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Cancer therapy may aid survival

Could prevent 10,000 deaths a year, study says

By Raja Mishra, Globe Staff, 6/3/2003

CHICAGO -- A new lung cancer treatment regimen could prevent up to 10,000 deaths worldwide annually, according to a French study that provides rare positive news for sufferers of the most prolific killer among cancers. 

Two other studies -- one involving a new surgery and the other a low-side-effect drug -- also reported benefits for lung cancer patients, marking a flurry of advances that researchers celebrated yesterday at the American Society of Clinical Oncology conference here.

But the good news was tinged with bad. The life-saving treatment described in the French study -- a combination of surgery, the drug cisplatin, which is produced by Bristol-Myers Squibb under the name Platinol, and several other standard chemotherapies -- could only help a small portion of the world's lung cancer patients. About 1.2 million are expected to die of the disease worldwide this year.

The new surgical procedure, which slightly extends patients' life spans, also kills a small number of patients on the operating table, leaving doctors to wonder whether the procedure is worth the risk.

In addition, the new drug called pemetrexed, which is made by Eli Lilly & Co. under the name Alimta, was found to be less toxic but did not heal patients any better than standard chemotherapy. Nevertheless, lung cancer researchers said the studies represent significant progress for a disease that kills 85 percent of its victims within five years. Dr. Bruce Johnson, a lung cancer specialist at the Dana-Farber Cancer Institute who introduced the three studies, said they ''will change the practice of lung cancer therapy.''

The American Society of Clinical Oncology, host of this high-profile annual conference, put the spotlight on lung cancer research yesterday in part to underscore that lung cancer is unjustly neglected among cancers.

''Breast cancer is an important disease, but lung cancer kills more women,'' said Dr. Kathy S. Albain, a breast and lung cancer specialist at Loyola University's Cardinal Bernardin Cancer Center in Chicago. ''Lung cancer in this country is undertreated.''

The most significant of the studies, which involved researchers from five continents, was a massive 1,867-patient trial that tested surgery followed by treatment with cisplatin plus chemotherapy compared with surgery alone.

Patients who underwent surgery and chemotherapy had a median survival time of 51 months, compared with 44 months for the other patients.

After five years, 45 percent of the surgery-plus-chemo group was alive, compared with 40 percent of the other patients. If the treatment were offered worldwide, about 10,000 deaths would be delayed every year. The study marked a significant advance for a limited group of lung cancer patients that is certain to change the way oncologists treat them, specialists said.

''A 5 percent increase in survival is significant enough to recommend chemotherapy after surgery,'' said Dr. Thierry Le Chevalier of the Institut Gustave Roussy in Villejuif, France, who led the study.

The results for a new surgical approach to treating patients whose lung cancer has spread to surrounding lymph nodes -- about 34,000 Americans are diagnosed annually at this stage -- were more ambiguous.

Chemotherapy plus radiation has been standard treatment, but a Chicago-based team decided to add resection surgery, in which surgeons remove parts of the cancerous organs.

After three years, 38 percent of the surgical patients were alive, compared with 33 percent of the other group. However, 17 of the 392 surgical patients in the trial died shortly after the procedure, mostly due to respiratory complications from the surgery.

Loyola's Albain, who led the study, said the results were positive enough to at least discuss with patients. ''We now have two viable options to offer our patients,'' Albain said.

The third study concerned so-called second-line chemotherapy, the treatment given to patients whose cancers return after initial chemotherapy.

Here, the new drug, pemetrexed, performed no better than the current medication in extending life expectancy beyond eight months. But the test patients on the newer drug had significantly lower rates of infection, fever, and pneumonia, side effects that can lead to hospitalization.

Doctors must carefully weigh the risks and benefits involved and quickly identify patients who might benefit from the new treatments, cancer specialists said.

Dana-Farber's Johnson said, ''I'm going to go home and discuss the results of these studies with my patients.''

Raja Mishra can be reached at rmishra@globe.com.

This story ran on page D1 of the Boston Globe on 6/3/2003.
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