Criteria for deciding cost-effectiveness for expensive new anti-cancer agents.

Background: There is substantial evidence that environmental factors cause or accelerate the onset of malignancy. Environmental factors, due to the presence of many pollutants and carcinogenic agents, alter cellular growth, which leads to biochemical changes in the blood. Materials and Methods: In the present study, we estimated serum pseudocholinesterase (PCHE), serum aspartate transaminase (AST), and serum alanine transaminase (ALT) in 92 patients with head and neck cancer and 71 patients with cancer of the uterine cervix; all of them were patients attending our department for radiation therapy. We also estimated PCHE, AST, and ALT levels in 30 healthy normal individuals. The estimations in cancer patients were done before the start of radiotherapy, midway through radiotherapy (30 Gy dose), at the end of radiotherapy, and during subsequent monthly follow-up visits over a period of at least 6 months. Results and Discussion: We have observed that the PCHE levels were lower (31-49% of normal value) in all patients with malignancies, except in those with stage II head and neck cancers. We also found that the levels start increasing as radiotherapy progresses. The patients with no detectable/visible disease activity at 6 months follow-up showed PCHE values in the normal range. Similarly, the AST and ALT values were much higher (138-229% of normal value) in all the malignant cases as compared to the normal healthy individuals. The values decrease and approach normal levels as radiotherapy progresses and, in 92% of head and neck cancer cases [stages IIA, IIB, and IIIA] with no disease activity, the PCHE, AST, and ALT were normal or near normal; the corresponding figure in cancer cervix cases was 89%. From the present study we conclude that PCHE, AST, and ALT can be used as good prognostic biochemical tumor markers in the management of malignancies of the head and neck and uterine cervix.