Liver cancer: Doctor said: “Don’t take Nexavar!”

In my earlier posting, I wrote about one “rotten” morning I experienced. Now, let me share with you what a “weird or cuckoo” morning was like.

AKS is a 57-year-old Indonesia. His problem started with a fever a few months ago. He went to a hospital in Jakarta for help. He was told nothing was wrong with him.

AKS was not satisfied and consulted another doctor — an internist. Again he was told there was nothing wrong with him. Still not satisfied, he consulted a stomach specialist. He was told something was in his liver!

AKS came to a private hospital in Penang for further consultation in February 2018. He saw one doctor and did an endoscopy. The result indicated esophageal varices, gastritis. Negative for Helicobacter pylori. 

A CT scan was done and showed the following:

  • Coarse liver parenchyma suggestive of underlying cirrhosis.
  • Ill-defined mass in the right lobe of liver measuring 10.5 x 9.5 x 7.8 cm.
  • Smaller lesions scattered in both lobes of liver ranging from 1.0 to 3.5 cm in size.
  • Features suggestive of multicentric hepatoma.
  • Mild ascites.

Blood test results were as follows:

Alkaline phosphatase 198 H
GGT 178 H
ALT   63 H
AST 112 H
Alpha-fetoprotein 354.4

AKS was told to undergo a procedure called TACE (transarterial chemoembolization). He refused and went home to Jakarta.

In March 2018, AKS came back to Penang again. This time, he consulted an oncologist in another hospital.

His blood test showed deteriorating liver function.

Alkaline phosphatase 249 H
GGT 323 H
ALT   60 H
AST 143 H
Alpha-fetoprotein 617.7

AKS was prescribed Lenvima (or Lenvatinib). For 20 days the drug cost him RM5,000. The doctor said this drug would not cure him!

I asked AKS. The doctor did not ask you to take Nexavar? His reply, The doctor told me not to take Nexavar!

AKS took Lenvima for two days and felt nauseous and dizzy (as before). He and his family decided to seek our help.


  1. AKS went to see two doctors. They couldn’t find anything wrong. The third doctor said there was something in this liver. Then he came to Penang and the first thing the doctor did was endoscopy! But there was something in his liver? Why endoscopy? Is this procedure just a matter of routine? More procedures better?

Do you think all these make sense? Ask again, do you really need an endoscopy?

  1. As you can see, AKS went round and round, and only then a blood test and CT scan were done. Sure enough the results indicated tumours in his liver.
  1. AKS was asked to go for TACE. AKS refused.

For whatever treatment suggested, it would be wise if patients were to ask their doctors these questions:

  • What is this treatment for? Can cure you? Prolong life? Improve quality of life?
  • How much does the procedure cost?

There is a 10.5 x 9.5 x 7.8 cm tumour in his liver. In addition, there are smaller lesions scattered in both lobes of the liver ranging from 1.0 to 3.5 cm in size. Do you think TACE can help the patient? In what way?

Over the years, I have come across many patients who did TACE but did not benefit from this treatment.

  1. AKS was prescribed Lenvima (or Lenvatinib) for his liver cancer!

I have never heard of this drug before! I told AKS usually doctors would ask patients to take Nexavar. This was when I got a shocking reply. The doctor told AKS not to take Nexavar!

How could that be? What has happened? Does the doctor NOW know something about Nexavar that we all do not know?

For the past two months, I have liver patients coming to me and they were taking Nexavar — why the change of “heart”? There must be a reason for this change from the standard practice.

Let me say that those patients on Nexavar suffered severe side effects and gave up on the drug. That was why they came to us for help. I have written some cases about Nexavar and I am going to write more cases later.

There was one lady who paid RM 20,000 for a month supply of Nexavar. She was told that when she comes the next month, she will get one month supply of Nexavar for free (promotion — buy one, free one).  According to her son, after taking this drug for a week, she landed in the hospital and died.

So the question is, why was AKS told not to take Nexavar now? It is because of such experiences above or something else?

But  more tragedy to come. Instead of Nexavar, AKS was described Lenvima  or lenvatinib. I had to go into the net to find out what that is.

Lenvima, a drug made by Eisai Inc. was approved by US – FDA for the treatment of locally recurrent or metastatic, progressive, radioactive iodine-refractory differentiated thyroid cancer.

