|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 402-403
Authors' reply to Agarwal et al. and Venniyoor
Avaronnan Manuprasad1, Praveen Kumar Shenoy2, Joneetha Jones2, NV Vinin2, Adarsh Dharmaraj2, Geetha Muttath2
1 Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
2 Malabar Cancer Centre, Thalassery, Kerala, India
|Date of Submission||28-Mar-2020|
|Date of Decision||31-Mar-2020|
|Date of Acceptance||09-Apr-2020|
|Date of Web Publication||19-Jun-2020|
Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Manuprasad A, Shenoy PK, Jones J, Vinin N V, Dharmaraj A, Muttath G. Authors' reply to Agarwal et al. and Venniyoor. Cancer Res Stat Treat 2020;3:402-3
|How to cite this URL:|
Manuprasad A, Shenoy PK, Jones J, Vinin N V, Dharmaraj A, Muttath G. Authors' reply to Agarwal et al. and Venniyoor. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Jul 9];3:402-3. Available from: http://www.crstonline.com/text.asp?2020/3/2/402/287284
We thank Venniyoor  and Agrawal et al. for their critical comments about our article titled, “Short-course adjuvant trastuzumab in breast cancer: Experience from a tertiary cancer center in rural India” and the accompanying editorial., This was a retrospective study with limitations inherent to these kind of analyses, and we had acknowledged the same in our publication.
Agrawal et al. have pointed out that there has been a significant reduction in the cost of generic trastuzumab. It has to be noted that our study analyzed data from patients who received treatment between 2014 and 2016, when the availability of generic trastuzumab was limited and its cost was significantly higher than that of other drugs used in the adjuvant treatment of cancer. We had mentioned in our article that all our patients had received breast cancer treatment under government support schemes. In addition, a 9-week course of adjuvant trastuzumab was offered to those who were not willing for a 1-year course. We must also remember that breast cancer is not treated with adjuvant trastuzumab alone; the treatment includes surgery, chemotherapy, and/or adjuvant radiotherapy. This, along with mandatory investigations, adds to the cost of treatment of breast cancer. Gupta et al. from their study had concluded that 1-year adjuvant trastuzumab is not as cost-effective at the current price as 9-week adjuvant trastuzumab. They also concluded that a further reduction of 15%–35% in the price of trastuzumab has increased the probability of 1-year trastuzumab use being cost-effective to 90% in India. Their statistical analysis was based on an estimated cost of ₹16,998 for a 440-mg vial of trastuzumab. This is much lower than the price of most generic versions currently available in India.
In the study by Conte et al., it was seen in the subgroup analysis that patients with lower stage and lower nodal burden who received the 9-week schedule fared similar to those who received the 1-year adjuvant trastuzumab. Thus, 9-week adjuvant trastuzumab is an economically viable option, especially for patients with a lower risk of relapse, i.e., small tumors (T1 and T2) with no or low nodal involvement (<3 nodes). We also agree with Agrawal et al.'s comment about the need of a randomized trial for the 9-week schedule of trastuzumab in Indian patients; however, this may be difficult because of multiple reasons. Similarly, as Dr. Venniyoor pointed out, it is not trastuzumab alone but all the drugs together that determine the outcome. We have used the universally accepted chemotherapy regimens, including doxorubicin-cyclophosphamide and weekly paclitaxel, which might have contributed to the favorable outcomes seen in our analysis.
We conclude that short-course trastuzumab (9 weeks) is a feasible alternative and economically a more viable option in a resource-limited setting like India. Therefore, making it available under government schemes may improve the outcomes of patients with Her2-positive breast cancer in our country.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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