Cancer Drugs Comparedfor safety and effectiveness
By Craig Paardekooper

The dataset used for this study is available for download here
Download [for more info see Preparation]

The Python code used for this study is here Python CodeINTRODUCTION
There are 4 different types of therapy for treating cancer –1. Chemotherapy
2. Targeted Therapy
3. Immunotherapy
4. Hormone Therapy

1. Chemotherapy
Chemotherapy drugs target cells that divide quickly, like cancercells. This kills them or stops them from spreading, which slows thegrowth of the tumour.
Research has helped to determine the most effective chemo drugs foreach situation.

2. Targeted Therapy
Targeted therapy is a precise method of fighting cancer with drugs.
The drugs target the molecules involved with the growth or spread ofcancer.
Chemotherapy also uses drugs to fight cancer, but targeted therapy
is different.
Instead of acting on all rapidly dividing cells — both cancerous andnormal — targeted therapies seek out specific molecular targets on
the cells. Rather than killing the cells, these drugs interact withthem to block their growth and spread.

3. Immunotherapy
Immunotherapy — sometimes called biotherapy (biological therapy) —works with the immune system to treat cancer.
The immune system is the body’s defence mechanism. When it detects athreat, it reacts. We call this the immune response.
A strong immune system works to seek and destroy damaged andabnormal cells.
Sometimes, the immune system isn’t strong enough on its own.
Immunotherapy enhances the actions of the immune system to fightcancer cells.
The immune system consists of organs and cells throughout the body,such as:•••••The spleen
Lymph nodes
The lymphatic vessels and fluids
Certain cells in the liver and bone marrow
White blood cells

Immunotherapy uses concentrated amounts of the body's natural
substances — called biologic agents — to push the immune system towork even harder.
Immunotherapy works by further stimulating the immune response.
If the white blood cells aren't strong enough to fight cancer cellson their own, biologic agents can give the system a boost bychanging the chemical environment of the cancer.

4. Hormonal Therapy
Hormones are the body’s natural chemical messengers. They travel
throughout the body to regulate the activity and behaviour of cellsand organs.
Hormones play a vital role in functions such as:•

Digestion•

Metabolism

•

Sleep

•

Reproduction

•

Mood

When hormonal activity abnormally increases, cancer can form.
Hormone therapy uses drugs to alter abnormal actions of certain
hormones.

QUESTIONS
1. Is targeted therapy safer than chemo ? :It is expected that drugs that only target cancer cells will
have less side effects upon healthy cells, and will therefore
have a higher safety rating.
2. Is immune Therapy safer than chemo ? :It is expected that drugs that boost the immune system will
have a high safety rating compared to chemo because the immune
system is our natural defense against cancer – and therefore
will have minimal side effects.
3. Is Hormone Therapy safer than chemo ? :Hormones are the natural messengers of the body.

EUDRA-VIGILANCE data can be used to compare the SAFETY andEFFECTIVENESS of•••Targeted therapies
Immune therapies
Hormone therapies

compared to chemo.

SAFETY will be measured by •••incidence of fatality,
incidence of life-threatening events
incidence of hospitalisation

EFFECTIVENESS will measure by –•••incidence of complete recovery
incidence of improvement
incidence of no recovery

Data for 395 different cancer drugs were utilized. The data wasfiltered to exclude drugs where the number of cases was less than100. 152 different cancer drugs remained.
The data for each cancer drug was looked at, regardless of the organ
to which the cancer therapy is applied.RESULTS
The results spreadsheet shows the results for 152 cancer drugs after
filtering out drugs with less than 100 case reports. The spreadsheet
can be downloaded here –Results Spreadsheet – download
The spreadsheet includes data on pain, nausea, fatigue, diarrhea,
hair loss, neuropathy, cardiopathy, anemia
You will need to look up each drug to find out if it is Chemo, atargeted therapy, an immune therapy or hormone therapy.

SAFETY IS PARAMOUNT“FIRST, do no harm”. Safety is paramount, and should always be
considered before effectiveness.
••••

Is the drug below or above the mean for fatalities, life
threatening events or hospitalizations ?
Better still, what quartile does the drug fall into?
How many standard deviations is the drug score from the mean ?
What are the safer alternatives ?

It is all very well saying “If you don’t take treatment you willdie”, but what are the treatment options ? Are some options safer
than others ?

DEFINING THE LIMITS OF SAFETY AND EFFECTIVENESS

Based on the spread of the results, we can define the limits ofsafety and effectiveness
The quartile within which a score falls determines its safety andeffectiveness.

