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JUNE 8, 2004
By Cathy Arnst Baby Steps in the War on Cancer News of new drugs and small but solid gains in survival rates made this year's ASCO conference the most upbeat in years Cancer treatment is on the verge of a revolution, according to attendees at the world's largest cancer conference, going on in New Orleans June 5-8. Clinical trials presented at the American Society of Clinical Oncology's (ASCO) annual meeting revealed that, for the first time, doctors using new treatments or making better use of old ones were able to extend the survival of patients suffering from the big four cancer killers -- lung, colon, breast, and prostate. Significant advances were also reported against types of brain, kidney, and prostate tumors that have long been virtually untreatable. These aren't cures, but medical experts say this meeting is a watershed event in the effort to turn cancer into a chronic, manageable disease that a patient can live with, not die from. ASCO is the premier showcase for clinical-trial results of new drugs, but the past several years have seen as many disappointments as successes. This year, however, it was almost all good news for the next generation of "targeted therapies," which take direct aim at cancer cells with the goal of blocking their out-of-control growth. IN PERSPECTIVE. Avastin and Tarceva, two targeted drugs partly developed by Genentech (DNA ), received the most praise, thanks to their ability to extend survival in patients with colon and lung cancer, respectively. Pfizer's (PFE ) experimental SU11248 was heralded as one of the first drugs to show meaningful effectiveness against deadly kidney cancer. "During the past 15 years, I have conducted many studies for [kidney] cancer, but none of them have shown this degree of activity," says Dr. Robert J. Motzer of Memorial Sloan-Kettering Cancer Center in New York. Even ImClone Systems' (IMCL ) once-controversial Erbitux -- the drug behind the insider-trading scandal that led to the fall of Sam Waksal and Martha Stewart -- nearly doubled survival time in patients with head and neck cancer when combined with radiation. "That data was powerful and very exciting," says Dr. Leonard Saltz, also of Sloan-Kettering. To put the data in perspective, though, the median survival for patients on Erbitux in the head-and-neck trial added up to 54 months, vs. 28 months for those on radiation alone. That's hardly a cure -- and most of the other survival studies showed even smaller gains. In a trial of Aventis' (AVE ) Taxotere in advanced-stage prostate-cancer patients, median survival was advanced to 18 months, just a 2-month gain. Still, the Taxotere study is expected to change the standard of care for this extremely deadly stage of the disease. New York Presbyterian Hospital's Dr. Daniel Petrylak, who headed the study, echoed the views of many doctors at the meeting when he said, "This is a reason for celebration, no question, but we still have a long way to go." Here are some other significant results from this year's meeting: Lung cancer: Oncologists were particularly pleased at the many positive trials, since this is the nation's No. 1 deadly cancer by far. The most significant trial found, for the first time, that chemotherapy given after surgery can improve survival for patients in early stages of the disease. In this trial, which is also expected to change the standard of care, half of 344 patients received a combination of two common chemotherapy drugs after surgery, while the other half were treated by surgery alone. Chemo is rarely used in lung cancer because it hasn't been particularly effective or well-tolerated, but in this case, survival after four years was 71% for the patients on chemo, vs. 51% in the surgery-alone group. A large followup trial by Astra-Zeneca (AZN ) of Iressa, its lung-cancer drug approved in 2003 generated a lot of interest. The company pulled together data on more than 20,000 patients who have taken the drug and found that 31% were still alive one year after starting treatment. The study marks the first time survival data has been available for this drug. Colon cancer: The standard treatment for colon cancer is a brutal combination of chemotherapy drugs that must be given intravenously. But a new study found that Xeloda, an easily tolerated chemotherapy from Roche, showed promise. Taken as a tablet, Xeloda was able to reduce the risk of relapse and death by 13%, vs. the intravenous regimen, and that it had significantly fewer side effects. Brain cancer: Malignant brain tumors are some of the hardest cancers to treat. Most patients die within a year. A new study found that combining Temodar, an oral chemotherapy from Schering-Plough (SGP ), with radiation significantly improved survival: Three times as many patients survived at least two years than did those who received radiation alone. Although that still adds up to a survival rate of only 27%, Dr. Frank Haluska of Massachusetts General Hospital said the study will have "major implications" for treating brain cancer. Prevention: Since it's so hard to treat cancer, oncologists are increasingly interested in preventing it in high-risk populations. In one of the more striking prevention trials, Eli Lilly's (LLY ) Evista reduced the incidence of breast cancer by 66% over eight years in 3,500 postmenopausal women who were taking the drug for the treatment of osteoporosis, its approved use. Also intriguing was a finding that statins, commonly prescribed cholesterol-lowering drugs, reduced the risk of colon cancer by 51% over five years. Though none of these results was the silver bullet most patients would like, they represent one of the most successful ASCO meetings to date. "The giant step at this meeting is the realization that all of the new treatments we've been hearing about for so long are real," says Dr. Robert Mayer, director of gastro-intestinal oncology at Dana-Farber Cancer Center in Boston. "It's a brave new World. Now we have to figure out how to harness all that promise."  Arnst is a senior writer for BusinessWeek in New York Edited by Beth Belton
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