Chemotherapy is debilitating and expensive. It can cause heart failure and irreversible damage to nerves and the lining of the gut. 20% of cancer related deaths following cancer therapy may be hastened or caused by the toxic effects of the chemotherapy itself and not by the cancer:-
Mortality within 30 days of receiving systemic anti-cancer therapy at a regional oncology unit: what have we learned?
‘378 patients who received cytotoxic chemotherapy and targeted therapy. In total 13 deaths (3.4%) occurred within 30 days following SACT. Three deaths (0.8%) were definitely treatment-related - neutropenic sepsis, pneumocystis pneumonia and bowel perforation.’
To put up with this risk and toxicity how effective is it?
Only a small minority drugs approved by the FDA and EMA show evidence that improvements in surrogate markers, such as tumour shrinkage, are correlated with improvements in survival:-
The Strength of Association Between Surrogate End Points and Survival in Oncology: A Systematic Review of Trial-Level Meta-analyses.
‘Most trial-level validation studies of surrogate end points in oncology find low correlations with survival.’
Only 10% of FDA and EMA approved drugs show correlation between surrogate markers and improvements in end points such as quality of life or survival.
Do the 10% of studies showing statistical significant benefits in survival, show clinically meaningful benefits?
‘Hans Christian Andersen and the Value of New Cancer Treatments’
‘Only a minority of new cancer drugs approved by US and European regulatory authorities in recent years deliver clinically meaningful benefits to patients.’
Even when post-marketing study shows no clinical benefit compared to placebo most drugs retain their FDA and EMA approval. The most expensive drug studied, cabozantinib, actually worsened clinical outcomes but still remained on the market.
Significant statistical benefit is not the same as clinical benefit:-
‘Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group’
Overall survival was significantly prolonged on the erlotinib/gemcitabine arm, 6.24 months v 5.91 months. That is about 10 days.
Unintended Consequences of Expensive Cancer Therapeutics—The Pursuit of Marginal Indications and a Me-Too Mentality That Stifles Innovation and Creativity
Most patients believe that chemotherapy offers them a cure, however between 2002 and 2014 gains in progression free and overall survival were a very modest median of 2.5 and 2.1 months respectively.
It must be remembered that even these short lived benefits are the results of pharmaceutical companies own trials and not of independent study. For example it is not unusual for adverse reactions or deaths to be dropped from the treatment arm, or for treatment patients to have more blood transfusions etc. A lot of money is at stake.
‘The use of expensive therapies with marginal benefits for their approved indications and for unproven indications is contributing to the rising cost of cancer care’
‘The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies.’
‘The overall contribution of adjuvant cytotoxic chemotherapy to 5-year survival in adults was estimated to be 2.3% in Australia and 2.1% in the USA’. For the major cancers, lung, breast, prostate and colon, chemotherapy was estimated to contribute to 5 year survival in only 1 in 100 patients.
‘It is clear that cytotoxic chemotherapy only makes a minor contribution to cancer survival. To justify the continued funding and availability of drugs used in cytotoxic chemotherapy, a rigorous evaluation of the cost-effectiveness and impact on quality of life is urgently required.’
“Like the child in the Andersen fable, let’s see new drugs for what they are rather than for what we hope them to be.”(3)
Everyone jumping on the money ‘therapeutic’ band wagon.
In conclusion;
Only 10% of FDA approved drugs show any improvement in survival at all! Of this 10% an improvement in 5 year survival is only seen in 1 in 100 patients. The extension in survival in these patients is on average about 2 months.
Let’s talk prevention, prevention, prevention.
Jo
Refs
1 https://pubmed.ncbi.nlm.nih.gov/22897423/ Jaclyn Yoong 1 , Jo-An Seah, Katherine Hamilton, Lee Na Teo, Geoffrey Chong
2. https://pubmed.ncbi.nlm.nih.gov/26098871/ Vinay Prasad 1 , Chul Kim 1 , Mauricio Burotto 1 , Andrae Vandross 2
3.https://academic.oup.com/jnci/article/110/5/441/4735107?login=false Schilsky Schnipper
4.https://pubmed.ncbi.nlm.nih.gov/17452677/ Malcolm J Moore et al.
5.JAMA Otololaryngol head and neck surg. 140 (12) 1225 https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/1891387 Fojo, Lo
6.Clinical oncology 16(8) 549 https://www.clinicaloncologyonline.net/article/S0936-6555(04)00222-5/fulltext Morgan, Ward, Barton.
I found this quite interesting:
https://drronehrlich.com/prof-thomas-seyfried-cancer-as-a-metabolic-disease/
Thomas challenges the idea of cancer as a genetic disease through his extensive research and clinical practice.
This fits well with my view that what is termed covid is, in part, various forms of chronic disease and in particular, metabolic disorder.