DEFINING SAFETY

Safety (quartile ranges)
Hospitalisation
Life Threatening% of Reports% of Reports

Fatality% of Reports

count
mean
std
min
25%
50%75%
max

count
mean
std
min
25%
50%75%
max

152.000000
31.155263
16.246796
0.000000
20.755000
28.585000
39.067500
91.260000

count
mean
std
min
25%
50%
75%
max

152.000000
4.460789
4.163557
0.000000
1.502500
3.530000
6.227500
20.510000(1st quartile)

SAFE•••

fatality
life threatening
hospitalization< 3.11
< 1.5
< 20(2nd quartile)

LOW•
•
•

fatality
life threatening
hospitalization

3.11 – 4.91
1.5 – 3.53
20.7 – 28.58(3rd quartile)

MED
•
•
•

FatalityLife threatening
Hospitalization

4.91 – 7.90
3.53 – 6.22
28.58 – 39.06(4th quartile)

HIGH
•
•
•

FatalityLife threatening
Hospitalization

EXTREME

7.90 – 13.94
6.22 – 12.53
39.06 – 66.3

(OUTLIERS)•••

FatalityLife threatening
Hospitalization> 13.94> 12.53> 66.3152.000000
6.026711
4.787258
0.000000
3.110000
4.910000
7.900000
35.480000

DEFINING EFFECTIVENESS

Effectiveness (quartile ranges)
Completely Recovered
Recovering/Improving

Not Recovered

count
mean
std
min
25%50%75%max

count
mean
std
min
25%50%75%
max

152.000000
21.050592
10.256064
0.000000
14.277500
19.205000
26.455000
56.380000

count
mean
std
min
25%
50%75%
max

152.000000
12.299211
9.260022
0.000000
6.780000
10.795000
14.767500
65.090000(1st quartile)

POOR
•
••

Recovery
Improvement
No recovery

LOW< 14.27< 6.78> 25(2nd quartile)•••

Recovery
Improvement
No recovery

MED

14.19 – 19.26.78 – 10.79
14.71 – 25(3rd quartile)•••

Recovery
Improvement
No recovery

19.2 – 26.48
10.79 – 14.76
10.23 – 14.71(4th quartile)

GOOD
•
•
•

Recovery
Improvement
No recovery

EXCELLENT•••

26.45 – 43.09
14.76 – 26.79
6.94 – 10.23(Outliers)
Recovery
Improvement
No Recovery> 43.09> 26.79< 6.94152.000000
11.900263
8.329633
0.000000
6.947500
10.235000
14.712500
52.160000

WELL-BEING

The extreme adverse outcomes of fatality, life-threatening events,
or hospitalization are not the only effects of concern to drugrecipients.
In addition to these critical symptoms, there are general symptoms
that effect well-being, such as the incidence of pain, nausea andfatigue, that determine quality of life during treatment. To what
extent do different cancer drugs –•••••NAUSEA : make you nauseous ?
PAIN : cause pain ?
FATIGUE : make you tired ?
DIARRHEA : cause diarrhea
HAIR LOSS : cause hair loss ?

Finally we should be cognizant of any symptoms of chronic injury
resulting from the medications. Whilst curing one disease (cancer)
do these medications give rise to new diseases or illnesses ? To
what extent do different cancer drugs –•••••••NEUROPATHY : cause neuropathy ?
NERVE DAMAGE : nerve damage - tingling, burning, weakness ornumbness in the hands and/or feet ?
ANAEMIA : cause anemia - a low red blood cell count ?
INFECTION : cause loss of immune cells resulting in more
infections ?
MEMORY-LOSS : cause “Chemo-brain” – difficulty withremembering ?
COGNITIVE IMPAIRMENT : difficulty processing information ?
CARDIOMYOPATHY : Chest pain, arrhythmia, palpitations,tachycardia ?

I have created an extended spreadsheet for these ailments to help
you assess which cancer drugs may impact well-being.
See Cancer Drug Ratings – download

CARDIOPATHY and NEUROPATHY

As an example of this extended data, those cancer drugs showing
highest % for cardiomyopathy are –••••TRASTUZUMAB
KANJINTIGRANISETRONHERCEPTIN

And it so happens that Kanjinti and Herceptin are brand names forTrastuzumab. Clinical literature confirms a strong association withcardiomyopathy.
The datasets results for cardiomyopathy can be cross checked against
clinical ratings of cardiomyopathy for these drugs - Link

Similarly, the cancer drugs showing highest % for neuropathy are –•••••CYTARABINEPANTITUMUMAB
VECTIBIXHALAVEN
MVASI

And it so happens that Vertibix is a brand name for Pantitumumab.

