Posted on 01/26/2004 10:09:10 AM PST by GailA
Cancer Trial & Error
Patients test experimental treatments in hopes of achieving longer lives, improved care for others
By Mary Powers Contact January 26, 2004
When Susan Clark's cancer returned late in 2002, doctors warned that current therapy had little to offer.
So Clark and her husband went looking for hope. Two months later they flew to Washington, where Clark underwent treatment as part of a federally funded research study.
Clark, a 51-year-old Memphis attorney, is not alone.
This year roughly 1.3 million American adults will be diagnosed with cancer.
About 4 percent will enroll in a research study, hoping the experimental therapy will translate into a longer life. In return, they help improve care for other patients by helping test strategies for making cancer diagnosis, prevention and treatment better.
It is a system that in less than 40 years helped transform the most common childhood cancer - acute lymphoblastic leukemia - from almost uniformly fatal to a cancer that roughly 80 percent of children survive. Today about 70 percent of young cancer patients are treated as part of a research study.
Although no one is arguing for a comparable level of adult participation, investigators and advocates are pushing for greater adult participation.
"It is reasonable to conclude that increasing the percentage of adults (in clinical trials) would help make progress faster," said Dr. Ted Gansler, program manager for the American Cancer Society's clinical trial matching service.
Nearly a year after Clark's experimental treatment for ocular melanoma that spread to her liver, she remains cancer free and eager to make sure others explore the option.
Similar research efforts are under way to combat other ailments, both common and rare. The National Institutes of Health offers a database of other clinical trials, which can be accessed at http://www.ClinicalTrials.gov.
Patients considering a clinical trial often find a dizzying array of options. "It is a daunting challenge for patients to find that information and work with their doctor to find what is best for them," Gansler said, adding that more than 3,000 cancer trials are under way.
Dr. Donald Gravenor of the Family Cancer Center said that translates into at least five clinical trials nationwide for many common cancers. "Cancer patients probably have more access to clinical trials than ever before," added Dr. Donald K. Strickland, Memphis Cancer Center's medical director for clinical research.
There are so many that the cancer society offers a service to match patients and clinical trials.
The growth is fueled partly by scientific advances in understanding the factors that give rise to cancer. New understanding fuels new strategies to test.
In the last decade pharmaceutical companies also began bypassing their traditional research partners - academic centers and research institutions - and hiring oncologists in private practice to help test new ideas.
Then in 2002, University of Tennessee Health Science Center announced an ambitious plan to upgrade its cancer research and treatment efforts. With the Boston Baskin Cancer Group, a private physicians group, it launched the UT Cancer Institute. Since then it has added 30 clinical trials and a half dozen faculty members, said Dr. Mohammed Jahanzeb, UT hematology-oncology division chief.
It is all good news for patients like Sue Mullins, 51, and Sandra Reid, 52, both of Memphis.
They are volunteers in two of the roughly 200 clinical adult cancer trials under way locally through at least six medical groups.
Mullins, a medical secretary and receptionist, believes she is alive today because she signed up for a federally funded study focused on finding ovarian cancer earlier, when it is easier to cure. Dr. Mark E. Reed of West Clinic is overseeing the study's Mid-South arm.
Mullins already had endured two bouts of breast cancer when she entered the study in the fall. She qualified because her personal and family health history translated into an increased risk for ovarian cancer.
The study offered the monitoring she wanted. "I just wanted to be followed and know what was going on with me. I had enough surprises," she said.
There is no easy, reliable way to detect ovarian cancer. In this study, one question being asked is whether existing diagnostic tests would be more effective if simply combined in a new way.
She said the study led to her Nov. 11 surgery where doctors found a cancer closely related to ovarian cancer. She is undergoing chemotherapy now.
When Reid was diagnosed with ovarian cancer last spring her doctor stressed it wasn't a death sentence.
Anxious to prove him right, Reid joined the UT arm of a National Cancer Institute study. "With traditional treatment 70 to 80 percent of the time it (the cancer) comes back," she said. "That was the reason it was so important to get on this study."
Fifteen Mid-South patients are enrolled in the study comparing standard ovarian-cancer treatment with that treatment plus one of three experimental drugs. There was no sign of the cancer when her treatment ended the day before Thanksgiving. She is scheduled to return in March for another round of tests.
"If it comes back, I'll deal with it. Of course we are hoping it won't," said Reid, the district test coordinator for DeSoto County Schools.
So is Dr. Joseph Santoso, the study's local principal investigator. He directs the UT Cancer Institute division of gynecologic oncology.
The drugs being tested have proven effective against ovarian cancer when it returns. This study asks if using those drugs earlier and in combination with current treatment might reduce the ovarian cancer's stubbornly high mortality rates.
"We think it may benefit the patient, but we do not know. We all have to be very careful not to mislead patients about experimental studies," he said, adding that sometimes new drugs prove effective only to be side lined by unacceptable side effects. "There is no free lunch."
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