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Treating Cancer as a chronic was posted 07/31/2003 01:15 pm by illness-Marj
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Please read this article I am posting below. July 16, 2003 -- Cancer will become a manageable disease within a decade, a cancer expert predicts.

It's not just any expert. The prediction comes from Judah Folkman, MD, director of Surgical Research at Children's Hospital in Boston and professor of both pediatric surgery and cell biology at Harvard Medical School.

Folkman is famous for showing that cancers can't grow unless they make the body create new blood vessels for them. Drugs that stop this process -- known as angiogenesis inhibitors -- literally starve tumors. What has him so excited are two studies that for the first time show that cancer patients do better when treated with drugs of this type.

'As angiogenesis inhibitors in general get better -- gradually as the side effects come down -- we think in five to 10 years you can convert cancer to a chronic illness like heart disease or diabetes,' Folkman told WebMD during a news conference at the annual meeting of the American Association of Cancer Research.

Despite the rosy prediction, Folkman notes that it's going to take doctors a long time to learn how -- and when -- to use these new treatments. Even then, he says, they're going to have to change the way they think about cancer.

'The hardest part is the translation from clinical trials to patients,' he says. 'That is very difficult and takes a long time. The reason doctors call what they do 'practice' is that it takes years and years to learn. Once you have learned these skills, you are not enthusiastic about changing. Imagine how hard it would be to get used to driving on the left side of the road rather than on the right. Changing medical practice is even more difficult than that.'

At the news conference, Folkman introduced two recent clinical studies of different angiogenesis inhibitors.

'You will hear of two new drugs that will set a new standard for medical practice,' he said.

Avastin for Metastatic Colon Cancer

The first is called Avastin by Genentech Inc. A study first reported last month showed that adding Avastin to chemotherapy increases survival in patients with metastatic colon cancer. Lead researcher Herbert Hurwitz, MD, of Duke Comprehensive Cancer Center reported additional data at the AACR meeting.

Most patients who added Avastin to their treatment survived an extra five months. That's far from a cure. But these are people with one of the worst kinds of cancer. Until recently, survival was a matter of only a few months. Even with state-of-the-art treatment, this advanced cancer usually kills in 12-15 months. 'Why get excited over five months extra survival? The fact we saw any meaningful benefit is remarkable, given how complex these cancers are,' Hurwitz said at the news conference. 'And this is a first step we can build upon. ... What is remarkable is that some patients ... can stay on this kind of treatment for a long period of time. We don't yet know what is special about these people.'

Some of the patients who got Avastin developed perforations in their bowels. This was fatal in one case, although other patients got better and were able to resume treatment. The irony, Hurwitz suggests, is that in some cases this dangerous side effect may have been caused by shrinking tumors.

'How relevant this approach is for other settings and other cancers remains to be seen,' Hurwitz cautions. 'These findings make us optimistic. But if it were easy, we'd already be there. It clearly is not going to be a slam dunk for all cancers in all settings.'

SU11248 for Malignant GIST

Malignant GIST sounds awful. It is. GIST is a rare cancer called gastrointestinal stromal tumor. It's a cancer of the tissues that hold the digestive tract together. Patients get huge tumors and need multiple surgeries.

Almost everyone with malignant GIST used to die. Then Gleevec came along. Made by Novartis Pharmaceuticals, the drug disables an enzyme needed by some forms of cancer. It was a godsend to GIST patients, stopping and even shrinking their tumors.

But there's a catch. Gleevec's anti-GIST effects wear off. And then patients are right back where they started. Until now.

A new drug code-named SU11248, invented by SUGEN Inc. and developed by Pfizer Inc., can help. For most patients -- including some who didn't get any help from Gleevec -- it stopped GIST tumors from getting any bigger.

'Tumors were shut off in 73% of patients,' George D. Demetri, MD, of Harvard's Dana-Farber Cancer Institute, said at the AACR news conference.

SU11248 has two effects -- it interrupts a chemical signal cancer cells need for growth. And it's also an angiogenesis inhibitor.

'We now are learning how to use these mixed angiogenesis inhibitors,' Folkman said.


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