Tue, Jun 24, 2008 - Page 16 News List

When cancer is no longer a death sentence

Thanks to new treatments and a better understanding of how cancer cells behave, even incurable cancers that have spread throughout the body can often be controlled

By Jane E. Brody  /  NY TIMES NEWS SERVICE , NEW YORK

ILLUSTRATION: NY TIMES NEWS SERVICE

To see Barry Cooper working out at the YMCA in Brooklyn every morning before going to work as a patent lawyer, you would be unlikely to guess that he has cancer. Cooper, 63 and a grandfather of two, is one of a small but growing number of patients for whom once-fatal cancer has become a chronic disease.

Through a better understanding of factors that distinguish cancer cells from normal ones and the development of more specific treatments that capitalize on those differences, cancers that just a decade ago would have been rapidly fatal are now being controlled for years while the patients conduct near-normal lives.

Although these cancers may never be curable, they can often be controlled for long periods by a succession of treatments. When one therapeutic approach no longer works, another one that has come along in the meantime might stop the disease from progressing, at least for a while.

Even patients whose cancers were already metastatic — spread beyond the site of origin — at the time of diagnosis are benefiting from this sequential approach. Others like Cooper have cancers of blood-forming organs that previously had a limited response to available therapies.

“We’re seeing people being periodically treated and living year after year with advanced disease, with cancers that have spread to the lung, liver, brain or bone,” Michael Fisch, director of the general oncology program at the M.D. Anderson Cancer Center in Houston, said in an interview. “In 1997, we wouldn’t have guessed this would be possible.”

In March 2007, Elizabeth Edwards, wife of former presidential hopeful John Edwards, joined this group of chronic cancer patients when she disclosed that the breast cancer she was treated for in 2004 had spread to her bones and, possibly, lungs. Edwards described the disease as “no longer curable but completely treatable” and likened the situation to living with diabetes.

The 'hitchhiker' approach

Speaking generally, Francisco J. Esteva, a breast cancer specialist at the Anderson center, said in an interview: “Our ultimate goal is not to make this a chronic disease, but to keep patients alive long enough until we can find the right treatment for the right patient and cure the disease. Unfortunately, we’re not there yet, but meanwhile we try to keep patients alive with a good quality of life for as long as possible.”

Fisch calls the new therapy for advanced cancer “the hitchhiker model.”

Time is bought by going from point A, the first-line therapy, to point B, the second-line therapy, to point C, the third line of therapy, and so on. The approach can continue indefinitely, as long as new therapies become available and patients remain well enough to withstand the rigors of treatment.

But Fisch noted that adding meaningful years to the lives of patients with advanced cancer depends in part on avoiding the attitude, prevalent among some physicians, that cancer is hopeless after it has metastasized.

In December of 2005, at age 61, Cooper seemed hale and hearty, though he was unusually tired. Then a routine checkup resulted in a shocking diagnosis — chronic myelogenous leukemia, commonly called CML.

“My initial disbelief was followed by varying degrees of anger and denial,” Cooper said. “I found it very difficult to accept my diagnosis.”

His doctor reassured him that he was lucky. His disease, once a gradually progressive killer, was still in a chronic stage and of a type, Philadelphia positive, that could now be controlled by a drug, Gleevec, licensed just a year earlier. And if and when Gleevec, taken daily by mouth, no longer worked or caused intolerable side effects, the doctor told him, other drugs were in the pipeline that could take over.

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