| BUSINESSWEEK ONLINE : JUNE 21, 1999 ISSUE | ||||||||
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| BUSINESSWEEK LIFESTYLE
Baffling Advances against Breast Cancer Here's help in sorting out new treatments When faced with a life-threatening illness, it's easy to see your doctor as omnipotent, the one person who knows the best treatment and how to get it. Unfortunately, though, no such surety is available when it comes to breast cancer. Recently reported results of several clinical trials have clouded the picture of an already conflicting set of treatment options. Some of the studies cast doubt on the increasingly popular use of megadoses of chemotherapy accompanied by a bone-marrow transplant. Other tests suggest that women at high risk of contracting breast cancer can take a daily pill that may prevent the disease--but that could increase the risk of other ailments. If that's not baffling enough, patients now have access to dozens of different drugs and drug combinations for chemotherapy. All of this leaves doctors with only one certain piece of advice for the 180,000 U.S. women who will be diagnosed with breast cancer this year: ''A patient must educate herself as much as possible as to her treatment options,'' warns Dr. William Peters, director of the Barbara Ann Karamonos Cancer Institute in Detroit. In a way, the uncertainty is a sign of considerable progress against a disease that strikes one out of nine U.S. women. Some 20 years ago, the main treatment for breast cancer was a radical mastectomy--a painful, disfiguring procedure that removes the breast, chest muscles, and all the lymph nodes. But the rise of powerful patient-advocacy groups and a better understanding of the disease have drawn vast resources to breast-cancer research. Today, patients can choose between a modified mastectomy--removal of the diseased breast and surrounding lymph nodes--or a lumpectomy, where just the tumor and some lymph nodes are excised. After surgery, however, choices become more difficult. Doctors can follow up with radiation, chemotherapy, or both to kill remaining cancer cells. In the past decade, some 12,000 women have also undergone an experimental treatment calling for extremely high doses of chemotherapy that poison the entire body in an effort to kill off any malignant cells. This scorched-earth treatment also destroys bone marrow, so patients must undergo a risky bone-marrow transplant. Their own bone marrow is removed, frozen, and returned following the drug treatment. These painful transplants may actually be unnecessary. Out of five clinical trials reported in May by the American Society of Clinical Oncology (ASCO), investigators in four found no difference in survival rates between patients receiving high-dose chemo with bone marrow transplants and those getting standard doses. The fifth study, done in South Africa, did show significant survival improvement for bone-marrow transplant patients. But the patient sample was small and the timing of the treatment differed from the other four trials. The ASCO report does not mean an end to high-dose chemo, however. For one thing, each of the trials had different follow-up periods, ranging from three to seven years. True, ''based upon these studies, high-dose therapy has not yet been shown to be superior,'' according to Dr. Richard Klausner, director of the National Cancer Institute (NCI), But the operative words there are ''not yet.'' The NCI continues to support high-dose chemo trials on the theory that longer follow-ups and different drug regimes may produce better results. LESS TOXIC. Meanwhile, neither approach appears to be worse or better than the other. Dr. Edward Stadtmauer of the University of Pennsylvania says that standard-dose chemo turns out not to be as ineffectual as many doctors had thought, and high-dose chemo is less toxic than had been feared. Beyond that, oncologists disagree over how best to interpret the studies. The chemotherapy debate may be moot in the near future. Doctors are turning to less toxic remedies, such as Herceptin, Genentech's drug, introduced last year, that dramatically increases the survival rate for the 30% of breast-cancer patients whose tumors overproduce a protein called Her2. Herceptin is being tested in combination with other low-toxicity chemotherapy drugs, such as taxol and tamoxifen, against breast cancers that produce standard amounts of Her2. ''This treatment will establish a new standard of care,'' and could make bone marrow transplants obsolete, predicts Dr. Larry Norton, a breast-cancer specialist at Memorial Sloan-Kettering Cancer Center in New York. There are even drugs that may prevent breast cancer altogether. After analyzing all the studies done on tamoxifen, a 21-year-old estrogen replacement used to treat breast cancer after surgery, ASCO recommended in May that women age 35 and older with a risk of 1.7% or higher of incurring breast cancer should consider taking daily doses. However, tamoxifen is not without its own risks--an increased incidence of endometrial cancer, strokes, and cataracts, for example. And no one can be sure what the long-term implications are of taking a drug when you don't have the disease. A large prevention trial, comparing tamoxifen with a similar drug, raloxifene, is just starting to recruit patients. But it will be years before the results are available. In the meantime, a breast-cancer patient's best course is to learn about all the latest research before choosing her treatment--and then make sure her doctor is just as up to date. By CATHERINE ARNST _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ BACK TO TOP |
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