Part 2: What did you get out a failed, RM150,000 treatment?

Posted on 15/12/2016 by CA Care

We felt sorry for SF, her hope crushed. After 12 cycles of chemo and spending RM 150,000, she was told the tumors had shrunk and she was cured! (Or did she misunderstood her doctor’s message?). But after one month at home, she had bleeding and came back to her doctor again. Her tumour had grown back to its original size. It was a failure. Her doctor did not have time for her and hurriedly told her to for surgery.

With wounded feelings she and her husband left the hospital and sought the help of another oncologist in another hospital. She was started on radiotherapy to be followed by chemotherapy. We felt SF should just continue with her medical treatment and not take our herbs yet. We sent set her away without any herbs.

SF and her husband came back to see us again after a few days. We spent almost 2 hours talking. It was a “heart-breaking” morning for me. I laid out my advice as clearly, honestly and bluntly as possible. But I was mindful not to cause panic or to instill fear in her. Many times during our conversation, I asked her and her husband to think clearly and deeply the implications of what she wanted to do. She should then make her own decision based on what her heart wanted, after considering various points I raised.

What did you get out of your failed RM150,000 treatment?

Diarrhea after radiotherapy

Patient: I had diarrhea after the radiation.

C: Did you have any diarrhea before you went for radiation?

P: No, the diarrhoea started 2 days after the radiation (note: it continued as of this writing — already 3 weeks).

C: I really cannot tell you what else can happen after this. Did you ever ask the doctor if these treatments — radiation and chemotherapy — are going to cure you?

P: No, we never ask.

C: You should ask before you undergo all these!

Tumor shrunk after the first round of chemotherapy!

P: After 6 cycles of chemo, I was told the tumour had shrunk. And I needed another 6 more cycles. The doctor said I was cured. I requested the doctor to do a CT scan for me to confirm the result. The doctor said, No need, you are already cured. Go home.

C: What? He said chemo cured you?

P: He asked me to come back after 2 months for review. But one month at home, I had bleeding and we brought forward our travel and came back to see the doctor again.

Husband: The tumour had grown bigger (back to its original size, see table below).

C: Did you ask the doctor why? Only last month he said you were already cured. Now, what happened.

P The doctor was angry.

C: Har?

H: We were confused. We returned to see the doctor one day before he was to go on leave. It seemed he was “uncomfortable” and told us crudely — You just go for the operation! We then went to see another oncoloogist in another hospital.

Elevated liver function parameters

C: Let’s look at your liver function results (table below).

On 8 June 2016, after finishing 6 cycles of chemo, your liver function was still okay. But you see what happened after you did 12 cycles of chemo. All the liver enzymes values were elevated. Your liver was going downhill. Okay, some people may want to rationalize that it is normal after chemotherapy. The liver function enzymes will go back to normal again after you stop chemo. Well, I don’t know if you want to believe that or not.

You are going to be given more chemo. I cannot tell you what is going to happen to your liver after this. I don’t know how many more cycles of chemo they are going to give you, and what drugs they want to use. If they give you the more toxic or aggressive drugs, what is going to happen to your liver?

They want to give you more chemo because they hope to shrink the tumour before they proceed with surgery. You have already done 12 cycles of chemo in Hospital A before. The tumour shrunk and grew back after a month. Think carefully, what do you hope to achieve this time with chemotherapy? Shrink the tumour again?

Lung nodules disappeared

P: The doctor told me that the nodules in my lungs were all gone after the chemotherapy. At least, my lungs are free of cancer.

C: Wrong Ibu (mama)! Yes, the lung nodules were completely gone after the chemo but in the October 2016 scan, there was again a 0.6cm nodule in your lung. So the impression you had was wrong.

P: I did not know this. I did not understand all this. Only now that you have told me this.

Chemotherapy means sufferings

C: Two days ago, a lady came to see me on behalf of her elderly father who had lung cancer. She consulted the same oncologist (the second oncologist, not the first oncologist in Hospital A) that you went to. This oncologist told the lady that her father needs chemo but chemo is going to cause many side effects and he would suffer. The oncologist also said that the father could go for oral drug. But oral chemo-drug can also cause sufferings.

On hearing this, the daughter “ran away” and would not want any more medical treatment for her father! At least we should be glad that this oncologist was honest to tell us this.

Patients are an ignorant lot!

C: This episode really make me sad. For years I have been trying to “educate” patients. I wonder if I have failed miserably? I understand all that you have said and gone through. You put your full trust in your doctors — they are your gods — and the gods failed you!

