Except for those with the smallest tumors caught in early stages, cancer patients today often face a complicated course of treatment that reflects a highly sophisticated understanding of the mysterious disease--and requires greater resources and expertise, often referred to as a “team approach.” The team approach is considered useful in some of the most far-reaching advances in cancer treatment in the past decade. These include:
DEFINITION: Patients receive a combination of drugs designed to attack the cancer from several fronts and overcome the overwhelming problem of cells becoming resistant to one type of drug.
EXAMPLE: “In breast cancer in particular, poly-chemotherapy has resulted in 10-year disease-free cures in 25% to 30% of patients who, before, would not be around at the 10-year mark,” says Dr. Ezra Greenspan of the Mt. Sinai Medical Center in New York, one of the first physicians to advocate combination chemotherapy.
TREATMENT: High-dose chemotherapy combined with bone marrow transplantation.
DEFINITION: Normally, doctors are unable to give patients sufficiently high doses of chemotherapy because the toxic drugs indiscriminately kill both cancer cells and healthy cells, making patients susceptible to infections. A way of skirting this problem is to first remove a patient’s bone marrow, the tissue that manufactures key components of the blood including cells that fight infection, bring oxygen to the blood and prevent hemorrhaging. The patient is then bombarded with doses of cancer-killing drugs 10 times higher than normally given, plus radiation, before having their marrow or a donor’s marrow reinfused.
EXAMPLE: The treatment was pioneered with leukemia and lymphoma patients and is now being used on patients with advanced breast and testicular cancer. While still considered relatively new, the results so far are promising, says Dr. Stephen J. Forman, director of bone marrow transplantation at the City of Hope National Medical Center in Duarte. “The number of diseases that can be approached in this manner is increasing. For a patient with a disease 20 years ago that was invariably fatal, there are now not only hopeful but very well-established procedures for curing those diseases in a transplant setting.”
TREATMENT: Biological therapies, or biological response modifiers.
DEFINITION: These drugs are laboratory-manufactured copies of substances found naturally in the body in minuscule amounts. Touted in the early 1980s as “magic bullets” that might cure cancer, biological therapies have plunged from that pedestal but are now being applied more modestly and strategically with other treatments to “mop up” after chemotherapy, radiation or surgery.
EXAMPLE: A substance called granulocyte colony stimulating factor (G-CSF) may ease recovery from bone marrow transplantation by helping promote bone marrow regrowth and prevent infection.
TREATMENT: Adjuvant therapy.
DEFINITION: Involves administering chemotherapy or radiation before surgery in order to bring an inoperable tumor down to a size that can be removed surgically, or after surgery to eliminate remaining cancer cells. Adjuvant therapy can also involve combinations of other major treatments, such as radiation combined with chemotherapy.
EXAMPLE: Use of adjuvant therapy has nudged lung cancer survival rates from a dismal 8% in 1980 to 15%, says Dr. E. Carmack Holmes, director of the surgical oncology program at UCLA’s Jonsson Cancer Center. Holmes helped pioneer the technique out of desperation at the distressingly low survival rate of lung cancer patients, whose tumors are often not detected until they are large or have spread. Adjuvant therapy has since become standard for many patients with breast and testicular cancer, sarcomas, and, to some extent, colon and bladder cancer. “It has had a major impact in those cancers in which we have effective chemotherapy,” Holmes says.