Researchers Log Advances in Cancer Treatment
Researchers have shown for the first time that chemotherapy can extend the lives of patients with metastatic lung cancer, the leading cancer killer of both men and women in the United States.
The current primary therapy for lung cancer is surgery; only about 25% of patients also receive chemotherapy, most of them during the early stages of the disease. Once the cancer has metastasized, or spread, there has been little that could be done for patients.
The promising results were just one of several advances in cancer therapy reported last week at a New Orleans meeting of the American Society for Clinical Oncology (https://www.asco.org). No major breakthroughs were revealed, but progress was noted in a variety of areas.
“We are still trying to hit a home run,” said Dr. Charles Balch, executive vice president of the society, “but sometimes you hit a double that gets you across the plate. A lot of this is incremental progress.”
Dr. David Gandara and his colleagues at the UC Davis Cancer Center have been treating lung cancer patients with docetaxel, a close relative of the well-known cancer drug Taxol. Docetaxel, trade named Taxotere, is derived from needles of the European yew tree, while Taxol is obtained from the Pacific yew.
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Gandara’s group treated 81 metastatic lung cancer patients, who had already undergone surgery, with radiation and a combination of the drugs cisplatin and etoposide, followed by docetaxel. He reported that 48% of the patients survived for at least two years and that the median survival was 20 months.
“This is a group of patients whose expected survival for two years would be less than 10%,” Gandara said at a news conference. “Nothing in the literature parallels this kind of survival in this group of patients.”
In contrast to the UC Davis study, Dr. Joan Schiller of the University of Wisconsin reported on clinical trials with several combinations of cancer drugs that did not include docetaxel. Her group found that treated lung cancer patients had a median survival of eight months, compared with six months for untreated patients. Just over a third of the treated patients survived for at least a year and 12% lived two years.
The American Cancer Society predicts that 164,000 Americans will be diagnosed with lung cancer this year and 157,000 will die of it.
In other research reported at the meeting:
* Controlling hot flashes: The hot flashes suffered by women following therapy for breast cancer can be eased by two common antidepressants, Prozac and Effexor, according to researchers at the Mayo Clinic in Rochester, Minn.
Physicians hesitate to use estrogen to treat the hot flashes because of the fear it might trigger a cancer recurrence. The antidepressants might also be useful for controlling hot flashes in post-menopausal women and men undergoing hormonal therapy for prostate cancer, said Dr. Charles Loprinzi.
A report last week from Georgetown University had reported similar success with the antidepressant Paxil. All of the drugs were studied in dosages smaller than those used for treating depression.
Loprinzi reported at the New Orleans meeting on a study of 229 breast cancer survivors who were divided into four groups. Three groups each received a different dose of Effexor, while the fourth received a placebo. The best results were obtained in the group receiving half the normal dose of Effexor. Those women reported 61% fewer hot flashes than the control group.
A small number of the women reported side effects that included nausea, dry mouth and decreased appetite. Loprinzi did not report results from the Prozac study. Another group is performing a similar study with the drug Zoloft.
* Therapy for stomach cancer: Researchers from St. Vincent’s Cancer Center in New York City have scored the first improvement in therapy of stomach cancer in more than a decade. An estimated 21,900 Americans will be diagnosed with stomach cancer this year, and 13,500 people will die of it. The disease is commonly treated only by surgical removal of the tumor, because chemotherapy has not previously shown any benefit.
Dr. John S. McDonald and his colleagues studied the use of radiation therapy along with the drugs leukovorin and 5-fluorouracil after surgery. They enrolled 556 stomach cancer patients in the nine-year study. Half of the patients received only surgery, while half received the new regimen.
McDonald reported at the New Orleans meeting that, after three years of treatment, 49% of those receiving the new regimen were disease-free, compared to only 32% of those receiving surgery alone. Overall survival at three years was 52% for those receiving the drugs, compared to 41% receiving surgery alone.
* Use of interferon-alpha: Incremental progress was also achieved in treating kidney cancer, which strikes 31,000 Americans each year and kills 12,000. Chemotherapy and radiation therapy do not work in treating metastatic kidney cancer, but clinicians have had some success boosting patients’ immune systems with a naturally occurring protein called interferon-alpha.
Researchers had previously speculated that the interferon-alpha treatment did not work well because the kidney continues to spew out cancer cells, overwhelming the immune system. A group headed by Dr. Robert C. Flanigan of Loyola University in Maywood, Ill., decided to see if removing the kidney would improve treatment.
The group enrolled 246 patients with metastatic kidney cancer. Half only received interferon-alpha, while the rest had their kidneys removed before receiving the drug.
Flanigan reported at the meeting that patients whose kidneys were removed survived for an average of 12 months, compared to an average of eight months for those receiving only the drug. Researchers are developing new immune agents that should increase survival even more, Flanigan said.
* Thalidomide as treatment: New findings in patients with multiple myeloma indicate that thalidomide--long out of favor with doctors because of the severe birth defects it produced when given to pregnant women--may be a valuable drug in treating cancer. About 14,000 new cases of multiple myeloma are diagnosed each year.
Dr. Bart Barlogie of the University of Arkansas for Medical Sciences in Little Rock administered thalidomide to 169 patients who had received a bone marrow transplant but were not responding to treatment with other anti-cancer drugs. After 18 months, the overall survival rate was 55% and disease-free survival was 30%, he reported at the American Society for Clinical Oncology meeting.
The study did not have a control group, Barlogie said, but “an educated guess” is that most patients would have died within six months without thalidomide.
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Times wire services contributed to this report. Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.
