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Chemotherapy doesn't improve survival

AAP logoAAP 9/11/2016

Expensive chemotherapy does little to improve survival for people with advanced cancer, who often have "unrealistic expectations", an expert has said.

Peter Wise, a former consultant physician at Charing Cross Hospital in London, said spending "six figure" sums on chemotherapy drugs is inappropriate for many people with advanced cancer who will "almost inevitably die" from their tumours.

Chemotherapy - which is one of the cornerstones of cancer treatment and can be used alongside other targeted drugs or radiotherapy - has only been shown to extend life by a few months on average, he said.

Instead of wasting money on these drugs, cash should be ploughed into "under-financed" areas that can actually extend survival, such as prevention, early diagnosis and more prompt treatment of single tumours, he added.

Writing in the British Medical Journal (BMJ), Mr Wise said cancer survival has improved in recent decades, but only a small part of this can be attributed to expensive drugs.

Some 48 new regimens approved by the US Food and Drug Administration (FDA) between 2002 and 2014 led to a typical two months survival benefit, while more historic data shows little evidence of overall benefit of chemotherapy.

Mr Wise also pointed to problems with clinical trials of new drugs, saying that the end result of any trial should be whether survival rates improve.

But "surrogate endpoints" are used as a way of shortening clinical trials and getting drugs to market quickly. These endpoints include patients having early tumour shrinkage and longer periods of time before disease gets worse - known as progression-free survival.

"These endpoints are ... more rapidly available but, with some exceptions, have been shown to correlate poorly with overall survival," Mr Wise said.

"Many drugs approved on the basis of better progression-free survival have been subsequently found not to produce better overall survival than the comparator drug."

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