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December 14, 2007

On HDT/ABMT for Patients with Advanced Breast Cancer: The Final Word?

We've previously covered the story of high-dose chemotherapy + autologous bone marrow transplantation ("HDT/ABMT") being used experimentally on patients with advanced breast cancer, and have argued that the narrative is relevant both to the therapeutic misconception and to the ongoing Abigail Alliance litigation, which is currently pending on writ of certiorari at the U.S. Supreme Court.

Todd Ackerman, the fine medical journalist for the Houston Chronicle, reports today on the results of a systematic review of the efficacy -- or lack thereof -- of HDT/ABMT for patients with advanced breast cancer.  Excerpts:

In releasing their report on a review of existing studies, the researchers said women who received high-dose chemotherapy, followed by transplants from their own bone marrow, fared no better than patients on other therapies.

"This shows more is not necessarily better," said Donald Berry, head of quantitative studies at the University of Texas M.D. Anderson Cancer Center and the review's lead investigator. "We're still in the dark ages at recognizing who benefits from which treatment, but we've seemed to reach a plateau delivering chemotherapy."

Berry's quote there is particularly important, as it underscores the uncertainty in the efficacy and benefits of different treatments for breast cancer, which, as Jay Katz documents, is all too often suppressed or diminished, rather than disclosed.

Ackerman continues:

The analysis, presented at the 30th annual San Antonio Breast Cancer Symposium, appears to be the final confirmation that the once cutting-edge therapy shouldn't be an option for women whose breast cancer has spread to their lymph nodes.

The therapy fell out of favor after four randomized studies presented in 1999 showed no benefit, and a fifth that did show a benefit was revealed in 2000 to have been falsified.

Actually, HDT/ABMT was never evidence-based therapy at all, but was an experimental protocol that was hoped to be therapeutic for advanced breast cancer patients (HDT/ABMT is evidence-based therapy for other cancers, particularly certain leukemias, which underscores the importance of understanding that "cancer" is really about 150 different diseases).  The fact that it was never "therapy" at all is itself an apt example of the power and scope of the therapeutic misconception.

Berry said he was surprised that the review did not show even a subset of patients who benefited from the therapy.

Perhaps this review will constitute the final word on this sad story, in which dozens, if not hundreds of women suffered -- the procedure itself has horrifying side effects -- and may have even died prematurely due to the statistically significant mortality risks from the procedure.  The story also reminds, as many commentators have noted, that terminally ill patients can be conceived of as a vulnerable population insofar as the power of hope is enough to prompt many such patients to undertake virtually any experimental protocol that provides even the tiniest glimmer of such hope.


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