Lenvima is also used in combination with the drug everolimus, for the treatment of advanced renal cell carcinoma.

Here are the side effects of Lenvima:

Less common side effects (occurring in about 10-29% of patients) are:


There is a fine note which says: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful. Is this not what is happening now? Liver patients is given a drug for thyroid or kidney cancer?

Its sounds like an “new experiment” on patients! Giving  a chemo-drug that is approved for the treatment of thyroid or kidney cancer to liver cancer patient … to see what happen?

I went cuckoo this morning! Oh, it is just a weird morning. My first time to learn such thing.




Liver Cancer: Took Nexavar for about a week. Wife said, “Disaster!”

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.


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?




Extensive Liver Cancer: TCM University Hospital prescribed chemo drugs! After three days patient gave up due to side effects!

Henry (not real name) is a 58-year-old Indonesian. In 1994 he was diagnosed with Hepatitis B. He took herbs and was okay. But about three to four years later, a checkup showed the virus count has gone up high. He did nothing about it. In September 2017, Henry started to have bloated stomach. The doctor in Indonesia diagnosed it as gastritis. Later he went to the hospital and was told that he had liver cancer. He was prescribed some drugs.

No satisfied, Henry went for further treatment in China in early January 2018. He ended up in a TCM (Traditional Chinese Medicine) University Hospital.

A PET scan was done and the results showed the cancer had spread from the liver to his lung and lymph nodes around his neck.

Henry was prescribed three drugs to take:

  1. Adefovir (or Hepsera) – pharmaceutical drug
  2. Bicyclol – drug from a Chinese herb
  3. Sorafenib (or Nexavar) – pharmaceutical drug

A two-day consultation together with the above medication cost IDR 50 million (approx. RM 15,000).

Not satisfied, Henry went to another hospital (not a TCM hospital) for a second opinion. A blood test was done and the results were as below:

ALT 29.0
AST 40.0
Alk phosphatase 332.0
GGT 548.0
Alpha-fetoprotein 275,330.70
CA 125 278.50
CA 19.9 7.36
CA 15.3 24.80

The oncologist in this second hospital told Henry to go for chemotherapy. He refused and went home to Indonesia. 

What happened after taking the chemo-drugs?

Listen to his conversation with us this morning.


Chris: You took the three chemo-drugs that the doctor in TCM University hospital gave you. Then  what happened?

Patient: Not suitable for me! Just after three days, I had severe pain in my abdomen. This was after taking the Nexavar.

C: You itch too?

P: Yes, after taking the first two drugs (Adefovir and Bicyclol).

C: Then you gave up?

P:  Yes, we went to another hospital for blood test.

C: Did the doctor prescribe any medication (after they know that the AFP was 275,330.70)?

P: No medication. He asked me to go for chemotherapy. I refused and returned home to Indonesia.

Information from the internet 

It is not difficult in this information age to know what the drugs prescribed by your doctor would do to you. What you need to do is read or have the desire to “know”. The problem with most patients is they don’t want to know! They believe that doctors know best.

These are what I got from the internet.

Adefovir (Hepsera)

This drug is used to treat a chronic viral infection of the liver (hepatitis B) in people 12 years of age and older. It is not a cure for hepatitis B and does not prevent the passing of hepatitis B to others.

The possible side effects are:

  • muscle pain or weakness
  • numb or cold feeling in your arms and legs
  • trouble breathing
  • feeling dizzy, light-headed, tired, or very weak
  • stomach pain, nausea with vomiting, or
  • fast or uneven heart rate.


This is a novel, drug derived from Fructus Schisandrae (Wu Wei Zi), a Chinese herb for treating hepatitis B and C.

Sorafenib (Nexavar) 

This drug is commonly prescribed by oncologists worldwide to treat:

  • kidney cancer that has spread outside the kidney and who are no longer being helped by other treatments.
  • liver cancer that can’t be removed with surgery.
  • thyroid cancer that is no longer being controlled by radioactive iodine treatment.

