i watched charlie rose last night, who did a special inspired by the fortune magazine issue titled “why we’re losing the war on cancer (and how to win it)”. i’ve had the magazine sitting around for the last week or so (got the subscription by trading miles) and i intend to read it on the way into the city.
it was an interesting panel. the head of memorial sloan kettering, and the head of the national cancer institute on the side of the cancer treatment establishment. clifton leaf, author of the fortune article and andy grove, chairman of intel. both men are cancer survivors.
andy grove spoke very passionately about the need to dismantle the established framework for fighting cancer, and rebuild it with a completely new structure. with an emphasis on early detection and prevention, rather than palliative care directed at measurable goals such as shrinking the size of tumors in end-stage patients. the establishment doctors were very uncomfortable and defensive.
my father died of colon cancer. had his condition been discovered a year earlier, there is a very high likelihood that he would still be alive. yet the vast majority of resources in cancer research are directed at caring for people who are dying anyhow. to this day i question the value of this pursuit, because the buying of time in cancer patients, with few exceptions, involves the three fairly barbaric treatments that have been used for decades: slash, burn, and poison. (scalpel, radiation, chemotherapy).
prevention is a tricky one. tobacco is the most widely known carcinogen, yet i have many friends, and a brother, who continue to disregard the direct connection between this activity and one of the most excruciatingly painful and debilitating forms of disease and death. even i make a calculation of risk before sneaking a smoke, and then dismiss it as statistically insignificant. booze moved quietly onto the list of known carcinogens several years ago, yet you don’t really think of it when you enjoy your cocktail. yet if we see a pregnant woman with a “strong” island ice tea, our reaction is one of horror and alarm. hmmmm.
early detection and biomarkers are where resources need to be funneled. andy grove is right. but the money seems to go towards developing expensive, last-ditch treatments for desperate, dying people willing to spend any amount of money to stay alive.
ok, now i have to go to work.
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6 responses to “cancer”
Doesn’t cranberry juice fight cancer?
Vodka cran = a long lifehmmmm does that mean 10(Vodka cran) = 10(a long life) ? i may have been a little premature in my decision to stop drinking!
The Associated Press reported that Cancer is the Top Killer for Those Under 85. There has been no real progress in the treatment of most common forms of cancer. Recent NCI data showed that U.S. cancer mortality rates have increased and age-adjusted cancer mortality rates in response to treatment have not improved in several decades, despite the introduction of many new drugs. There is a mind-set of cancer culture that pushes tens of thousands of physicians and scientists toward the goal of finding the tiniest improvements in treatment rather than genuine breakthroughs, that rewards academic achievement and publication over all else. Tumor shrinkage should not be the criteria for approving cancer drugs.
The January 10, 2002 issue of the New England Journal of Medicine noted that 20 years of clinical trials yielded survival improvement of only 2 months for patients with advanced lung cancer. It also pointed out that oncologists at a single institution may obtain a 40-50% response rate (not cure) in a tightly controlled study, but when these same studies are administered in a real world setting, the response rates (not cure rates) decline to only 17-27%.
In the March 15, 2004 issue of the Journal of Clinical Oncology, an editorial stated that a review of all the large, prospective, randomized trials published comparing the newer taxane-based regimens, none of these regimens have increased either complete response rates or overall survival, with median survivals remaining at two years or less. This is precisely the same results which were being obtained 30 years ago.
The results of nearly 30 years of clinical investigation in the treatment of patients with cancer, neither standard or high-dose regimens had done a great deal to improve the outcome of patients. For over the past 20 years, they relentlessly combined chemical agents in various regimens with ever-increasing dose intensity and the survival for patients is exactly the same, less than two years. Not a hint of significantly improved survival.
In the March 22, 2004 issue of Fortune, an extensive expose of why there has been no progress in drug treatment of cancer in three decades, the author writes that it is not localized tumors that kill people with cancer, it is the process of metastasis, 90% of the time. Aggressive cells spreading to the bones, liver, lungs, brain or other vital areas, that are wreaking havoc. You’d think cancer researchers would be bearing down on the intricate mechanisms of invasion and spread? However, according to a Fortune examination of NCI grants going back to 1972, less than 0.5% of study proposals focused primarily on metastasis, trying to understand its role in cancer or just the process itself. Of nearly 8,900 NCI grant proposals awarded in 2003, 92% didn’t even mention the word metastasis.
So pharmaceutical companies don’t concentrate on solving the problem of metastasis (the thing that really kills people); they focus on devising drugs that shrink tumors (the thing that doesn’t). There is a national problem in the way we treat the problem. It is time to set aside empiric “one-size-fits-all” treatment of cancer for “individualized” treatment based on testing the individual properties of each patient’s cancer.
2.03 am elsewhere on this blog, with cancer in the news today, gdpawel added some interesting information to my original post from a year ago. […]
Peruse the article:
Neil Love, M.D. reports in a survey of breast cancer oncologists based in academic medical centers and community based, private practice oncologists. The academic center-based oncologists do not derive personal profit from the administration of infusion chemotherapy, the community-based oncologists do derive personal profit from infusion chemotherapy, while deriving no profit from prescribing oral-dosed chemotherapy.
The results of the survey show that for first line chemotherapy of metastatic breast cancer, 84-88% of the academic center-based oncologists prescribed an oral dose drug (capecitabine), while only 13% perscribed infusion drugs, and none of them prescribed the expensive, highly remunerative drug docetaxel.
In contrast, among the community-based oncologists, only 18% prescribed the oral dose drug (capecitabine), while 75% prescribed infusion drugs, and 29% prescribed the expensive, highly remunerative drug docetaxel. The existence of this profit motive in drug selection has been one of the major factors working against the individualization of cancer chemotherapy based on testing the cancer biology.
This is not to imply that the academic center-based oncologists are without their fair share of collective guilt. They were misguided in not recognizing that they were trying to mate notoriously heterogeneous diseases into one-size-fits-all treatments. They devoted 100% of their clinical trials resources into trying to identify the best treatment for the average patient, in the face of evidence that this approach was non-productive. However, such unsuccessful experiments will never be viewed as such by the thousands of people whose careers are supported by these experiments.
Henderson, et al, entered 3,100 breast cancer patients in a prospective, randomized study to compare cyclophosphamide/doxorubicin alone versus cyclophosphamide/doxorubicin plus Taxol (in the adjuvant, pre-metastatic setting). The results were microscopically positive, at best, and cannot begin to justify the enormous financial and human resources expended (while making no effort at all to test and improve methods to individualize treatment).
But these results changed the face of the adjuvant chemotherapy of breast cancer. Cyclophosphamide+Doxorubicin+Taxol became standard of care. Taxol recently went off patent. Now the thrust is to identify on-patent therapy which is microscopically better in clinical trials of one-size-fits-all treatment. Already, the community-based oncologists are migrating to Cyclophosphamide+Doxorubicin+Docetaxel (expensive/remunerative) so what was the purpose of doing that 3,100 patient prospective, randomized Henderson study?
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