all, researchers have  found that tumors treated with Avastin (also Sutent) developed more cancer stem cells, which fuel a cancer’s growth and spread and are often resistant to standard treatment. https://cancercaremalaysia.com/2013/05/14/chemotherapy-spreads-cancer-and-make-it-more-aggressive-articles-from-the-internet/

Ultimate, you need to make your own decision. Decide wisely!