The possible side effects are:

  • Rash
  • Hand – foot syndrome (Palmar-plantar erythrodysesthesia or PPE) – skin rash, swelling, redness, pain and/or peeling of the skin on the palms of hands and soles of feet. Usually mild, starting 5-6 weeks after start of treatment. May require reductions in the dose of the medication.
  • Diarrhea
  • Fatigue
  • High blood pressure (particularly in first 6 weeks of treatment)
  • Hair loss (thinning or patchy hair loss)
  • Nausea
  • Itching
  • Low white blood cell count
  • Low platelet count
  • Poor appetite
  • Vomiting
  • Bleeding
  • Increased amylase/lipase blood counts
  • Low phosphorus level
  • Constipation
  • Shortness of breath
  • Cough
  • Numbness, tingling or pain in hands and feet.
  • Dry skin
  • Abdominal pain
  • Bone, muscle, joint pain
  • Headache
  • Weight loss

These side effects may occur in 30% of patients taking Nexavar. Some patients or their family members shared their experiences with Nexavar.

  • From Hepatitis to Liver Cancer: Nexavar for Free – No Thanks

  • Liver Cancer: Benefit and Side Effects of Nexavar


This is a sad  and pathetic story! Let’s start thinking a bit and ask some questions.

  1. Henry went to a TCM university hospital and he was prescribed pharmaceutical drugs. Does this sound right? Why do you need a TCM hospital then? Don’t you think the oncologists in a modern medicine hospitals are better trained and educated than those TCM professors or sinseh when it comes to prescribing pharmaceutical drugs?

Personally I was really disappointed after hearing this story. When I started CA Care more than twenty years ago, I learned and read a lot about TCM from the Chinese. My experience showed me that the traditional wisdom of healing can help cancer patients. And up to this day, I know I am still not wrong!

I would want to believe that those trained in TCM — in TCM university mind you — should be better and well placed to help cancer patients than me. To dish out chemo drugs to cancer patients is indeed a “betrayal” of sort. Hello TCM professors (I know that most TCM practitioners like to be called professors!) you can do better than that! 

Another disappointing thing is, even with TCM experts, they never teach patients that to get well patients need to take care of their diet and change their lifestyle. This is a real let down. What has gone wrong here?

Sun Simioa, China’s great physician said, Only those who apply diet for treatment are superb physicians. Doctors should first understand the cause of disease, then treat it with diet. Medicine should only be used if diet fails.

Indeed, you don’t have to be a TCM professor or scholar to understand this. Even some oncologists in the Western world know this very well.

  1. Sun Simiao also said, Whenever a great physician treats diseases, he should not give way to wishes and desires, but has to develop first a marked attitude of compassion. Above all, keep an open heart. “As I move on the right path I will receive great happiness as a reward without asking for anything in return.

From this great master of Chinese medicine, I learned about medical ethics, Sun Simiao was especially concerned about physicians being influenced by a desire for rewards, including financial rewards, fame, or favors granted to them: they should not have these as their goal. In the same note physicians should be honest — especially to their patients.

So, do you think the TCM doctor gave Henry an honest advice?

Take a look at the PET scan done in the TCM university hospital. His cancer is serious. His liver is badly damaged. And the cancer has spread to his lymph nodes and lungs. What is his chance of cure? Can we be honest about it?

Let’s be honest professor, what do you think can be achieved by asking Henry to shallow Adefovir,  Bicyclol and Sorafenib?

I believe this TCM professor would be able to help Henry better if he is well armed with the real art and deep knowledge of TCM. There is no need to “ape” what the western doctors do.

After looking at Henry’s PET scan and his blood test results — take note his alpha-fetoprotein was at 275,330 — I frankly told Henry no one on earth can ever “cure” him. He has to be realistic and know that his liver cancer is incurable. If he is able to live a quality life — can eat, can sleep, can move around and no pain — then be grateful and don’t ask for more.

This I believe can be achieved with the proper guidance of TCM principle and use of TCM herbs. For the past twenty plus years, I have given terminally ill patients herbs and taught them to change their diet and lifestyle. The results were amazing.

Let me end with this story …. A Tale of Two Patients: Alive and healthy — miraculous healing or fluke shot?


From Hepatitis to Liver Cancer: Nexavar for Free – No Thanks

Sonny (not real name) is a 59-year-old male. He was diagnosed with Hepatitis B about five years. He opted for herbal treatment from Taiwan. After six months, his alpha-fetoprotein increased further indicating it was not effective. Nevertheless he continued to take the Taiwanese herbs up to this day.  About three years ago he went to see a doctor and was prescribed Lamivudine and ever since he has been taking both Lamivudine and the Taiwanese herbs.

