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Many patients with advanced cancers get treatments that won't help
Date:6/7/2011

egimen with insufficient data involved bevacizumab (trade name Avastin) used after the patient had progressed on a combination of that drug and chemotherapy. The treatment shown to be "ineffective" was capecitabine (trade name Xeloda) after progression on the same class of drugs. The regimen with no compelling rationale was panitumumab or cetuximab (trade name Erbitux) after progression on similar drugs.

The 140 patients received 869 cycles of chemotherapy. Some received two or more unproven treatments.

  • Ninety-one of those patients went through 632 intravenous cycles of bevacizumab, at an estimated cost of $1.3 million. Potential side effects include hypertension, heightened risk of bleeding and bowel perforation.
  • Fifty-nine patients received 218 non-evidence-based cycles of capecitabine, at a cost of more than $600,000. This drug, taken orally, can cause diarrhea, nausea, vomiting, fatigue, rash and swelling of the hands or feet.
  • Six patients underwent 19 cycles of panitumumab, at a cost of almost $70,000. This drug can trigger itching, dermatitis and rash.

"We did not study why these physicians and patients turned to unproven therapies," said co-author Caleb Alexander, M.D., associate professor of medicine at the University of Chicago. "I suspect that both patients and care providers, when facing life-threatening disease with limited options, are more willing to step outside guidelines."

"There could also be financial implications," he added. "A physician who has run out of options may be hesitant to send a patient to a center that has access to greater resources but may be far away."

The researchers emphasized, however, that as the costs of cancer care continue to rise, the impetus to base treatment decisions on solid evidence can only increase. "It's important to get the right medicines to the right patients," said Alexander.

"DeSouza's research highlights the importance of evidence-base
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Contact: John Easton
John.Easton@uchospitals.edu
773-702-6241
University of Chicago Medical Center
Source:Eurekalert

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