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[Downloaded free from http://www.journal.sajc.org on Thursday, August 28, 2014, IP: 218.241.189.21] || Click here to download free Android application for this jour Letter to Editor Therefore, the patients of breast cancer on tamoxifen therapy should be followed‑up for a longer period. Endometrial thickness is the main indicator to monitor the progress of carcinoma endometrium, hence regular TVS is indicated during follow up and if the thickness observed more than 8.0 mm than all the diagnostic measures should be considered. In summary, the risk of endometrial cancer increases following tamoxifen therapy for invasive breast cancer; however, the net benefit of adjuvant tamoxifen therapy greatly outweighs the risk of developing endometrial cancer.[2] 2. 3. 4. Anil Kumar Dhull, Vivek Kaushal, Sunita Singh1, Rajeev Sen1 Gynecol 1996;39:629‑40. Chauhan AK, Dhull AK, Singh H. Carcinoma Endometrium. Obstet Gynecol Today 2008;13:165‑71. Kleinman D, Karas M, Danilenko M, Arbell A, Roberts CT, LeRoith D, et al. Stimulation of endometrial cancer cell growth by tamoxifen is associated with increased insulin‑like growth factor (IGF)‑I induced tyrosine phosphorylation and reduction in IGF binding proteins. Endocrinology 1996;137:1089‑95. Suh‑Burgmann EJ, Goodman A. Surveillance for endometrial cancer in women receiving tamoxifen. Ann Intern Med 1999;131:127‑35. Access this article online Quick Response Code: Departments of Radiation Oncology, Regional Cancer Centre, 1 Pathology, PGIMS Rohtak, Haryana, India Correspondence to: Dr. Anil Kumar Dhull, E‑mail: [email protected] DOI: 10.4103/2278-330X.105867 References 1. Website: www.sajc.org Barakat RR. Tamoxifen and endometrial neoplasia. Clin Obstet Cost‑utility analysis of using nimotuzumab in end‑stage cancerous patient: Is it too expensive? Sir, The use of new alternative cancer therapy for end‑stage cancerous patient is interesting. Of several new agents, nimotuzumab is an immunological‑based cancer therapeutic agent. Nimotuzumab is widely mentioned for its usefulness in management of end‑stage cancerous patient.[1,2] The prolongation of life expectation is mentioned as a usefulness of nimotuzumab administration.[3] However, the main concern is its high cost. Whether it is cost effectiveness is interesting. Here, the authors present the experience in using nimotuzumab in end‑stage cancerous patients (about five cases). Based on our setting, the average cost for nimotuzumab management of the cancerous patient for a 3‑month period is about 450,000 baht (about 15,000 USD) and the average extended life span is only about 1.5 months. It can be seen that the cost utility is about 10,000 USD/1 month life span extension. Of interest, the cost per utility is very expensive and this might not be better than no nimotuzumab in term of life expectation expansion (since the cases might have this prolonged life span without use of any drug). Although the new drug is effective but the great concern is on its high cost. The use of this drug has to be carefully considered on this fact. Kamon Chaiyasit, Viroj Wiwanitkit1 Maefahlaung University Hospital, Bangkok, Thailand, 1 Hainan Medical University, China Correspondence to: Dr. Kamon Chaiyasit, E‑mail: [email protected] References 1. 2. 3. Li LF, Wang HQ, Liu XM, Zhang HL, Qiu LH, Qian ZZ, et al. Nimotuzumab in combination with chemotherapy in patients with advanced non‑small cell lung cancer. Zhonghua Zhong Liu Za Zhi 2011;33:626‑8. Bebb G, Smith C, Rorke S, Boland W, Nicacio L, Sukhoo R, et al. Phase I clinical trial of the anti‑EGFR monoclonal antibody nimotuzumab with concurrent external thoracic radiotherapy in Canadian patients diagnosed with stage IIb, III or IV non‑small cell lung cancer unsuitable for radical therapy. Cancer Chemother Pharmacol 2011;67:837‑45. Saurez G, Cabanas R, Zaldívar M, Garnier T, Iglesias B, Piedra P, et al. Clinical experience with nimotuzumab in cuban pediatric patients with brain tumors, 2005 to 2007. MEDICC Rev 2009;11:27‑33. Access this article online Quick Response Code: Website: www.sajc.org DOI: 10.4103/2278-330X.105873