Tempering hope on cancer research


LOS ANGELES -- For doctors who treat cancer there are some moments that cause great pain: When you first break the news to patients that they have cancer that cannot be cured and, as during the past several days, telling patients that reports of exciting laboratory research in cancer treatment will not help them.

Right now, millions of families are struggling through the emotional roller coaster that follows the cancer diagnosis of a loved one. They have jumped at the recent news of an innovative experimental drug therapy for cancer. Unfortunately, there is a fine line between hyperbole and responsibility when it comes to reporting on a scientific discovery.

City of Hope, a cancer treatment and research center near Los Angeles where I work, received many calls from anxious patients. "Should we stop taking our current treatments? Should we wait for this new therapy with endostatin and angiostatin which is reported to eradicate tumors in mice?"

In this situation, doctors have the task of bringing patients back to the reality of the moment. This new treatment approach is not ready to be dispensed to anyone. And it may never be.

Yet, the prospect of a non-toxic way to control tumor growth is wonderful. Yes, the results in animals look promising. But the road from research in mice to men and women fighting cancer is a long one, indeed.

Star researcher

For almost 30 years, we have known about the concept of developing anticancer agents that block the growth of blood vessels to tumors. Dr. Judah Folkman, the Harvard researcher credited in the latest media reports, is a pioneer in attempting to realize the potential of this approach. His most recent success with two inhibitors of tumor blood vessel growth was first reported in November 1997 and the production of these molecules for human trials is now under way.

There are also other molecules directed at blocking tumor blood vessel growth that look promising in mice. Human trials of these agents are already underway at many research centers. But we know that when mice are implanted with tumors for test purposes, their reactions to treatments can be quite different from humans with tumors that are spontaneous.

We remember well other "breakthroughs" in cancer treatment. In the 1970s interferon raised the public's expectations that a magic bullet had been found to combat cancer. Further testing showed interferon to be effective on some cancers, but not on all, and not all the time.

Human trials for endostatin and angiostatin are most likely a year or so away. For one thing, these two agents need to be manufactured in the quantity and quality needed for trials evaluating safety and efficacy, let alone for general cancer treatment. Clinical trials are essential to answer a number of important questions. The most obvious: Will the treatment work in humans? If it does, what is the correct dose and what are the side effects? If these drugs affect blood vessel development in human tumors, what is their impact elsewhere in the body?

As frustrating as the deliberate process of moving from laboratory research to saving human lives can be, we should not underestimate the progress made so far. We now understand the mechanisms underlying the causes of cancer. This knowledge is enabling us to rationally develop treatments that are more effective and less toxic to the patient.

When cancer is diagnosed at an early, localized stage, treatments of surgery and radiation are frequently prescribed and can offer significant cure rates. That's the key reason why early detection remains a critical strategy for decreasing cancer mortality.

When cancer has spread, it can be another matter. It is much harder to identify and target all the cancer sites that may exist in the body.

That is why the latest news is intriguing and potentially very important. If we find an agent that selectively blocks the blood supply to tumors, we can expect to control cancers that have migrated to different parts of the body.

There is excitement in cancer research centers around the world because of marked progress in understanding the origins and biology of cancer. We watch Dr. Folkman's work with great expectation, but with some caution, as we concentrate on our own research. We do not know for sure from where the real breakthroughs will come. We do know that scientific miracles are VTC rarely single events. Usually progress is made by a series of steps along an erratic path to major advances in treatment.

At City of Hope, research goes on side by side with the treatment of thousands of patients each year. We know, first hand, the gap between a front-page story about a promising new treatment and the unrealistic expectation it may create for people grasping for effective treatment now.

Understandably, journalists are driven to report developments immediately that might affect life or death prospects for their audiences.

False hopes

It is up to doctors to translate the news of the day to patients who sense that their time may be running out and that they may miss out on a possible new cure for cancer. To minimize heartbreak, it is critical for the media and the medical community to communicate to the public the remarkable progress occurring in cancer research without raising false hope for today's patients.

John Kovach is director of the Comprehensive Cancer Center at City of Hope National Medical Center outside Los Angeles. He can reached by e-mail at sphillipmtplink.coh.org.

Pub Date: 5/14/98

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