Trastuzumab was "rapidly adopted as the standard of care" in the US for treating breast cancer, but one of the barriers to its use in other countries is its high cost, say the authors. In Canada the treatment costs $C50,000 a year ( 25,000) per patient, and despite its effectiveness was not approved for funding in Ontario until after a media backlash.

The drug represents the first of probably many new cancer treatments of this kind, say the authors. The new hope it gives to patients also highlights new cost issues - both for the drugs themselves and surrounding cost of treatment.

Equality of patient access must extend to these accompanying areas, for example in diagnosing suitability for the drugs. Recent UK figures, for instance, show that only half of women are currently tested for the cancer gene targeted by the new treatment.

Healthcare systems around the world must no longer be left scrambling when effective new treatments come on the market. Transparent, timely and appropriately funded processes must be in place if patients are to get equal access to the best new treatments, conclude the authors.

bmj

The expression of 93 genes, collectively referred to as the Chemotherapy Response Profile (CRP), was found to predict which patients would experience a complete response to chemotherapy, as defined by the absence of disease at the time of second-look surgery. The CRP also confirmed the importance of genes such as BAX in this process, which regulate the cell's response to chemotherapy agents such as paclitaxel.

The authors then went on to compare the results of the CRP and the OCPP. "We found that together these two gene profiles [CRP and OCPP] are a more powerful predictor of a patient's prognosis than either profile separately," says Cannistra. "This represents the first time that two profiles have been combined to yield such a powerful result in this disease."

One of the most difficult types of cancer to treat, advanced ovarian cancer accounts for approximately 26,000 new cases and 16,000 deaths in the U.S. each year.

"Being able to identify the expression pattern of these genes from the original tumor sample [i.e. whether genes were 'turned on' or 'turned off'] provides us with valuable information about a patient's prognosis as this type of information cannot always be obtained from standard clinical features, such as tumor grade or residual disease status," notes Cannistra. "And with the identification of each new gene expression profile, we come one step closer to eventually being able to develop treatments tailored to individual ovarian cancer patients."

Coauthors of the study include BIDMC investigators Dimitrios Spentzos, MD, Douglas Levine, MD, Towia A. Libermann, PhD, Shakirahimed Kolia and Hasan Out and Jeff Boyd, PhD, of Memorial Sloan-Kettering Cancer Center in New York.

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