In September 2011 Sonny had bloated stomach and lost his strength. An ultrasound of his abdomen indicated liver cancer. On 30 July 2011, his alkaline phosphatase was at 224, AST = 79 and GGT = 354 (all these values are beyond normal range). He was told by the doctor that he had an incurable, terminal stage liver cancer. He probably has two months to live or at most six to eight months. Before he dies he would vomit blood.

Sonny went to Singapore for a second opinion. A CT scan on 4 October 2011 showed a 14 x 12 x 12 cm tumour  in the caudate lobe. There was also a 3.8 x 3.4 x 2.4 cm nodule in Segment 2 of his liver. There was tumour thromhus demonstated in the right portal branch and the main portal view. Thrombus was also seen in the proximal left portal branch. In addition he had liver cirrhosis with mild splenomegaly and moderate ascites.

Blood test on 4 October 2011 showed elevated alkaline phosphate = 315, AST = 164, ALT = 73 and GGT  = 614.

His tumour markers, however, were within normal range – AFP 14.7, CEA 0.8 and CA 19.9 27.2.

There was nothing the doctor in Singapore could do for him. He was offered oral chemo drug, Nexavar which cost S$10,000 per month. He was told this would not cure him but could prolong his life for two months. However, the Malaysian doctor who first saw him did not recommend Nexavar because of its severe side effects.

Sonny then went to the University hospital in Singapore for another opinion. There was nothing more that could be done. Since the University is currently carrying out a clinical trial on Nexavar, Sonny was offered to take this drug for free. He said no thanks to this offer of free Nevaxar – listen to what he has got to say in the video below.


Dissecting Chemotherapy 11: No Chemo for Dad’s Liver Cancer – Wisdom of a Daughter

Daughter: My father was diagnosed with liver cancer in August 2011.

The doctor wanted him to do chemotherapy. We did not allow him to do so. I argued with the doctor.

The doctor did not get angry with you? Yes, he was but I did not bother. Since we did not want to go for chemo (injection) he was asked to take an oral drug for his liver. This cost RM 20,000 per month.

Wait, wait. Let’s start from the very beginning. Actually what happened and when? D: My father had winds in his stomach. This was in August 2011. He consulted a doctor who told him that he had a gallstone. His liver had some shadows. The doctor then suggested that my father do a CT scan. He went to do a CT scan and the result showed a Stage 2 liver cancer. The doctor suggested chemotherapy. We told the doctor we wanted to go home first and consult with all the members of the family. After that we went to seek a second opinion from a liver specialist.

The Second Opinion – the Liver Specialist

D: The liver specialist studied the CT scan. He also suggested chemotherapy. This time I accompanied my father to consult with this specialist because I did not want him to undergo the chemotherapy. I told the doctor, “We do not want chemotherapy.” When the doctor saw my father, he encouraged him to get admitted into the hospital. He said, “Uncle get admitted immediately and tomorrow we shall start with the chemo.”

I was not happy. The first doctor we consulted with told us that my father had to stop all his heart medications before undergoing chemotherapy. My father had a heart by-pass before. But this liver specialist did not even consider this. He was pushing my father to do chemo quickly. But I refused.

Okay, you refused chemo. What did the doctor say? D: I argued with him. Then I requested that he do another CT scan for my father. So, a second scan was done.

Did you ask the live specialist if chemo can cure your father of his liver cancer? D: Cannot. I asked him, “Doctor, you want to give chemo to my father – can you cure him?” The doctor could not give me an answer. He just kept quiet – no answer. Then he said. “It all depends on the patient himself.”

What ? It now depends on the patient? D: I asked the doctor further – “ You give my father the chemo, what can  happen to him after that?” He answered, “The liver may become hard, the patient becomes yellow (jaundice). And his eyes may become yellow.” I countered the doctor, “Okay doctor, my father currently has no pains, can eat, can sleep, can walk and move his bowels – after the chemo, his health is jeopardised  and he may not be able to do all these – what’s the whole idea?

What did he say to that? D: The liver specialist said, “I have found the best oncologist to do the chemo for your father, do you know that? I have already made the necessary arrangements for your father to do the chemo tomorrow. Now you tell me you don’t want to do it.” But I said, “In the first place, we never ever agreed to undergo chemo.”

