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Study: 3-month drug therapy for breast cancer sufficient, cheaper

MUMBAI: In a landmark study that will help cut down the cost of drug therapy for breast cancer patients by almost two-thirds, doctors from Tata Memorial Hospital in Parel have recommended a shorter, three-month treatment instead of the present one-year-long treatment. The meta-analysis was led by Tata Memorial Centre director Dr Rajendra Badwe and ACTREC director Dr Sudeep Gupta and was published in JAMA Network Open on Tuesday. “We have shown that three months of the drug is no inferior to a one-year course,” Dr Badwe, who is the director of the Tata Memorial hospitals across the country, told TOI. There are various types of breast cancer, the most common cancer among Indian women. In one of the types, called HER2-positive breast cancer, an antibody drug called trastuzumab is given to the patient for 12 months as supportive therapy. The HER2-positive cancer accounts for roughly 25% of all breast cancer patients, said Dr Badwe. Dr Gupta said that the 12-month duration has been the standard treatment for the past 15 years because of initial clinical studies. Although trastuzumab improved cure rates, it has been expensive with a 12-month course costing about Rs 4 lakh to Rs 5 lakh for generic versions and about Rs 8 lakh to Rs 10 lakh for the original medicine made by a multinational company. “At this cost, this drug has been beyond the reach of many patients in India,” Dr Gupta said. The drug is also known to cause heart-related complications in a small number of patients. As a result, there has been worldwide interest in trying to see whether shorter durations of this drug will suffice for the treatment of breast cancer. Dr Gupta, who is the main author of the study, said that the Tata Memorial team decided to look at a number of randomised studies, mainly from Europe, that compared trastuzumab durations between three and six months with the 12-month course of the drug. Except for one study from the United Kingdom, called the PERSEPHONE trial, none of them were able to definitely prove that shorter durations were adequate. So the Tata Memorial team decided to synthesise information from six studies with more than 11,000 patients to show that shorter trastuzumab durations – ranging from three to six months – are sufficient for many patients with HER2-positive breast cancer and also result in lower rates of cardiac complications. “A novel aspect of this study is the statistical methodology by which individual patient data was extracted from published papers and then combined together to create a definitive analysis,” Dr Gupta said. This analysis has important implications for increasing access to this drug among patients worldwide at an affordable cost and without loss of effectiveness. “In India where 1.5 lakh to 1.8 lakh new cases of breast cancers are diagnosed every year, around 45,000 patients will benefit every year,” Dr Gupta said. Medical oncologist Dr Seema Gulia and statistician Sadhana Kannan are the joint first authors of this paper.
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