Chemo revolution: A dramatic new approach to fighting cancer is set to transform survival rates

No one in their right mind would want to take chemotherapy drugs for any longer than the absolute minimum. Or would they?

Traditional chemotherapy is usually gruelling because in poisoning the fast-growing cancer cells it also poisons all the body's other fast-growing cells, such as hair follicles and those lining the stomach. So the tumour shrinks, but your hair falls out and you feel incredibly ill.

That's why everyone wants to undergo chemotherapy for the shortest time possible to get the job done.

As a result, treatment tends to follow a 'boom and bust' pattern - you get chemotherapy for a short while until the cancer has shrunk or gone into remission and then it stops and you hope it doesn't come back. If it does, treatment starts again.

But a new approach to treating cancer involves giving drugs for much longer than usual.

Chemotherapy becomes a kind of everyday maintenance therapy, effectively treating cancer as a chronic disease.

Lung cancer patients, who in general have short survival times, are set to benefit most from this development.
This form of cancer kills more people in Britain than any other - 30,000 a year - and the survival rate is poor. Only 6 per cent of patients are still alive five years after diagnosis.

However, a trial reported last month found that giving lung cancer patients a more targeted drug for longer than usual increased survival times. The scientists running the trial declared it a major breakthrough.

'This will change how we treat cancer,' said Dr Chandra Belani, deputy director of the Penn State Hershey Cancer Institute in the U.S.

What's made this approach possible is the latest generation of cancer drugs, which are more targeted and better tolerated by patients. But is this the most effective strategy?

In the normal pattern of treatment, you may be pleased the chemotherapy has stopped, but it could mean the cancer has a chance to regroup and grow again. Yet giving the drug for longer prevents the cancer from returning for longer.

This is an approach already well established for breast and prostate cancer, says Professor Peter Johnson, chief clinician at Cancer Research UK.

'These patients take drugs to block their sex hormones, which can feed the cancer - oestrogen for women, testosterone for men - and that prolongs survival very effectively.'

But it's only since this new generation of drugs has arrived that other patients have been able to benefit.

'The idea is to turn a cancer into a chronic disease that you live with long-term, such as diabetes or heart disease, rather than a death sentence,' says Professor Johnson.

So, in the same way patients are given statins to ward off a second heart attack, cancer patients can be put on drugs to stave off the disease.

The benefits of this approach were confirmed last month in a trial of the lung cancer drug Alimta, which has just been given a licence by the EU regulators.

The patients involved had already had regular chemotherapy, their tumours had shrunk and normally treatment would have stopped there.

But some were then prescribed Alimta, while other took a placebo. Overall, those on the drug survived for just over 13 months, compared with 101/2 months on the placebo (those who had the type of cancer that responds best to the drug lived on average for 151/2 months).

You might think this is not a massive improvement, but because lung cancer is usually spotted so late, it has one of the worst survival rates. So for these patients, any improvement is clearly welcome.

But it is not just lung cancer patients who are set to benefit from these maintenance regimes.

Until recently, survival rates for patients with two other cancers - the blood cancer multiple myeloma and Non-Hodgkin lymphoma, which affects white blood cells - were fairly poor, too.

If you had been getting old-style stop- start chemotherapy for --multiple myeloma, on average you'd survive for three to four years. Recently, a new drug called Revlimid, which patients can take all the time, has almost doubled that.

'As it isn't nearly as toxic as chemotherapy, most patients can keep taking it,' says Eric Low of the charity Myeloma UK.

One American patient, who only wanted to be known as Kevin, said: 'I've been on it for a year and the only problem has been some fatigue and an upset stomach.'

But as Professor Johnson warns, while these drug regimes can certainly be an improvement on traditional treatments, they are far from free of side effects.

Malcolm Cole, a retired computer journalist, found the side effects much more severe than Kevin.

'When I first went on the drug, I was over the moon,' he says. 'It was by far the best treatment I'd had and put my cancer right into remission.'

Unfortunately, he then suffered several side effects within a few weeks.

'I had tremors in my hand and an epileptic fit that may have been connected,' he says.
Despite this, Malcolm does not regret taking the treatment and is continuing with it despite his experience.

The other drug that is making a difference to blood cancers is Rituxan. Taking a maintenance dose of the drug helped patients with non-Hodgkin lymphoma stay in remission for longer.

Another reason these new drug regimes might be more successful is because they are given only to patients who will benefit.

Targeted chemotherapy drugs are not the only maintenance therapy for cancer. A promising new approach works by getting the body's own defences to keep on doing the job instead.

Known as 'therapeutic' vaccines, they could be the next big thing. One given to patients with lung cancer continuously cut the relapse rate by about 25 per cent and had much milder side-effects.

A big trial of the drug, known as Mage 3, is recruiting patients in Britain. But none of these drugs is a magic bullet.

'Alimta, for instance, offers useful gains for lung cancer patients,' says Professor Johnson. 'But it will need more trials to prove it's a breakthrough.'

And there are concerns that maintenance therapy could be a way for the drug companies to boost sales of their very expensive treatments.

Revlimid, which was approved by NICE - the National Institute for Clinical Excellence - in June, costs as much as £40,000 a year; Rituxan is £18,000 a year.

'Of course the companies want their drugs to be used as early as possible and for as long as possible,' says Dr Lawrence Einhorn, oncologist and Distinguished Professor of Medicine at Indiana University School of Medicine.

Deciding who is going to get these drugs in a way that is fair, open and affordable is going to be almost as big a challenge as developing them in the first place.

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