Cancer

[gardnmom]

and the risk of secondary malignancy caused by radiation.

 

[Roseofsharon]

Both of my parents died of cnacer -so I keep an eye on information about... A friend sent me this info. What do you think? I will just copy & paste her message.

 

Evergreen

 

I wanted to make you aware of this potential resource. I am forwarding a copy of a newsletter produced by a website called www.cancerdecisions.com. The purpose of the site is to produce reports on treatments for specific cancers looking at the whole range of conventional and alternative treatments. I think the reports cost about $60 each but if I were diagnosed with any type of cancer, it is the very first step I would take in researching my options.

 

One of the biggest problems in trying to decide what to do when faced with a life threatening diseases is gathering enough real, valid and helpful information. Some sources can be unintentionally misleading or one sided. One piece of information I have gathered lately from several different sources is that when we are told that a certain treatment "works" or has been shown to extend life, the extension of life may be only a few weeks or months. If this is a cancer treatment that also severely reduces the quality of life, then knowing that the "help" may be very fleeting is a vital piece of the puzzle.

 

Here is the News letter:

THE MOSS REPORTS

 

When physicians reporting the results of a major clinical trial announce a 23 percent improvement in survival for lung cancer patients taking a new drug, it would be hard to see this as anything less than a breakthrough.

 

But examine this claim a little more closely and you will discover that the 23 percent improvement in survival actually translates into patients living for 12.5 months, rather than 10.2 months. Furthermore, a significant proportion – 4.5 percent - of patients receiving the new wonder drug can be expected to die as a direct result of the treatment itself, a mortality rate which, according to one of the lead researchers involved, is "well within accepted limits."

 

There seems to be a vast and widening gulf between the way in which therapeutic advances of this sort are perceived and reported by the medical profession, and the real-world benefit that patients can expect to receive from submitting to such treatments.

 

This week and next, I report on my visit to the annual meeting of the American Society of Clincal Oncology, a forum in which, as you will see, announcements of this sort are plentiful. My goal, as always, is to be an objective observer, and if it seems to me that the Emperor has no clothes, I see it as my duty to say so. The most important thing I, in my capacity as a science journalist, can accomplish is to give my readers the tools they need in order to make up their own minds and come to their own conclusions.

 

This has also been my hope and my aim in writing The Moss Reports, a series of detailed summaries of the best available conventional and alternative treatments for almost 200 different cancer diagnoses.

 

If you would like to order a Moss Report for yourself or someone you love, you can do so from our website, www.cancerdecisions.com, or by calling Diane at 1-800-980-1234 (814-238-3367 from outside the US).

 

Ok, there is more I will do on the next post...

 

 

 

 

 

 

[Roseofsharon]

REFLECTIONS ON ASCO 2005

 

I have just returned from the 41st annual meeting of the American Society of Clinical Oncology (ASCO). Twenty-five thousand oncologists converged on Orlando, Florida, to present their latest work and to learn about the progress that has been made over the past year in treating various types of cancer. There were nearly 10,000 abstracts presented at this meeting, as well as numerous commercial displays in the vast and towering exhibition hall. Some of these were masterpieces of advertising design, although not necessarily of hard science.

 

Like the blind men in the fable trying to describe an elephant, every observer of a meeting this complex comes away with his or her own, somewhat subjective, impression. In future issues of this newsletter I shall comment on particular studies that I consider most promising. But right now I would like to give you my personal observations on the state of oncology as revealed by this ASCO meeting.

 

I first attended an ASCO meeting in the 1970s, when the organization was relatively small and unknown. The first thing that strikes me, as I look back, is the dramatic shift from a chemotherapy-based model of cancer treatment to the new paradigm based around molecularly ‘targeted’ therapies.

 

Such a change should in fact be welcomed by people who are sympathetic to complementary and alternative medicine (CAM). The great philosophical debate over the excess toxicity of standard chemotherapy has been won by those favoring a "kinder, gentler" approach to cancer treatment. Indeed, almost every speech and most of the poster sessions featured targeted drugs of one description or another.

