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Aggressive
Bone Cancer Treatment Touted-(AP-07/05/2003)
Confirming
what many cancer specialists have long believed, British researchers have
shown that high-dose chemotherapy and a stem cell transplant together
are far more effective against the bone cancer multiple myeloma than standard
chemo. Patients in the eight-year study who got the more intensive treatment
generally survived a year longer. "A one-year increase in survival in
a study like this is very significant," said Dr. Len Lichtenfeld, spokesman
for the American Cancer Society. "This is much more than we usually see
in cancer studies." In addition, patients getting the more aggressive
treatment were five times more likely to have virtually all traces of
cancer eliminated from their blood. "We have been operating under that
assumption for several years now," said Dr. Arnold Rubin, an oncologist
and professor at Robert Wood Johnson Medical School in New Brunswick,
N.J.
The study "confirms
what we already know to be the most efficacious treatment." Patients and
doctors have come to believe that when it comes to cancer, more aggressive
treatment is better. But earlier studies of high-dose chemotherapy and
stem cell transplants for multiple myeloma were less rigorous and generally
inconclusive.And
in breast cancer and some other cancers, high-dose chemotherapy has been
found no more effective than standard treatment. Moreover, high-dose chemotherapy
can be grueling for patients. The cancer drugs kill healthy cells along
with cancerous ones, causing such side effects as severe nausea and hair
loss. Rubin
said the new study would help doctors sway insurance companies hesitant
to pay for the more aggressive treatment, which can cost up to $150,000,
or about three times as much as standard chemotherapy. In multiple myeloma,
a usually fatal cancer that normally strikes people 60 or older, abnormal
plasma cells multiply uncontrollably inside the bone marrow.
The study, covering
401 patients age 65 or younger from the United Kingdom and New Zealand,
was reported in New England Journal of Medicine. Patients were randomly
assigned to receive either the standard or the aggressive treatment. The
200 getting standard chemotherapy received a combination of four cancer
drugs at different times over a few weeks, then repeated the cycle every
six weeks up to 12 times. The 201 other patients got at least three cycles
of a similar treatment initially, then had their stem cells removed by
having their blood pumped through a machine that filtered out those cells.
They remained hospitalized while getting a very high dose of an intravenous
cancer drug, which would have destroyed their stem cells and the rest
of the blood-forming system in the bone marrow. The stem cells were then
reinfused into the patients' bodies and quickly began making new red,
white and other blood cells.
The median survival
time was 42.3 months for patients receiving standard therapy; that jumped
to 54.1 months for those getting the more intensive treatment. However,
because some patients who were failing on the standard treatment switched
to the more intense one but were still counted as being in the standard
group, the difference may be even more dramatic. "The improvement in survival
is probably greater than one year," Lichtenfeld said. Forty-four percent
of patients in the intensive group saw virtually all traces of cancer
eliminated from their blood, compared with 8 percent in the standard treatment
group. Lead researcher Dr. Tony Child, a professor of clinical hematology
at the General Infirmary in Leeds, England, said that the aggressive approach
proved so effective that it would be nearly impossible to find enough
volunteers to take part in another head-to-head study of the two treatments.
Participants would have to be willing to receive the standard therapy.
[Top]
High-Dose
Chemo in Ewing Sarcoma Patients May Lead to Later Malignancies-(Cancer
Info-26/10/2000)
Children with Ewing
sarcoma family of tumors (ESFT) treated with high-dose combinations of
topoisomerase II inhibitors, alkylators and granulocyte colony-stimulating
factor (G-CSF) will have a greater mean corpuscular volume (MCV) and decreased
platelet counts, possible indicators of an increased risk of developing
myelodysplasia (MDS) or acute myeloid leukemia (AML), according to new
research.
Researchers studied
73 patients with ESFT treated in two separate protocols (48 subjects in
EW87 and 54 in EW92) that used the same chemotherapy drugs but differed
in cumulative dosage, course and use of G-CSF. The follow-up time for
patients was 3.8 years in the EW92 group and 7.9 years in the EW87. Drugs
used were vincristine, dactinomycin, cyclophosphamide, ifosfamide, doxorubicin
and etoposide. Patients in protocol EW92 received higher chemotherapy
doses and G-CSF and moderate or high doses of cyclophosphamide during
continuation therapy.
The investigators
measured MCV and took platelet counts at diagnosis and during follow-up
visits after treatment was finished. Initially, patients in EW92 had greater
MCVs than those in EW87 (95.2 fL vs. 86.3 fL; P < .0001). Differences
in MCV persisted throughout a 40-month period. Eighty-five percent of
patients in the EW92 group had at least one platelet count less than 140,000/mm3,
compared with only 13 percent of the EW87 group. Therapy-related MDS or
AML has not developed in the EW87 patients, while three people in EW92
have developed these diseases. The researchers could not establish a correlation
between the risk of developing MDS or AML and high MCV and low platelet
counts. However, they theorize that intensified chemotherapy damaged stem
cells, creating a genetically unstable clone that underwent additional
mutations leading to the development of MDS or AML.
[Top]
Effort
to save a young girl’s life – (Medivision- 1-15 January)
A 12 year-old girl
from Warangal district in Andhra Pradesh successfully underwent a complicated
surgery involving replacement of the pelvic bone affected by osteosarcoma,
with a titanium implant. The operation was carried out at the Government
Mahatma Gandhi Hospital in Warangal. Mishra Dhatu Nigam Ltd., a defence
unit, arranged for the production of the specialized implant in commercial
pure titanium with acetabular cup and iliac wing, in a record time of
24 hours. Within a week of surgery, the patient could sit and do her routine
works; she was discharged after two months and can now walk with support.
[Top]
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