to the editor: Although we concur with the provocative recommendations by Smith and Hillner (May 26 issue), we would also suggest that on-cologists not prescribe chemotherapy agents shown only to increase progression-free survival, unless they are accompanied by clinically relevant increases in overall survival or health-related quality of life. It is instructive to review the approval of ixabepilone, which the authors indicate improves progression-free survival without improving overall survival but also costs more than alternative therapies. Ixabepilone was approved by the Food and Drug Administration on October 16,2007, on the basis of an open-label trial involving 752 women with locally advanced or metastatic breast cancer. The trial showed an increase in progression-free survival of 1.6 months among women treated with ixabepilone and capecitabine as compared with patients who received capecitabine alone, but it also identified significantly more grade 3 or 4 treatment-related neuropathy (21% vs. 0%), fatigue (9% vs. 3%), and neutropenia (68% vs. 11%).
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