 

At the same time, I find little in the actual practice of targeted therapy to kindle much enthusiasm. In this, I am at odds with most leaders of oncology. For instance, in his 2005 Karnofsky Memorial Lecture (the highest honor given by ASCO), Charles L. Sawyers, MD, of the University of California at Los Angeles (UCLA), spoke for many of his colleagues when he said that the age of molecularly targeted cancer therapy had unquestionably arrived. As he saw it, the fact that so many presentations focused on the use of so-called tyrosine kinase inhibitors such as imatinib (Gleevec), gefitinib (Iressa) and erlotinib (Tarceva) validated the basic concepts of targeted therapy.

 

Since it has been seven years since the Food and Drug Administration (FDA) approved Herceptin (trastuzumab), one of the very first targeted drugs, to treat breast cancer, and four years since it approved Gleevec for chronic myelogenous leukemia (CML), one could certainly expect to see some definitive proof of the targeted treatment philosophy. But while such agents have undoubtedly scored some successes over the years—Gleevec in particular is a very worthwhile agent—the field as a whole has run into many unanticipated obstacles as it tries to tackle the common tumors of adults.

 

In particular, it has turned out that these agents have more side effects than was predicted initially by advocates of molecular targeting. For example, take the surprisingly widespread occurrence of potentially fatal bleeding episodes with the drug Avastin (bevacizumab). According to the manufacturer’s own website:

 

"Serious, and in some cases fatal, hemoptysis [the coughing of blood from the lungs, ed.] has occurred in patients with non-small cell lung cancer treated with chemotherapy and Avastin. In a small study, the incidence of serious or fatal hemoptysis was 31 percent in patients with squamous histology and 4 percent in patients with adenocarcinoma receiving Avastin as compared to no cases in patients treated with chemotherapy alone. Patients with recent hemoptysis should not receive Avastin."

 

In addition, when given as stand-alone treatments, most of these agents have demonstrated surprisingly poor results in various clinical trials. As was seen recently with the phase III clinical trials of Iressa, they sometimes do not actually extend overall survival at all. In April, 2005, the US National Cancer Institute (NCI) decided to discontinue all further clinical trials with Iressa, once a front-runner in the targeted therapy movement. "Iressa Clinical Trials Squashed Like a Nasty Cigarette Butt," is how one former pharmaceutical developer (Stacey Lloyd) graphically summed up NCI’s action.

 

 

Plenary Session Disappointments

 

At the ASCO plenary session held on Saturday afternoon (May 14, 2005), there was a discussion of three different combinations of chemotherapy with targeted drugs, in this case antiangiogenic agents. Such agents are designed to stop the formation of new blood vessels that can promote the growth of tumors. This session illustrated the complex obstacles that researchers in this field have encountered. Two of the speakers reported that the targeted drug bevacizumab (Avastin) provided what they called a significant survival advantage in patients with metastatic colorectal cancer and advanced non-small cell lung cancer, respectively. However, a third study, using the up-and-coming antiangiogenic drug PTK/ZK, failed to show that this drug significantly improved progression-free survival when given in combination with chemotherapy as a first-line treatment for advanced colorectal cancer.

 

At first sight, you might think that two positive trials out of three is not bad. However, what the survival numbers actually show is something quite different. Thus, when Avastin was given alone to patients with metastatic colorectal cancer, their median overall survival was just 10.2 months. A standard chemo regimen of 5-FU, leucovorin and oxaliplatin, called FOLFOX 4, yielded a very similar 10.8 months. Only when the two treatments were administered together did survival rise to 12.9 months. Thus there was a gain of two months through the use of this intensive - and expensive - regimen. How much of this increased survival time was spent by patients feeling sick because of toxicity remains to be discovered.