But he told you, There is no cure and the patient becomes yellow – why do the chemo then?  D: I eventually told the doctor very bluntly, “My father doesn’t want to do chemo.” My mother also said, “The patient refused chemotherapy.”

How did he respond to that? D: Okay, if the patient did not want chemo, there is nothing we can do.

Did you ask him how much the chemo is going to cost you? D: No, we never get into that. He did not tell us about the cost and also how many cycles of chemo he was going to give.

Assistant to the Liver Specialist:  Patients come in healthy, they go out yellow! Why not try the RM 20,000-per-month oral drug for liver cancer?

D: The second CT scan report was ready after two weeks.  I requested to have a copy of the report so that I can bring it to you (CA Care). I went to the hospital and met the assistant of the liver specialist. He is also a medical doctor – a nice person. I asked him, “From your experience giving chemo to so many patients, how many really do well? This nice and friendly doctor answered, “To tell you the truth, patients come in looking healthy, but they go out looking yellow after the chemo.” This is what the assistant told me. Then the assistant said, “If you don’t want to do chemo, why don’t you take the oral drug instead. “ This drug cost RM 20,000 per month. But I told the doctor, “But doc., this drug has so many severe side effects” (Read this post: Benefit and side effects of Nexavar).

My Friend’s Husband Took the Oral Drug for Liver Cancer, He Vomited Blood and Died Within Two Weeks

D: The doctor replied, “ No, no serious side effects – you only feel itchy and have reddish palms.” I told the doctor, “My friend ‘s husband had liver cancer. He took the oral drug that cost RM 200,000 per month.  He vomited blood and within two weeks was dead.” The doctor went silent. He kept his cool and smiled. The he asked, “If you don’t want to do chemo for your father, what do you want to do then?” I replied, “I am going to bring my father to take herbs.”

What was his response? D: He said, “Go ahead and try it.”

He did not get angry with you?  D: No, he was not angry.

Did you know what is the name of that oral drug? Nexavar? D: I did not take note of that. I only know that it can damage the liver and kidney. I read this on the packaging of the medication.

They Just Want You To Do Chemo – That is the way it is

D: Unfortunately, that is the way it is with doctors today. They just want patients to do chemo. After injecting the chemo into you, the poison is already in the body – if you die, you die. That is your business.

Wife: The doctor told us, my husband is still strong. He will be able to withstand the chemo – he can withstand the chemo. D: No, no, I think he will die.

This is the way our world is now. You need to take care of yourself. You have to be responsible for your own health and wellbeing. If not, it may be like “just jumping into the sea.”

Read related story: My friend – business partner – died after chemo for his liver.

Liver Cancer: Benefit and Side Effects of Nexavar

Mutu (not real name,H520) is a 48-year-old male. In November 2010 he had coughs with some phlegm. In late December 2010 he was admitted into a private hospital with complaints of right hypochondrial pain (i.e., pain under the rib-cage margin). He was nauseated but no vomiting. He also had post prandial dyspepsia (i.e., a medical term meaning feeling of unusual fullness, nausea, loss of appetite or belching following a meal).

CT scan of the abdomen showed multiple masses measuring 7.3 x 5.1 cm, 6.3 x 6.1 cm and 7.3 x 4.5 cm,   in the right lobe of his liver, suggestive of diffuse hepatocellular carcinoma or liver metastases. A biopsy was performed on 23 December 2010 and confirmed moderately differentiated infiltrating liver cancer.

A blood test results, done on 19 January 2011, are as follows:

Mutu was prescribed Nexavar – an oral chemo-drug that cost about RM20,000 per month.  He was told that Nexavar would not cure his cancer. It would only control it (whatever that means, see discussion later).

After taking Nexavar for a week, he suffered the following side effects:

  1. Bloatedness
  2. Shoulder muscle pain
  3. Sleeping difficulty
  4. Nausea and sometimes vomiting
  5. Dizzy when walking
  6. Loss of appetite due to bloatedness
  7. Cramps of fingers and toes
  8. Constipation

Listen to our conversation on 23 January 2011, the day he first visited us.


Let me highlight some of the important points of this case in a question-and-answer format.

