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Grapefruit juice gives cancer treatment a boost

Rating

3 Star

Grapefruit juice gives cancer treatment a boost

Our Review Summary

This article is based on the story of one cancer patient treated experimentally with  a drug called rapamycin supplemented by grapefruit juice.  This approach is being investigated for advanced tumors for which there is currently no effective treatment.  The story does a good job of explaining the treatment in lay terms, particularly how grapefruit juice might enhance the efficacy of the drug by allowing the body to absorb more of the drug.  However, because the story featured only one patient who had the most dramatic results it tended to overestimate the benefits of the treatment.  For example, the patient’s perspective that her life expectancy with a stage IV metastasized cancer had gone from 3 to 5 years to ‘indefinite’ with treatment.  The story failed to mention the results of other participants in the trial that were not as strong.  See  http://news.uchicago.edu/news.php?asset_id=1596 for study details.

Readers are likely left with an exaggerated impression of the value of the study and of the use of grapefruit juice.  While reduced costs are noted as a potential advantage, the reality is that cost reductions would not be evaluated in the present study.  While reduced costs is a possibility, increased costs have been noted in the use of the combination in patients with solid organ transplants. 

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The cost of the drug rapamycin, approximately $1,000 per month, is provided in this article.  The story also reports that rapamycin supplemented by grapefruit juice would lower the cost of treatment to about $250 per month.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story focuses on the anecdotal experience of one patient with exceptional results.  It fails to go into detail about the results of the other patients in the study. Please see Evidence comments for details.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

This story provided information on the common, less serious side effects of rapamycin and related drugs including suppression of the immune system, diarrhea and fatigue.  It did mention the potential harms of taking grapefruit juice with certain medications because the interaction can result in a dangerously high doses of the medication. However, it didn’t mention that rapamycin side effects that can be enhanced via the enzyme inhibition caused by grapefruit juice include peripheral edema, elevated triglycerides and cholesterol, kidney damage, abdominal pain, pain, diarrhea, headache, high blood pressure and decreased platelets.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

While the story indicated it was based on ‘early results’, it should have emphasized that the preliminary nature of the research study. It should have also noted that the results have not been published in a peer refereed scientific journal. Details of the finding published on the the University of Chicago’s website http://news.uchicago.edu/news.php?asset_id=1596 show that 7 of 25 patients had little tumor growth and that the tumor shrank in the patient featured in the story.  Presumably the treatment had no effect on almost 70% patients.

Does the story commit disease-mongering?

Satisfactory

This article paints an encouraging view of the potential benefit of the rapamycin supplemented by grapefruit juice treatment by featuring the story of just one patient.  While these results are significant for this patient, the story does note that her results are the most dramatic example.  The patients remarks that her life expectancy has gone from 3 to 5 years to ‘indefinite’ and that ‘I may outlive everybody’ may offer false hope to other cancer patients. The benefits of this drug-food interaction are clearly over stated and may provide readers with an overly optimistic outlook for the treatment regimen. Nonetheless, we can’t quite call this disease-mongering, even though we don’t like the way it was handled.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

This story indicates indicates that the results of this investigational treatment were presented at the American Association for Cancer’s annual meeting.  It also features interviews with 3 sources: the lead investigator on the study, a patient involved in the research and an independent expert.  The independent expert’s statement presented a main risk and potential benefits of the new treatment.

Does the story compare the new approach with existing alternatives?

Satisfactory

The subjects in the study were under treatment for numerous solid tumors, each having a number of options available, including other experimental treatments.  Since there are numerous other options presumably available, a listing would not be possible.  It would have been appropriate, but not necessary, for the story to mention the possibility of other treatment options.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

As indicated in the story, rapamycin is a drug that is currently used to treat some types of cancer.  The story reports that the treatment of combining rapamycin supplemented by grapefruit juice is in early, experimental stages. It also notes that the grapefruit juice used in the research trial is not commercially available.

Does the story establish the true novelty of the approach?

Not Satisfactory

The rapamycin supplemented by grapefruit juice is a new treatment for cancer that is just beginning to be studied.  However, this treatment has been tested in patients receiving kidney transplants with varying degrees of success and significant harms in some cases.  Because of the variability in active constituents in grapefruit juice, the interaction is uNPRedictable.  Several authors in the transplant field have suggested that rather than reducing costs, the use of grapefruit juice in addition to rapamycin can actually increase costs due to side effects or treatment failure.  The story should have noted the previous use of grapefruit juice and the difficulties seen in transplant patients.

Does the story appear to rely solely or largely on a news release?

Satisfactory

Because several different sources appear in the story, it’s safe to assume that it did not rely soley or largely on a news release.

Total Score: 6 of 10 Satisfactory

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