Shah (not real name) is a 57-year-old Indonesian. He was diagnosed with liver cirrhosis in 2010. He came to a private hospital in Melaka and was prescribed Legalon or milk thistle. He did not take his medication seriously. His problem became more serious and in 2015 his problem developed into a full blown liver cancer or hepatoma.

He was admitted to a hospital in Jakarta for treatment. He did TACE (transarterial chemoembolization) twice followed by four times of RFA (radiofrequency ablation). RFA cost him IDR 35 million each session.

In addition Shah had to take the following 11 medications, one of which is Nexavar – a oral chemo-drug for his liver cancer.

Nexavar — IDR 200 million (??) 

Listen to our conversation of what happened.

 

Chris: Did the doctor tell you why he gave you Nexavar?

Wife: To make sure that the cancer is under control.

C: How long were you on Nexavar?

W: Just about one week, and the supply was for a month.

C: What happened?

W: Disaster! (BadanNya hancur!) He gave up and did not want to take it anymore.

C: Did the doctor say how long he has to take Nexavar?

W: For as long as he lives! Now the doctor said take a rest first. After the side effects subside, continue with Nexavar again.

C: What are the side effects?

Wife and patient: Vomiting, loss of strength, giddy, fever, hard stools.

C: How much did you pay for this drug?

W: IDR 200 million per month.

Comments

I am not sure if the figure, IDR 200 million for Nexavar, is correct. This is equivalent to RM 57,000 ringgit.

The wife must have been confused. It could have been the total cost of his hospitalization, including other drugs as well.

In Malaysia, Nexavar cost about RM 20,000 per month. Sometimes you get an offer: buy one, free one! That is you pay for the first one month, then you get free supply of the drug for the second month. One patient took this drug for a week and died. So she lost her deal for a free supply!

Is this the first case of Nexavar giving problems to patients? No. Many patients told me similar stories of side effects.

So, why do the doctors keep on prescribing Nexavar? Well, I really don’t know. Perhaps Nexavar is more “scientific” than herbs. If you don”t die from it, keep taking it — that’s the message given to Shah and his family.

As I am writing this story, here is an email I received.

Dear Dr Teo, 

I am writing to you with regards to my father, aged 82 years old. In December 2017, he was diagnosed with hepatocellular carcinoma  (liver cancer). Tumor was approximately 7 cm in size. He has subsequently went for TACE early January 2018. The latest CT scan has showed that there is necrosis of the tumor. However, the APF reading this week shows a level of 2,000+. 

His hepatologist and us agree that we should take action to find a way to heal and hopefully, prevent the recurrence of tumor again. He has recommended that we think about Nexavar or  seek alternative herbal treatment. 

My father has indicated that he would like to start on herbal treatments.  

I am wondering if you would be available to meet us next week? 

Think about it: His hepatologist recommended Nexavar or herbal treatment! What say you?