Testicular Cancer: Stem Cells Combined With High-Dose Chemo After Preferred Treatment Fails
- From: J <nexsw@nvalid,anon>
- Date: Mon, 13 Aug 2007 08:42:21 -0400
<
http://www.webmd.com/cancer/news/20070725/testicular-cancer-second-chance?src=RSS_Basic
Testicular Cancer: A Second Chance
New Treatment Strategy Uses Stem Cells Combined With High-Dose Chemo After
Preferred Treatment Fails
WebMD Medical News
Reviewed by Louise Chang, MD
July 25, 2007 ? When the preferred treatment fails to cure testicular
cancer, a daring new treatment strategy offers hope.
The strategy involves intensive doses of chemotherapy. These doses would
be lethal to blood cells, but researchers rescue patients by giving them
infusions of stem cells isolated from the patients' own blood.
Can such a tricky business really work? Yes, suggests a study by
testicular cancer pioneer Lawrence Einhorn, MD, Rafat Abonour, MD, and
colleagues at Indiana University Cancer Center.
The researchers tested the treatment in 184 consecutive patients with
metastatic testicular cancer that continued to spread despite
state-of-the-art, platinum-based, combination chemotherapy.
Amazingly, 116 of these 184 patients had complete remission of their
cancer without relapse for a median 48 months.
"Over the years we have mastered how to give these drugs -- two
chemotherapy cycles with stem cell support," Abonour tells WebMD. "We have
been able to show we can cure over 65% of these patients. Even among those
not previously considered curable, 25% are cured with our approach."
The technique isn't without risk. The drugs apparently killed three of the
patients; two from liver failure and the other from toxic effects on the
lungs. Three others developed leukemia; two died.
"The toxicity window is very narrow," Manish Kohli, MD, a testicular
cancer expert at the University of Rochester School of Medicine, tells
WebMD. "There were three drug-related deaths in this study -- and that is
in the hands of experts. But this provides hope as an option for patients
who respond poorly to first-line treatment."
Patients undergoing the treatment take drugs that drive stem cells from
the bone marrow to the blood. These cells are harvested and stored. The
patients then undergo high-dose chemotherapy at five times the usual dose,
followed by an infusion of stem cells to replenish their blood cells.
Three or four weeks later, doctors repeat the process.
"We give them the big-dose chemotherapy, the big guns, to get rid of all
the cancer cells. This also kills off the bone marrow, so we replace it by
infusing these healthy cells," Abonour says. "So the patients, instead of
being without normal blood cells for four to six weeks, it is only four to
seven days. You can do it safely that way."
Testicular Cancer 'Eminently Curable'
Kohli, who was not involved in the study, notes that while some 7,200
American men get testicular cancer each year, only 380 die. The overall
cure rate is 90% -- and even when testicular cancer has spread, some 70%
of patients are cured.
"This is an eminently curable cancer, so losing those 380 patients a year
pinches us," Kohli says. "It has been a dilemma how to treat these
patients. They are typically very young men in their late 30s or early
40s. Much life is ahead of them, and we want them to live as long as
possible."
Abonour says that this dilemma is resolved, unless patients have other
conditions that make it impossible for them to tolerate intensive
chemotherapy. He suggests that all testicular cancer patients who fail
preferred treatment are candidates for the new technique.
That's true, agrees Edmund K. Waller, MD, PhD, director of the bone marrow
and transplant center at Emory Winship Cancer Institute in Atlanta.
"The potential to cure patients after they fail standard therapy without
transplant is somewhat limited," Waller tells WebMD. "If they have
second-line therapy that is not curative, the chances for third-line
success is less."
Kohli, Waller, and Abonour say the excellent outcomes seen in the Indiana
study can only be achieved in cancer centers that can field teams of
experts able to provide intensive patient support.
"High-dose chemotherapy with stem cell support is not done in community
hospitals, but typically at a referral center," Waller says.
"Families really should ask the important question: Is the oncology team
familiar with the disease?" Abonour says. "It takes an experienced team to
work together to identify the right patients and the right treatment for
each of them."
The study by Einhorn, Abonour, and colleagues appears in the July 26 issue
of The New England Journal of Medicine.
SOURCES: Einhorn, L.H. The New England Journal of Medicine, July 26, 2007;
vol 357: pp 340-348. Rafat Abonour, MD, associate professor of medicine
and associate dean for clinical research, Indiana University School of
Medicine, Indianapolis. Edmund K. Waller, MD, PhD, director, bone marrow
and transplant center, Emory Winship Cancer Institute, Atlanta. Manish
Kohli, MD, associate professor, University of Rochester School of
Medicine, N.Y.
______________________________________________
The important questions are: Steph's "Questions to Ask"
http://tinyurl.com/4akk6
.
- Prev by Date: Gene therapy and melanoma
- Next by Date: Test May Help Spot Pancreatic Cancer
- Previous by thread: Gene therapy and melanoma
- Next by thread: Test May Help Spot Pancreatic Cancer
- Index(es):
Relevant Pages
|
|