  1. Assuming for a moment that you are a medical expert. I believe you have seen hundreds or thousands of CT scans and blood test results. From your experience, what can you make out of this case by just looking at the scans and blood test results? The images are bad and the AFP (alpha-fetoprotein) exceeded a million points. Honestly, is a biopsy really necessary? So, after a biopsy, what can you offer to “cure” the patient?
  2. It appears that all that modern medicine can offer is Nexavar. Would you as an expert offer this drug to the patient knowing that it cost about RM 20,000 per month and it does not cure? I guess you would if the patient is rich enough to pay for it or if his insurance covers the cost. This is a win-win situation you may say. After all this is what buying a health insurance is for! But hang on. In this case what if Mutu’s total medical cover is limited, assuming it is RM 100,000? That means the insurance pays for only five months’ supply of Nexavar. What happens after that? And within 8 to 11 months patient dies (see point 4 below)?
  3. As an expert, would you admit to your patient that Nexavar cannot cure his cancer? Yes, you did in this case. That is honorable of you.  Obviously not many patients are going to pay that kind of money if there is no cure.  You justified by saying that Nexavar can control it. That sounds good, convincing and heroic  isn’t it? Especially if the patient is desperate and helpless. Such patients need that “last straw”. But what do you really mean by control?
  4. Have you gone into the website of the drug company that sells Nexavar? If you do, you may find this very impressive table with equally impressive so-called “scientific” data.

  • In a study of 602 people … Nexavar helped slow cancer growth and helped extend the lives of patients compared with patients who did not receive Nexavar.
  • Nexavar extended overall survival by 44%.
  • See the diagram below (from: Accessed on 1 February 2011)

For the benefit of those who are not used to reading and interpreting research data, let me explain a bit more. From the diagram above, we know that there were 299 patients taking Nexavar (n= 299) and the  median overall survival is 10.7 months. Compare this to 303 patients who did not take Nexavar (group called Placebo, n = 303) which had a median overall survival of 7.9 months.

The glaring facts of this study showed that:

  • By taking Nexavar patients lived longer by 2.8 months. Take note that they were not cured at all. Eventually patients died. The median survival ranged from about 8 to 11 months, irrespective of whether they take Nexavar or not.

So based on the above experimental data, ask this question. Would you spend RM 20,000 per month and for every month, to live 3 months longer? Again, take note that the price of Nexavar varies –  depending on  where you buy it and whether you pay cash or pay through insurance claim. Obviously the price is higher when your insurance pays for it.

Of course, if this point is crudely presented like I did above, extending life by 2.8 months is not impressive at all!  The educated people deviced a better way of saying things in a nicer, attractive but deceptive way. Another way of saying is:  Nexavar extended overall survival by 44%. Increasing survival by 44% is very impressive indeed.

Mark Twain (of the USA) made famous this phrase:  “There are three kinds of lies: lies, damned lies and statistics.” This phrase is now used to describe “ the use of statistics to bolster weak arguments, and the tendency of people to disparage statistics that do not support their positions”. In simple language, the   statisticians (the experts of numbers) “massage” the data to make what seems ugly to look pretty. Take note also this “manipulation or massage” of data is not wrong – it is academically legitimate!

So take it from me that “Extending life by 2.8 months” or “Extending overall survival by 44%” are both right and academically acceptable. Unfortunately I still cannot figure out how they come up with the 44 percentage figure. I need a bit more time to learn this “art of stretching the truth with numbers.”

With a simple mind like common folks, I would have just do this: I would take 10.7 minus 7.9 = 2.8. Then I would divide 2.8 by 7.9 and multiple by 100 to convert it into a percentage. If I did this, I ended up with only 35%. To avoid having to explain “the confusing concept of statistics”  let us give the benefit of the doubt to the experts and the drug manufacturer and accept what they say: Nexavar extended overall survival by 44%.

But folks let’s concentrate on what matters most.  You can choose between these two “options” below. But know that both mean the same thing!

  • As a patient if you are told that Nexavar can extend survival by 44%, what would be your reaction?
  • On the other hand, if you are told that Nexavar can extend your life by only 2.8 months, what would be your reaction?

Having got over this, what if you are clearly told that the extension of survival by 2.8 months is no free lunch.  Apart from having to pay RM 20,000 per month, there are a variety of side effects you may have to endure. In this case, Mutu suffered eight side effects after consuming Nexavar for a week.