 

NOTE: The median is the middle number in a set of ordered data. Thus, the median of the numbers 1,1,1,2,4,6,6 is 2 since 2 is the middle number when all of the numbers are placed in order. In statistics, the median is considered a more reliable measure than the mean, which is more commonly what is meant by the word "average."

 

Another figure that oncologists frequently look at is median progression-free survival (PFS). This refers to the time that elapses between administration of the treatment and the time that progression of the disease is detected in a living patient. Here the figures were even less encouraging. With Avastin alone, this period of remission was just 2.7 months. With FOLFOX 4 alone it was 4.8 months. When the two were given together it was 7.2 months. At that point, the cancer was detected to be once again on the march. So, again, we’re talking about a gain of a few months.

 

In the second reported trial, the standard regimen FOLFOX4 was given with PTK/ZK, a new orally administered, targeted antiangiogenic agent. The effects of this combination were then compared to FOLFOX 4 given with a placebo pill. No figures on median overall survival will be available until 2006. But the combination that included PTK/ZK yielded an average (median) progression-free survival of 7.7 months. This was nearly identical to the 7.6 months experienced by the FOLFOX 4 group. It seems therefore that in this group of patients the new drug had no effect on the progression of their cancer.

 

In a third trial, a standard regimen of two drugs, paclitaxel and carboplatin (PC), was compared to PC + bevacizumab (Avastin) in the treatment of metastatic non-small cell lung cancer. The median overall survival here was 10.2 months for PC alone vs. 12.5 months when Avastin was added. The median progression free survival was 4.5 months for PC alone vs. 6.4 months for the combination. These studies support the idea that Avastin (at least in clinical trials) adds around two months to disease free and to overall survival when it is added to standard chemotherapy for some advanced solid tumors of adults.

 

TO BE CONCLUDED, WITH REFERENCES, NEXT WEEK.

 

 

 

 

--Ralph W. Moss, Ph.D.

 

IMPORTANT DISCLAIMERS

 

The news and other items in this newsletter are intended for informational purposes only. Nothing in this newsletter is intended to be a substitute for professional medical advice.

 

 

 

I don't know what I would do if I was diagnosed myself with cancer- but it helps to be informed...

 

[gardnmom]

My daughter had breast cancer, the first thing she did was tell me and then called her aunt who was going through a fight with cancer which she eventually lost. At her suggestion she did the research... DD suggested and then insisted on the lumpectomy, refused the radiation, but did accept the chemo. Then after all the testing etc, she got diabeties, but she has been cancer free for about 12 years. I'm sure she could tell you exactly how long, but had she had the radiation, she would be looking at a possible recurance of the cancer after 10 years.

So my conclusion is do the reasearch yourself, evaluate it yourself, discuss it with your Dr. and do what is best for you.

[Guest Guest]

Very interesting information, and very timely....thank you!

[gardnmom]

You are very welcome......

[Roseofsharon]

My dad had lymphoma (this was almost 40 years ago) they opened him up to do surgery and ended up sewing him back up with doing nothing -said he was too far gone, gave him 6 mos. to live- BUT he did do some Chemo.. & he had a baby girl at home (me) (he was 56 when I was born BTW)- any way - I don't know all the details as I was a child, but I know he was always a strong & healthy (at least he never seemed sickly to me) dad for 13 years. He continued to work past retirement as a carpenter. He was always there to play catch in the yard or whatever.

And that was (almost) 40 years ago -and they have come a long way -

 

I may not have read the above article as well as I should have before posting, because they make it seem kind of hopeless if you get cancer -and I do not feel that way at all. I just think I would explore All my options -and I would definitely tell my mom first if I could.

[Guest Guest]

My Mom has had cancer twice. In 1981 she was diagnosed with Lymphoma. She went through "test" chemotherapy with new drugs that had just been developed. The drugs were successful, and she has been in remission since 1982. In 2001 she went through radiation treatment for breast cancer, and had a partial mastectomy. The cancer was caught very early, so we are hopeful that it won't return. However, 10 years would put her at 85 which is a long life.....but I still want to keep her around forever.