Please share your thoughts with your colleagues as you bring a medical perspective to the issue. It may help the discussion if you indicate your background and medical qualifications, i.e., are you a breast cancer oncologist, a nurse, a PA in breast cancer treatment, etc.?
Influential groups such as the NCCN have continued to call for Avastin to remain as an option for metastatic breast cancer treatment, despite the FDA’s move in the opposite direction. Who’s right and why?
Is the FDA doing the right thing in protecting patients or can patients and doctors decide on the benefits and risks themselves?
What course of action should the FDA and Genentech take with regard to Avastin?
How will this affect your pledge to the Hippocratic Oath, if you are forced (for insurance of other reasons) to pull a drug from a patient when it is working for them and they may have few if any alternatives?
I'm a PA working in internal medicine. From what I have read it appears Avastin extends life but does not stop tumor progression in patients with metastatic cancer. As long as people are properly informed of the benefits and risks from their Physicians I do not see a reason why the FDA should stand in the way. They are not in touch with the individual patient and cannot know the benefit vs risk for each individual. It places Physicians in awkward situations when there is a treatment available however bureaucracy stands in the way.
ReplyDeleteAdam,
ReplyDeleteActually, on average, Avastin does not increase overall survival but does increase progression free survival. This extra time that a patient is tumor free greatly increases their quality of life. It also allows them to remain healthier before switching to the next drug, if one exists.
But is is important to note that there are women who are responding above average to Avastin & for whom the drug undoubtedly does extend overall survival. Some of these women have been on Avastin for over 5 years.
As to your other comments, you are spot on! How can the FDA practice medicine by remote control without any of the facts that an attending physician has at her or his fingertips.
I am a surgical Physician Assistant and agree that as long as patients are fully informed of the possible risks and clinically studied benefits of Avastin they should have the right of deciding how they feel most comfortable managing their disease. Everything in medicine has its associated risks, that is not a reason to not treat patients. Every surgery carries the risk of infection and bleeding this does not mean we do not operate and remove that option for our patients. As clinicians it is our responsibility to make our patients aware of these risks and allow them to make an educated decision for themselves; just as patients should have the opportunity to do with Avastin. The FDA decision to remove Avastin from the market is an obvious impingement on patient rights and autonomy.
ReplyDeleteVanessa, you make great points as the patient should be the one managing their disease, this decision impinges on their rights. If surgeries are still carried out even with risks, the drug Avastin should be available even with associated risks. Risks and side effects are better than death.
ReplyDelete