Is Herceptin a worthwhile trade-off?

I will not go into the cost of funding expensive drugs such as Herceptin as this was ably dealt with by your columnist Claire Bonello (The Sunday Times, August 17).

I would like to make breast cancer patients aware that Herceptin does not as yet confer a cure and that there is a potentially serious problem of cardiac toxicity that undermines any therapeutic advantage of this drug. Vigilance is needed in determining its risks and benefits.

Herceptin is an innovative drug that has rightly been hailed as the precursor of a new class of therapeutic agents. It is restricted to those patients who have a HER-2/neu positive tumour and who ideally should be in excellent cardiac health. It can be used alone or in combination with Taxol.

The benefits of Herceptin in the treatment of breast cancer, while apparently real, are rather small and not without the potentially worrying risk of cardiac toxicity. Patients will need to know before treatment about the drug's possible host of very unpleasant short-to-medium term adverse effects. Taxol is not without its own collateral damage which may not occur until months or years after the medicine was administered.

Following a 2007 presentation at the 43rd annual meeting of the American Society of Clinical Oncology (ASCO), Sharon Hunt from Stanford University in Palo Alto, California, said there is no debate that Herceptin has been a major addition to chemotherapy. Dr Hunt added that there was always a price to pay - the main price with Herceptin seems to be cardiotoxicity and experts are in the process of finding out how high that price will be.

An editorial in The Lancet in 2005 commented on the conflicting evidence that surrounds the apparent benefits of Herceptin: "The best that can be said about Herceptin's efficacy and safety for the treatment of early breast cancer is that the available evidence is insufficient to make reliable judgments. It is profoundly misleading to suggest, even rhetorically, that the published data may be indicative of a cure for breast cancer."

Scrooge-like politicians and strict bureaucratic administrators within the Department of Health should not take heart from the debate surrounding Herceptin, thereby denying the treatment to cancer patients, prolonging their agony and jeopardising their chances of survival.

HER 2-positive tumours account for around 25 per cent of breast cancer and tend to be associated with aggressive disease, a higher likelihood of recurrence, and a decreased response to treatment.