Also, unfortunately some of these gods are not honest. They don’t tell you the whole truth that you need to know.

P: Indeed I don’t understand all these.

C: You came to see me twice. I have explained to you what I know and I ask you to think carefully what you want to do.

H: Before this I believed that after the surgery — the tumour gone — all problems would be solved! That was what I thought. I did not know all these before your explanation. Now, I understand and realise the implications.

P: I was hoping that after the chemo, I would be cured. I did not want to go for surgery!

Lung Cancer: Meaningless Temporary Drop of CEA After Iressa

Posted on 02/04/2015 by CA Care

In September 2013, Liz – a 54-year-old Indonesian – has pains around her right rib-cage. An USG indicated fluid in her lungs. Liz was referred to a lung specialist who thought she had tuberculosis (TB). Liz was prescribed TB medication for three months.

After three months, there was again fluid in her lungs. About 1.3 litres of fluid was tapped out. Liz was told to continue taking her TB medication.

Liz went to Jakarta and consulted another doctor. Pleural tapping was again done and 0.6 litre of fluid was removed from her lung. Liz was again asked to continue with her TB medication.

Not satisfied Liz went to Singapore. Blood test, CT and PET scan were performed (note: no CT or PET scan were ordered by doctors in Indonesia).

Blood test results, 14 April 2014

Alkaline phosphatase	188 (H)
AST/SGOT	84 (H)
ALT/ SGPT	83 (H)
GGT	100 (H)
CEA	44.3 (H)
CA 125	26.6 (H)
CA 19.9	4.6
AFP	6.4

CT Scan of the Thorax, 14 April 2014

A large right -side pleural effusion is seen involving the upper lobe of the right lung and extending to involve the middle lobe.
Suspicious of a nodular mass more than 2 cm in size present in the upper lobe of the right lung.
Presence of a small nodule in the left lung in the lower lobe, 6 mm in size. This is suspicious of a possible metastatic lesion.

Cytopatholoogy report of right pleural fluid, 14 April 2014

pleural fluid negative for maligancy.
pleural fluid is haemorrhagic with few inflammatory cells and an occasional mesothelial cell.

PET/CT Study on 15 April 2014

Hypermetabolic mass in the upper lobe of the right lung is consistent with pulmonary malignancy.
Mildly hypermetabolic paratracheal and precarinal nodes are suspicious of nodal metastasis. Multiple nodules scattered in both lungs are suspicious of pulmonary metastasis.
Hypermetabolic lytic lesions in the thoracic vertebra and left ischium are compatible with metastases.

Cytopathology report – FN lung biopsy, 17 April 2014

Malignant cells present consistent with infiltrative moderately differentiated pulmonary adenocarcinoma.

MRI Brain

No MRI imaging evidence of intracranial metastatic disease is detected.

Liz was not able to walk by herself and had to use the wheel chair. She received 10 sessions of radiation treatment. After radiotherapy, she was able to walk. But she still had cramps and numbness in her legs. Liz told us that this leg numbness and cramp developed after 2 months on the TB medication.

For her lung cancer, the oncologist prescribed Iressa, costing SGD 3,500 per month.

Meaningless temporary decrease of CEA after taking Iressa

April 2014	Started on Iressa, CEA = 44.3
11 June 2014	X-ray chest: Slight interval improvement. CEA = 18.7 (decrease from 44.3)
13 August 2014	X-ray chest: Stable lobulated opacity seen. CEA = 31.2 (started to increase)
14 October 2014	X-ray chest: No significant change. CEA = 36.0 (slight increase)
20 January 2015	X-ray chest: Right pleural effusion is stable. CEA = 47.6 (increase from initial value)

Meaningless improvements of PET scan images after taking Iressa (Study of April 2014 versus October 2014).

(Top: April 2014 after Iressa bottom: October 2014)

(Left: April 2014 after Iressa right: October 2014)

Iressa did not help Liz. The oncologist offered two options:

Stop taking Iressa and go for chemothrapy.
Or continue taking Iressa for another 2 months and see what happen.

Liz decided to stop further medical treatment and came to seek our help.

Meaningless Shrinking of Tumour by Chemotherapy

Posted on 26/05/2012 by CA Care

YHC (H856) is a 68-year-old man. In November 2011, he had a swelling in his right collar bone region. A biopsy was done and the doctor suspected it was cancer. YHC went to another hospital for a second opinion. A CT scan of his brain and neck was performed on 14 December 2011. The results indicated:

Normal examination of brain.
Right supraglottic soft tissue (upper part of the larynx, the area above the vocal cords) prominence raises the possibility of a tumour.
Bilateral supraclavicular and superior mediastinal nodes are in keeping with metastatic nodes. The largest seen on the left measuring 3.5 cm.

