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Click on image for a larger version of this graph.STAFF

Cancer drug development sparks hope

Though a cure is not promised, many new pills are making doctors optimistic about future of battling disease

Web posted May 20, 1998

By Tom Corwin
Staff Writer

As he leaves the laboratory to walk down the long hallway toward his office for an update on a patient with a dangerous brain tumor, neurosurgeon and researcher James Fick is traveling the difficult path of getting breakthroughs in cancer research to patients.

With whirlwind announcements in the past few weeks of a number of promising cancers treatments sprung from the lab, that could be changing, though not soon, said Dr. Fick, of Medical College of Georgia.

``There is a lot of enthusiasm that it is the beginning of a new era of cancer therapy,'' Dr. Fick said. ``But all that being said, it doesn't mean there are cures right around the corner.''

What may be contributing to the sudden rush of announcements is that a process that has worked in the lab is finally producing tangible new treatments, said Dr. William Dynan, chief of gene regulation at the Institute of Molecular Medicine and Genetics at MCG.

``This technology has been around for years (but) it's now being tested in humans,'' Dr. Dynan said. For instance, Herceptin, whose success was announced Sunday, is a genetically engineered antibody that actually seeks out the oncogene, or cancer-causing cell, the first successful test that showed it could stop or slow advanced breast cancer in humans.

Other recent developments centered around anti-angiogenesis drugs, which seek to prevent the uncontrolled growth of blood vessels that tumors feed on and use to expand. The news about two such agents killing tumors in mice, angiostatin and endostatin, caused one drug company's stock to nearly quadruple.

Part of the reason for that may be that one announcement feeds on another, said Elise Gladstone, health specialist at the district office of the American Cancer Society.

``Everybody is striving to demonstrate what these products can do,'' Ms. Gladstone said.

But there may be an even more mercenary motive for the rush of announcements, said Dr. Fathy El Etreby, director of Clinical and Basic Research in the Section of Urology at MCG.

``The driving force behind all of this is really the pharmaceutical companies,'' Dr. Etreby said. ``The economic interest is, I hate to say it, much more important than the benefit of the patient (to the companies).''

Take Tamoxifen, which a long-term national study recently showed was effective in reducing breast cancer by 45 percent. Dr. Etreby's own study pairing Tamoxifen and the French abortion pill RU 486 showed it prevented breast cancer growth in mice. Tamoxifen, already an established cancer treatment, accounts for about $200 million in sales a year, Dr. Etreby said.

``If you produce a more effective drug as compared with Tamoxifen, you've already made at least $100 million a year,'' Dr. Etreby said. Hence, Wall Street's excitement over angiostatin and endostatin, Dr. Etreby said.

But the two drugs still face the same hurdles all drugs face in moving from mice to men, Dr. Fick said. For one thing, the treatment in mice is often too short to tell if the drug is harming normal cells in the body, Dr. Fick said.

``What works like magic in mice can turn out to be extremely toxic in humans,'' Dr. Fick said. ``There are a number of potential therapies for tumors that are very effective in reducing tumor growth and have unacceptable side effects that can contribute to a patient's death.''

And researchers with anti-angiogenesis drugs, which seek to prevent the spread of tumors and hopefully shrink them, face a further quandary -- who becomes the test subject, Dr. Fick said. Do you target tumors that might spread, tumors that have spread, or tumors that are so far contained, with each one presenting difficulties in proving how the drug worked, Dr. Fick said.

Dr. Fick has faced a more difficult problem in his own study, which uses gene therapy to target and hopefully shrink an insidious brain tumor known as glialblastoma multiforme. In order to have a controlled study, patients are assigned at random to the experimental or standard treatment in order to compare the two, and so far, two have been relegated to the standard treatment, Dr. Fick said. It's part of the ``delicate balance'' researchers must take in dealing with patients desperate for a new treatment and a cure.

While not wanting to convey false hopes, the doctor also wants the patient to be aware of new developments and encourage the patient to battle, Dr. Fick said. What may ultimately come from the recent spate of news is an ``explosion'' of clinical trials for patients. And while the hope is always for a cure, what is more likely is a new treatment that can slow or stop the growth of cancer and add years onto a patient's life, Dr. Fick said.

``And that's a great outcome,'' he said.