I asked my friend @Buyersstrike yesterday if anyone took The Motley Fool seriously, and he replied that yeah, some people think it’s real. Whether anyone could take this particular example, entitled No Cure Yet for Breast Cancer, but 3 Big Advances in 2016, seriously is a separate and more concerning question (TL;DR: HOW?), but for entertainment’s sake, let’s pick it apart.
First, the title. No cure “yet”? Are we anticipating a cure? It’s just around the corner? There’s also a promise that said cure will save “millions of lives”, which, given that 40,000 people die annually from breast cancer, is a promise that will take a while to realize. But that’s just the kind of article this is, which you already knew from the happy pink-ribbon-adorned women in the accompanying photo.
About that cure. There is one. Right there in paragraph three. Its name is lapatinib. Let that sink in for a second.
The article calls a neoadjuvant lapatinib/Herceptin study conducted in the UK the “biggest breakthrough” in breast cancer in 2016 because 11% of patients who received Tykerb and Herceptin before surgery (in very limited doses – 11 days’ worth of Tykerb) had a pathologic complete response (pCR; no evidence of disease following surgery). Is that supposed to be good? There are published pCR rates for neoadjuvant chemo in breast of over 40%. But that’s a full course of neoadjuvant treatment, and … this is England. The only thing this paper really confirms is that a dual blockade works better than a single targeted agent, which, Yeah. We know.
My first thought when this lapatinib story broke in March was that the UK was angling for damage control after trying to drop T-DM1 from its cancer drugs fund last year (See? We do care about our patients!). Similarly, GSK, Tykerb’s manufacturer and the study’s sponsor, has something to gain by reminding people that Tykerb exists. This felt like a PR move, and I’m surprised anyone bit – nevermind declared it a major scientific finding. What do you even do with the results? Even if 11% of patients are “cured” (note that we have no outcomes data on these patients, so we don’t know if the treatment had any effect on recurrence rates) after 11 days of Herceptin and Tykerb, how do you select them? How do you differentiate these responders from the 89% who have a moderate or no response?
The author, who appears to be a bit of an anglophile (complete with a Daily-Mail understanding of science), goes on to praise the Cambridge Research Institute, which “unpacked the whole picture” of the genomics of breast cancer, identifying 93 genes “whose mutations convert a normal breast cell into a cancer cell.” Jesus Christ. The author goes on to conclude, “The more we know about the genetics of cancer, the more we will know about what treatments will work for an individual women.” It’s surprising to see the grammatical errors outpace the scientific misunderstandings, but there you have it.
There’s one more major scientific advance to be revealed – and it’s the cancer-finding blood test. Recall my experience with liquid biopsy, which is a highly sensitive and very expensive way of identifying tumor DNA in the bloodstream. Despite persistent macro disease, multiple liquid biopsies (as well as CTC tests, which are much less sensitive and nowhere near as costly) have failed to detect any cancer in my bloodstream. I don’t know the kind of tumor burden you need to get a positive result from these tests, but it’s clearly a lot. I would not expect early-stage disease to be identified with any regularity unless the paradigm makes remarkable leaps forward. We also have lots of old, non-specific ways of tracking tumor burden; there’s CEA for all kinds of solid tumors, including lung, breast and colorectal; we have the CA 15-3 and 27.29 in breast, and the CA-125 in ovarian. These tests are not diagnostic and can be elevated in non-cancer patients for any number of reasons. Suffice it to say that blood tests for the detection and even just monitoring of cancer are currently unreliable at best; I’m talking about monitoring because I can’t even wrap my head around the suggestion that definitive blood-based diagnostics are somehow imminent – carbon-13 and nitrogen-15 are named specifically (and completely at random, from what I can tell). The writing on the shortcomings of our current diagnostic standard, the mammogram, is ludicrous: “… mammograms, the best method currently available, are inaccurate 16% of the time.” The “best method”? Based on what? Accuracy? Specificity? Inaccurate how? Did an editor look at this? To imply that changes in carbon-13 isotopes measured via blood test might somehow become a definitive cancer diagnostic is shockingly stupid. There’s no other word for it. It’s stupid. What is this pathway? You have an iffy mammogram, so someone checks your carbon-13? Then what? How do you get the answer?
The author describes herself as a breast cancer “survivor”, and this wouldn’t be a breast cancer article without a reminder that all that really matters is a good attitude. “But there’s no reason to end on a somber note, because research is now showing how powerfully our own bodies can be mobilized to fight it.” Lack of science in that assertion aside, if you said this to a melanoma or lung cancer patient, you would get the shit beaten out of you, and deservedly so. The good-attitude insult only applies to breast patients. But while I’m baffled by the apparently random selection process for the three “big advances” cited in this article, I’m hardly shocked by this closing spin – what’s more emblematic of breast cancer advocacy than a soft-focus view on all that pesky science?