•
•
•
••
•
•
•

countmeanstdmin
25%
50%
75%
max

152.000000
0.729737
0.993755
0.000000
0.000000
0.375000
1.010000
6.450000

You can see from this chart that the vast majority of cancer drugs
cause little neuropathy, but there are 5 that cause a significantly
higher incidence.
••

The mean score is 0.72 %The standard deviation is 0.99 %So the incidence of neuropathy becomes significant at about 2.7%.
There are five cancer drugs with higher incidence of neuropathy than
this.
Even so, most people would prefer a cancer drug closer to the mean,or below the mean, when a poor choice can lead to chronic mental
impairment.

MONOCLONAL ANTIBODIES

Monoclonal antibodies are antibodies created in a lab that only
target cancer cells. Theoretically, monoclonal antibodies shouldhave fewer adverse effects compared to chemo, since MABs aresupposed to leave healthy cells alone.
However, in reality there is some overlap where the MABs bind tohealthy cells too. This can be seen in the variation in the level ofcardiomyopathy with different MABs.

Whilst Sacituzumab has the lowest incidence for both cardiomyopathy
and neuropathy, they both have high rates of fatality and low rating
for recovery from cancer.
Rituximab however has the highest rate for recovery and improvementout of all the MAB drugs. It also has low fatality, low pain, lowfatigue, and low neuropathy ratings.

ANAEMIA

Cancer drugs with the highest % for anaemia are –This is confirmed by medical literature –“Lynparza treatment commonly causes anemia, a blood disorder inwhich your red blood cell levels become low. Anemia was one of themore common side effects seen in clinical trials of the drug. Anemia
from Lynparza may be mild to severe. Red blood cells work to carry
oxygen throughout your body” Source
Lynparza is a brand name for Olaparib. Notice that both of thesedrug names occur in the top 3 ranks !
Olaparib has a strong association with anaemia - Source

Hycamtin is also strongly associated with anaemia.
“Anaemia Moderate to severe (Hb ≤8.0 g/dl) in 37% of patients (14%of courses). Red cell transfusions were given in 52% of patients(21% of courses). Frequently reported non-haematological effects
were gastrointestinal, such as nausea (52%), vomiting (32%),
diarrhoea (18%), constipation (9%) and mucositis (14%).”
The active ingredient in Hycamtin is Topotecan. Notice that thesetwo drugs occur with ranks 4 and 6 respectively ! - Source

Lutetium (Lu 177) is also strongly associated with anaemia. Lutetium
is a radiation treatment.
“This medication decreases bone marrow function, an effect that may
lead to a low number of blood cells such as red cells, white cells,
and platelets. This effect can cause anemia, decrease your body's
ability to fight an infection, or cause easy bruising/bleeding.” Source
Other radiation treatments are Pluvicto (which includes Lutetium),and Xofigo, that includes radium.
These radiation treatments are all strongly associated with anaemia.
Here is the list of cancer drugs again, sorted in order of anaemia –I have highlighted the drugs that are radiation treatments. Thesedrugs are carried into the bone marrow, where their radioactive
cargo destroys the cancer cells, but also destroys stem cells thatgenerate red blood cells leading to anaemia.

The above examples of anaemia show the effectiveness of this dataset
in identifying cancer drugs that cause anaemia. Even when a drug ortreatment is under different brand names, they appear in close
proximity of rank to one another.

Many people might assume that anaemia is the inevitable result ofany cancer treatment. However, this is not the case. In thefollowing graph you will see that most cancer drugs have only asmall anemic effect – so identifying the safer ones and discussing
alternatives can make a difference.

••
•
•
•
•
•
•

countmean
stdmin
25%
50%
75%
max

152.00000
1.33875
1.956990.00000
0.39750
0.90500
1.48500
14.61000

You can see from this chart that the vast majority of cancer drugs
cause little anaemia, but there are 5 that cause a significantly
higher incidence.
••The mean score is 1.3 %The standard deviation is 1.95

So the incidence of anaemia becomes significant at about 5.2%. There
are five cancer drugs with higher incidence of anaemia than this.
Most people would prefer a cancer drug closer to the mean, or below
the mean, when a poor choice can lead to anaemia resulting inchronic fatigue, bruising, bleeding and infection.
Anaemia arises because the cancer drug attacks the bone marrow
preventing new blood cells from being created.

IMMUNE DEFICIENCY (NEUTROPENIA)

This is depletion of immune cells called neutrophils – your firstline of defence against bacterial, viral and fungal infections.
Depletion of these immune cells will allow pathogens to multiply inyour body – which can result in infection and sepsis.

••
•
•
•
•
•
•

countmean
std
min
25%
50%
75%
max

152.000000
2.523092
3.247471
0.000000
0.227500
1.000000
3.825000
16.140000