YHC underwent chemotherapy. The first cycle of chemo almost “knocked” him off. The side effects came six days after the treatment. He had to be hospitalised because of fevers, vomiting and diarrhea. Because of this the oncologist reduced the dosage of the subsequent chemo. So YHC went through the second to sixth cycles of chemo without any problem. However, after the sixth chemo, YHC had to be hospitalized again due to pneumonia. He was in the ICU for a week and this treatment alone cost him RM 30,000.

Study the results below.

CT scan on 27 January 2012

Comparison made with previous CT dated 14 December 2011,

The prominence of the right supraglottic soft tissue is reduced when compared with the previous scan.
Bilateral supraclavicular enlarged nodes are partially regressed.
A small pericardial effusion is present.
There are confluent nodes in the mediastinum which compress the superior vena cava. There are also confluent right hilar nodes. The approximate size of the confluent nodes is 6.4 x 4.8 x 3.7 cm.
There is mild thickening of the gastroesophageal wall.

CT scan on 5 March 2012

There is further regression of prominent right supraglottic soft tissue.
Bilateral supraclavicular modes are still present.
The anterior mediastinal soft tissue mass due to confluent nodes is smaller, measuring 4.2 x 3.4 x 3.3 cm. It still compresses the superior vena cava. Confluent right hilar nodes also appear smaller. There are discrete nodes overlying the aortic arch which are also slightly reduced in size.
There is a new finding of bilateral pleural effusion, larger on the right, associated with right lung basal ateletasis. There is also partial collapse-consolidation of the right upper lobe.

CT scan on 28 March 2012

The mediastinal mass of confluent nodes has increased in size. The paratracheal component of the mass is 5.0 x 3.5 x 5.4 cm severely compressing the superior vena cava.
The anterior mediastinal lymph nodes have also increased in size, measuring up to 1.5 cm.
A right pleural effusion is noted.

Impression: Bronchogenic carcinoma with mediastinal lymph nodes increased in size from the previous examination.

Comments

This case really baffled me. YHC was first told that he probably had a lymphoma. Because of that, the oncologist only looked at his brain and the neck when they took the CT scan. The medical report on 27 January 2012 indicated … “lymphadenopathy likely due to metastatic nodes with differential diagnosis of lymphoma.”

However, when all the chemos were done, the report on 28 March 2012 – for the first time, mentioned “bronchogenic carcinoma with mediastinal lymph nodes.”

Does this mean that after all the chemos were completed, “someone” decided that his cancer was actually a lung cancer? So, was he treated correctly in the first instance? YHC’s biopsy report was given the oncologist who later misplaced or lost it. Imagine such thing can happen in a private hospital!

The second fact was just as equally baffling. Let us look at the condition of his lungs before and after the treatments. His lungs were getting worse after chemotherapy!

One important lesson we can learn from this case is that shrinking of tumour or mass after chemotherapy is meaningless – indeed, it is misleading and has no meaning. Let me highlight the important points again. After the first few chemos the mass became smaller and smaller as evidenced by the CT scan. So everybody was happy – the patient was happy, his family members were happy and the oncologist was equally happy. But do we (especially those who see this happen every day) not realize through experience that this shrinking of tumour is meaningless? Experience shows that the mass would grow in size again soon afterwards. The previous gain is often lost after more chemos. Is this not what happened most of the time?

Let us go back to the CT scan reports again:

26 January 2012: Right supraglottic soft tissue is reduced in size. Bilateral supraclavicular nodes are partially regressed.

5 March 2012: There is further regression of right supraglottic soft tissue.

28 March 2012: The mediastinal mass has increased in size. Anterior mediastinal nodes have also increased in size.

One would want to believe that with more and more chemotherapy, the mass will go on reducing in size until it disappears. No, this did not happen! And this phenomenon occurs often! Read what Dr. Ralph Moss said below:

Chemotherapy did not cure him. In fact the treatment made him worse. But the doctor told YHC to continue with more chemo and radiotherapy. YHC refused further medical treatment saying, “I would have to do more and more chemo and eventually “bye, bye!” He had spent more than RM 100,000 and was not going anywhere. Even the oncologist told him, “more chemo is not going to make him better. His condition would turn from bad to worse.” Why do more chemo then?

