One January morning in 2021, Carol Rosen took a standard treatment for metastatic breast cancer. Three gruesome weeks later, she died in excruciating pain from the very drug meant to prolong her life.
Mar 26 2024KFF Health News
Yet a recent survey found that only 3% of U.S. oncologists routinely order the tests before dosing patients with 5-FU or capecitabine. That's because the most widely followed U.S. cancer treatment guidelines — issued by the National Comprehensive Cancer Network — don't recommend preemptive testing. "FDA has responsibility to assure that drugs are used safely and effectively," he said. The failure to warn, he said, "is an abdication of their responsibility."Europe ahead on safety British and European Union drug authorities have recommended the testing since 2020. A small but growing number of U.S. hospital systems, professional groups, and health advocates, including the American Cancer Society, also endorse routine testing. Most U.S.
Oncologists are accustomed to chemotherapy's toxicity and tend to have a "no pain, no gain" attitude, he said. 5-FU has been in use since the 1950s. Oncology is not the only area in medicine in which scientific advances, many of them taxpayer-funded, lag in implementation. For instance, few cardiologists test patients before they go on Plavix, a brand name for the anti-blood-clotting agent clopidogrel, although it doesn't prevent blood clots as it's supposed to in a quarter of the 4 million Americans prescribed it each year.
Dana-Farber uses a Mayo Clinic test that searches for eight potentially dangerous variants of the relevant gene. Veterans Affairs hospitals use a 11-variant test, while most others check for only four variants. In Ontario, where Kapoor was treated, the health system had just begun testing for four gene variants discovered in studies of mostly European populations. Anil Kapoor and his siblings, the Canadian-born children of Indian immigrants, carry a gene form that's apparently associated with South Asian ancestry.