DMB, thanks for the explanation. Being an engineer, I far prefer mechanisms and causal relationships than statistical 'suck it and see' type developments.
What you say makes sense.
It's surprising that MACOP-B didn't give better results than the same sort of lymphoma would normally give and there arose an escalation of 3rd generation choices. Presumably they did some statistical countups of how people did on each treatment method, but it seems you are saying they didn't keep score. If 3rd generation treatments were not improving things, that should show up in the body count within a couple of years. There are 50,000 people per year to keep track of so some rapid statistics are available.
But since the mechanism is quite different for Rituxan, from the toxic mechanisms, it seems the kill rate of cancer cells should go up. In any event, unlike methoxetrate and other serious poisons which damage the patient, Rituxan seems to be something which causes very limited damage to people who receive it. So it could be added to standard treatment without damaging the person further. Even the loss of B-cells due to Rituxan doesn't seem to result in many serious infections according to things I've read so far. Though the doctor we consulted said that he had had a couple of cases of tuberculosis. I wonder if he got the only two out of all the thousands treated and whether they recovered anyway with antibiotics.
I certainly agree, you wouldn't want to harm the patient without any data to suggest their survival or comfort prospects are improved, but in the absence of harm, it is more a financial decision as to whether the extra $7000 or whatever the Rituxan treatment costs is worth the unproven prospect of an improvement.
Has there been any damage to patients by Rituxan? I realize there is infusion fever and presumably some people react and treatment has to be stopped, but is there any actual harm such as damaged hearts, tuberculosis or anything serious?
It's pretty scary to think that maybe 10,000 people per year could benefit from another 5% or 10% survival prospect by using Rituxan and they are not getting the chance if there is no risk. That's another 1,000 per year who could live instead of die. In the USA alone.
Thanks for the comments,
Regards,
Maurice |