To me, the crucial point is not whether the tumour shrinks or not, but rather can the cancer be cured by the treatment. If the treatment cannot cure, then shrinking of tumour is meaningless. I would prefer to advise patients to be happy and just be contented if they feel better after the treatment rather than place their hope on a shrinking tumour that brings them nowhere.

Meaningless Decline of CA 15.3 and Tumour Shrinkage Following Treatment With Iressa and Tarceva

Posted on 26/04/2012 by CA Care

I received an e-mail from Dr. Mark (not real name), a Ph.D. in cancer biology working in a hospital. This is what he wrote:

After visiting the CA CARE website … I realized that this is what I have been looking for in order to help my mum. I would like my mum to try your herbal therapy.

My mum is 70 years old.

At the end of April 2007, she kept complaining of stomach discomforts, bloatedness and loss of appetite. She saw a Gastro-specialist and the diagnosis was H. pyroli infection and she was given antibiotic treatment. Unexpectedly, an X-ray test was also done and her lung was found abnormal. She did a CT scan and blood test including tumor markers on that same day. The results showed a possibility of lung cancer. One week later she did a lung biopsy. The result showed that the lung tumor mass was a moderately differentiated adenocarcinoma. However, she didn’t have breathing problems or coughs at that time.

She was then referred to an oncologist at the same hospital. My mum is an Asian woman with non-smoking history and the tumor type is adenocarcinoma. Hence she falls into the category that may respond well to a new targeted drug called Iressa. The doctor said we can monitor her progress using CA15.3, the tumor marker with highest titer when first found (5,147 on 24 April 2007).

After one month of taking Iressa, her CA15.3 went down to 367 (on 28 May 2007).

On 30 July 2007, it declined further to 68.

We were so happy that the drug worked so well. A CT scan showed that tumor had shrunk (August 2007).

At the forth month, the CA15.3 raised to 154 (on 27 August). The doctor was a bit worried but mum continued taking Iressa.

A month later the marker rose to 713 (on 28 September 2007). A CT scan showed more shadow in the lung compared to scan done in August 2007. She did a brain CT scan for the first time and some metastases were found in the brain and bones but the lesions were small.

My mother started taking another targeted drug called Tarceva (works on similar mechanism but seemed to be more effective). She had side effects like rashes, dry skin and loss of appetite.

We were very positive of this new drug because according to the literatures more side effects means higher chances of response. However one month after taking the Tarceva, her CA 15.3 went up to 1,496 (on 26 October 2007). The doctor suggested that she go ahead and take for one more month and then do a CT scan after that. I have asked the doctor if results showed that Tarceva doesn’t work, will he put my mum into chemotherapy. He said yes, but due to my mum’s weak conditions, it will be a mild one.

Besides having Tarceva, she is on Bonefos for her bone metastasis. We also give her supplements.

On 18 December 2007, I received an e-mail from Dr. Mark again. He wrote:

My mum has passed away on 30 November 2007. I think she died from pneumonia. Her left lung was totally white. She had yellow sticky phlegm but she had no strength to cough them out. Her white blood count was very high and neutrophil count was over 94%.

My mum only managed to take the herbs and capsule A+B for a few days before she could became unable to swallow anything, including drinks. She deteriorated very, very fast. I didn’t notice that she had any lung problems before visiting you, hence I didn’t get the Lung Phlegm tea for her.

On the evening of 26 November 2007, we managed to get a doctor to make a home visit. He said that my mum’s left lung was hardly functioning and she was dehydrated. He suggested giving her oxygen and dripped her with dextran saline. My mum shook her head when I asked her whether she wanted to go to the hospital. The next day, we rented an oxygen tank and set up drips for her by a nurse at home. The nurse pointed out that my mum was having lots of phlegm and since she couldn’t cough it out, she might be at a risk of getting pneumonia.

On 28 November 2007, she was not improving at all and I asked her again trying to convince her to go to the hospital to solve the phlegm and constipation problems. She finally nodded her head. So we immediately arranged for an ambulance to send her to the hospital which is about 5 to 10 minutes away from our house.

An X-ray film showed that her left lung was totally white. Her heart was shifted to the right, probably due to the fluid in the lung. She had high blood pressure and her heart rate was over 130/min. On the evening of the second day, she became unconscious. The doctors told us that they wouldn’t do resuscitation because it would only prolong her suffering. On the night of the third day we lost her, while all the family members gathered around her. Although we were really sad, we were also glad that she didn’t suffer much from pain.