But don’t fault the drug company. You have been forewarned. Patients taking Nexavar may suffer the following side effects (according to the company’s website):

  1. Decreased blood flow to the heart and heart attack.
  2. Bleeding problems. Nexavar may increase your chance of bleeding.
  3. High blood pressure.
  4. A skin problem called hand-foot skin reaction. This causes redness, pain, swelling, or blisters on the palms of your hands or soles of your feet.
  5. Perforation of the bowel.
  6. Possible wound healing problems. You may need to have a surgical or dental procedure.
  7. Birth defects or death of an unborn baby.
  8. Rash, redness, itching, or peeling of your skin
  9. Hair thinning or patchy hair loss
  10. Diarrhea
  11. Nausea or vomiting
  12. Mouth sores
  13. Weakness
  14. Loss of appetite
  15. Numbness, tingling, or pain in your hands and feet
  16. Abdominal pain
  17. Fatigue
  18. Weight loss

Those medically trained may find the following list of side effects more exacting:

Very common: lymphopenia, hypophosphataemia, haemorrhage (incl. gastrointestinal, respiratory tract, cerebral), hypertension, diarrhoea, nausea, vomiting, rash, alopecia, hand-foot syndrome (palmar plantar erythrodysaesthesia syndrome), erythema, pruritus, fatigue, pain (mouth, abdominal, bone, tumour, headache), increased amylase and lipase.

Common: leucopenia, neutropenia, anaemia, thrombocytopenia, anorexia, depression, peripheral sensory neuropathy, tinnitus, congestive heart failure, hoarseness, constipation, stomatitis (including dry mouth and glossodynia), dyspepsia, dysphagia, dry skin, dermatitis exfoliative, acne, skin desquamation, arthralgia, myalgia, renal failure, erectile dysfunction, asthenia, fever, influenza like illness, weight decrease, transient increase in transaminases. Uncommon: folliculitis, infection, hypersensitivity reactions (including skin reactions and urticaria), hypothyroidism, hyperthyroidism, hyponatraemia, dehydration, reversible posterior leukoencephalopathy, myocardial ischaemia and infarction, hypertensive crisis, rhinorrhea, interstitial lung disease–like events (pneumonitis, radiation pneumonitis, acute respiratory distress, etc), gastro oesophageal reflux disease, pancreatitis, gastritis, gastrointestinal perforations, increase in bilirubin, jaundice, cholecystitis, cholangitis, eczema, erythema multiforme, keratoacanthoma / squamous cell cancer of the skin, Stevens-Johnson syndrome, gynaecomastia, increase in alkaline phosphatase, INR abnormality, prothrombin level abnormality.

Rare: QT prolongation. Not known (cannot be estimated from the data available): angioedema, drug induced hepatitis, radiation recall dermatitis.

Date of Revision of the Text: November 2010

5. Solutions?

The lady was indeed sharp. She asked me: “Then, that are the solutions?” I must admit I cannot guarantee any cure. We know that in cancer there is no such thing as a cure (meaning, real cure, not just surviving 5 years). In the case of advanced liver cancer, we all know that survival is only in terms of months. So, we are faced with a difficult case. This is the first time that a patient came in with his alpha-fetoprotein reading well over a million. The highest we have ever seen in 14 years is about half that value.

We have two suggestions for Mutu.

a)      Take care of your diet. He was given a list of food that he can and cannot eat. Unfortunately this list is way off the mark compared to our recommendation.

b)       Take herbs and hope for the best. If a patient has no pain, can eat and sleep – these are about all we can hope for. How long to live is not ours to decide.

It is up to Mutu to decide if he wants to continue taking the Nexavar and reap whatever benefits (and also side effects) that are associated with it. But ask this: Is it worth it?

Some of you may say: Ah, you snake oil peddler – you and your herbs and dietary fad – these are just quackery. They are not proven and not scientific. Hang on, before you cast the first stone, take time to read the following ten stories. Tell us where we go wrong if you think that we are wrong!

1.  Liver Cancer: Two months to live yet still fine after one and a half years!

2.  Liver-Bile Duct Cancer: Herbs Kept Him In Excellent Health

3.  Only On Herbs And She Lives More Than Five Years!

4.  He Declined Medical Treatment

5.  Hepatoma – He Refused Chemotherapy

6.  Healing of Metastatic Liver Cancer

7.  The Story of Tony

8.  Colon-Liver Cancer: Seven Years On The Herbs

9.  The Story of Goh

10. The Story of My Buddy: Colon-Liver Cancer