I really want to say thanks to you and your wife again, for your kindness and hospitality and of course your herbs. It’s too late for my mum to take your herbs. However, it is never too late to know you and CA Care Therapy.

Comments

Dr. Mark had written a detailed account of about his mother’s case – thanks to his training as a observant scientist. I have the privilege of meeting Dr. Mark when he came to see us with his mother’s medical report on 20 November 2007. What struck me most about this case was that CA 15.3 was used to monitor the progress of lung cancer. I asked him if this is a typing error in his e-mail. Shockingly the answer was no.

Initially on 24 April 2007, the doctors used a few markers such as CEA = 462.9; CA 125 = 324; CA 15.3 = 5147; and CA 19.9 = 14. Among them CA 15.3 turned out to give the highest reading. That being so the doctor decided that CA 15.3 could best reflect the treatment progress. Conventionally CA 15-3 is used mainly to monitor patients with breast cancer.

One notorious side effect of Iressa is pulmonary (lung) toxicity. Patients taking Iressa have been reported to suffer from a complex disease known as interstitial lung disease (ILD). This disease causes difficulty in breathing with or without coughs or low-grade fever. The symptoms become severe rapidly and patients have to be hospitalized. The New Straits Times of 6 December 2002 had this heading: 81 deaths linked to lung cancer drug. The Japan’s Health Ministry confirmed 291 cases of debilitating side effects and 81 patients died due to Iressa. On 19 September 2005, Japan Today,had this heading: Miracle cancer drug turns into deadly remedy: The drug produced serious side effects such as severe pneumonia, resulting in death.

Recall what Dr. Mark said: She deteriorated very, very fast. I didn’t notice that she had any lung problems before visiting you. Was Dr. Mark’s mother another victim of the fatal side effect of Iressa? No one asked. No one dared to ask? Or no one wanted to know?

We felt sorry that the herbs were unable to help in this case. This is what we often tell our patients. It is not how long we live – it is the quality of life that we live while still alive that matters. Be happy and grateful if we can eat, can sleep, and can move around. To fight cancer and destroy it totally is an impossible task no matter what others may want us to believe.

The initial drop in the tumour maker and the shrinkage of tumour are meaningless as this case had demonstrated. Don’t be misled by such an illusion. In fact, this is not an isolated case. We have encountered and documented many other cases like this, which delivers the same message of misguided and misplaced hope.

You may wish to read our other articles (The Meaningless Shrinkage of Tumor While on Tarceva Treatment, Even High-tech Treatments Do Not Guarantee That Cancer Can Be Cured or Will Not Spread) about Iressa, Tarceva and Bonefos and what they can do for cancer patients.

Meaningless Shrinking of Tumor While on Tarceva

Posted on 26/04/2012 by CA Care

Mark (not real name) is a 34-year old male. Sometime in September 2006 he had coughs which led to the diagnosis of lung cancer. A CT scan on 18 December 2006 showed a 5 x 5 cm mass at the right upper lobe of this lung. The right lung also had fluid (pleural effusion). In addition, there were several metastatic lesions in the partially collapsed right mid and lower lobes of the lung. The left lung was clear. Unfortunately the cancer had already spread to the fourth and sixth ribs. A core biopsy of the lung mass indicated a moderately differentiated papillary adenocarcinoma.

Chemotherapy Failed

From December 2006 to February 2007, Mark underwent chemotherapy with Gemzar and cisplatin. Two cycles were given each month and he received a total of six cycles. The cost of each cycle was around RM 4,000. The oncologist told him that there would be no cure but the size of the tumor could be reduced by the treatment.

After the chemotherapy was completed, a CT scan on 7 March 2007 showed right lung severely collapsed with a mass lesion measuring 6 cm over the hilum. Mark had to undergo a procedure to re-inflate his lung.

Oral Drug Tarceva

Mark was told that chemotherapy was not effective. He was asked to take the oral drug, Tarceva which cost RM 270 / pill. The progress of the treatment responses are as follows:

1. CT scan on 9 March 2007 showed a 7.5 cm x 6 cm mass and a daughter nodule measuring 4.5 cm x 3.5 cm.

2. CT scan on 31 May 2007 showed a mass measuring 4 cm x 2 cm, a significant reduction in size of the right lung mass.

3. CT scan on 13 September 2007 showed no significant change compared to the previous CXR.

4. CT scan on 13 November 2007 showed a larger mass measuring 8 x 6 x 4 cm. There was fibrosis in the right apex and the right lung base. There was destruction of one of the lower left rib suggestive of bony metastasis.

While on Tarceva, Mark was told that initially the tumour had shrunk to about eighty percent of its initial size. Unfortunately this shrinkage did not last. After eight months of Tarceva (costing him approximately RM 64,000) it was clear that the treatment had failed.

Mark was told the disappointing news that the tumour had grown bigger again. Tarceva was not effective.

Bony Metastasis – Bonefos

In addition, the bony metastasis got worse. Mark was on Bonefos since his diagnosis and this medication cost about RM 400 per month.

Mark and his wife came to see us on December 2007. They wanted to know if by taking the herbs the tumour would shrink and how long would it take for the herbs to be able to do this. Honestly and frankly my respond was: I am sorry I don’t know.

Comments

Mark and his wife came to us to seek an assurance that herbs can help him. We have lung cancer patients who were told by their doctors that they only had six months to live, but after taking the herbs they went on to lead a normal life for another two to three years before they eventually succumb to the cancer.

A man with bone cancer was told: Go home and prepare your will. You only have six months to live. He declined Bonefos medication, took herbs and is still alive to this day – almost seven years now. However, it is absolutely wrong on our part to claim that herbs can cure cancer. Unfortunately when Mark came to see us, I was unable to provide him the guarantee that herbs can cure anything if that was what he and his wife came to see me for. I told them, we could only do our best to help.

I am reminded by what Randall Fitzgerald said (in The Hundred Years Lie):

For many people who grew by and dependent on technology and the laboratory drugs of Western medicine, breaking free of that paradigm or even considering the use of strange-sounding treatments from other cultures, requires a leap of faith.
For many of us, before we can discover natural healing alternatives, we must first experience the desperation of having exhausted the entire range of synthetic chemical remedies offered by modern medicine.

However, for some people even the experience of failure does not bring any message. The sad truth about advanced stage lung cancer is that there is no cure for it – not even with chemotherapy or Tarceva.

Stephen Spiro and Joanna Porter in an article: Lung cancer– where are we today? (American J. Respiratory and Critical Care Medicine. 166:1166-1196, 2000), wrote that although chemotherapy may be a logical approach, there is virtually no evidence that it can cure NSCLC (non-small cell lung cancer).

Ronald Feld et al. (in Lung. Clinical Oncology. 2nd ed. Harcourt Asia) summed up the present scenario: Despite this large patient base for clinical trials, the role of systemic chemotherapy in the management of NSCLC remains one of the most controversial issues in medical oncology today.

Dr. Jeffrey Tobias and Kay Eaton (in Living with Cancer) were more explicit when they wrote

For patients with NSCLC …(treatment) in truth is likely to be more valuable for palliation of symptoms rather than a treatment with a real prospect of cure… a cure couldn’t realistically be attempted.
the early dramatic response to chemotherapy is rarely beyond a year or two … perhaps six months later (there is) clear evidence of the return of the cancer.

What is Bonefos?

Bonefos is used in some cancers to reduce bone destruction that could result in bone pain and fractures. Its chemical name is Clodronate disodium belonging to a class of drugs called bisphosphonates. It stops the calcium from coming out of the bone which makes it weaker and hence increasing the risk of fractures and pain besides increasing calcium blood levels. Nowhere is it stated that it cures bone cancer. And in this case, Bonefos was not effective.

What is Tarceva?

Go into the website and find some hard truth about this oral drug. According to the earalier company’s website, (http://www.tarceva.net/survivalresults.aspx), Tarceva is the first and only oral HER1/EGFR tyrosine kinase inhibitor proven to significantly prolong survival. It significantly increased overall survival by 37% and demonstrated significant symptom benefits by prolonging the time to progression of symptoms.

This write-up is very impressive. But as always, let me caution patients to read information using some common sense. Ask what does increased survival by 37% means in real term? The data presented by the company are as below:

Median survival was 9.5 months with Tarceva versus 6.7 months with placebo. In real terms Tarceva only increased survival by 2.8 months. Mathematically it is very correct to say that the increased survival due to Tarceva is 41.8%. Definitely 41.8% increased survival sounds very attractive indeed.
Tarceva significantly prolonged progression-free survival (PFS) by 82%. The actual figures are: PFS 3.6 months with Tarceva versus 1.8 months with placebo.

Nowhere in the medical literature is there a claim that Tarceva cures lung cancer! Patients need to decide if it is worth spending RM 8,000 each month on medication that was shown to only prolong life by 2.8 months. In this case, Mark had already spent RM 64,000, and found out that Tarceva had failed him.

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