[OT] TAXOL DOES NOT HELP PREVENT RECURRENCE OF MOST COMMON BREAST CANCERS- PART TWO

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TAXOL DOES NOT HELP PREVENT RECURRENCE OF MOST COMMON BREAST CANCERS- PART TWO

(Last week we began a two-part newsletter on a newly-released study concluding

that the chemotherapy drug Taxol, which is commonly used in the adjuvant

treatment of breast cancer, brings no benefit to the majority of women for whom

it is currently prescribed. We conclude the discussion, with references, this

week.)

" The days of 'one size fits all' therapy for patients with breast cancer are

coming to an end, " said Anne , MD, of Weill Cornell Medical College, who

wrote an editorial accompanying the study in the New England Journal of

Medicine.

" We should have done this [analysis, ed.] a long time ago, " said study

co-author, Berry, MD, of the University of Texas M.D. Cancer

Center, but the tools were lacking and researchers now have the advantage of

longer follow-up of these women. Now, he added, " We can begin to use the biology

of the cancer to decide whether the chemotherapy will work " before subjecting

women to it.

" We want to make sure these data are correct before withholding it [Taxol] from

some patients... the stakes are high, " said the lead researcher, ,

MD, of the University of Michigan. " On the other hand, we don't want to keep a

therapy that doesn't work. "

Should women with HER2-negative and ER-positive cancers reject the use of Taxol?

Probably, according to the current data. Yet, despite this study's surprising

findings, there are indications that many doctors will continue to give Taxol to

most women with breast cancer, according to Gralow, MD, of the University

of Washington School of Medicine. Some doctors fear lawsuits if the cancer

recurs and chemotherapy was withheld. " It's just so much easier to give the

chemotherapy and know you've been super-aggressive. "

Women who have less aggressive types of breast cancer should also realize that

the absolute benefit of chemotherapy in this situation might in any case be

rather small. For instance, take the case of a 50-year-old woman of average

health, who has a 1.1-2.0 centimeter, grade I tumor, and 1-3 positive lymph

nodes. According to adjuvantonline.com, the risk assessment and prognostic tool

used by many oncologists, this woman will typically have an 86.6 percent chance

of being alive 10 years later, even if she does not receive adjuvant

chemotherapy treatment after surgery. Her chance of dying of cancer over this 10

year period is 8.8 percent and her chance of dying of other causes in the same

period is 4.6 percent.

If she takes hormonal therapy alone (typically, tamoxifen or an aromatase

inhibitor) she will improve her chances of being alive at 10 years by 2.7

percent. If she takes adjuvant chemotherapy, such as ACT, she will improve her

chances of being alive by a similar 2.8 percent. But if she takes both hormonal

therapy and chemotherapy then her odds improve by 4.6 percent. In other words,

chemo improves the odds of survival over surgery plus hormonal treatment by just

1.7 percent.

If this woman opted for the older CMF regimen (instead of ACT or one of the

other so-called second or third generation chemotherapy regimens) then her

benefit would be 1.4 percent and the improvement over hormonal treatment alone

would be 0.9 percent. According to adjuvantonline.com, she would thereby lose a

mere 0.8 percent survival benefit. But at least she would avoid the more serious

potential side effects of both Adriamycin and Taxol.

Of course, this is just one scenario out of a large number of possibilities.

Tumors vary in their size, grade, genetic characteristics, degree of

invasiveness, etc. And, yes, there are clearly instances in which aggressive

adjuvant chemotherapy is justifiable. But most of those cases involve HER2

positive and ER negative tumors, where, as we have seen, Taxol (and also

Herceptin) can improve the survival figures and make them closer to those

experienced by women with the more common HER2 negative and ER positive tumors.

In addition, I would call the reader's attention to a pending, as yet

unpublished, study that is still hanging over the heads of oncologists.

According to reputable press reports, scientists affiliated with the BCIRG 006

clinical trial have found that anthracyclines such as Adriamycin (doxorubicin)

also provide no benefit to 92 percent of breast cancer patients (Bazell 2007).

Only 8 percent of all women with breast cancer - those who over-express a

specific gene called Topoll-2 (topoisomerase II alpha) - are said to benefit

from anthracycline-based chemotherapy, since these drugs work by directly

targeting Topoll-2. This paper was fully discussed in a previous newsletter:

http://www.cancerdecisions.com/070107.html

If that is the case, then it appears that Adriamycin - nicknamed " the red death "

by some oncologists - will also need to be eliminated from the adjuvant

treatment of the great majority of women with breast cancer. From the

much-vaunted ACT regimen this would then leave only cyclophosphamide (Cytoxan),

an old and somewhat less toxic drug that was first approved by the Food and Drug

Administration (FDA) in November 1959 - 48 years ago this month! Wouldn't this

be an opportune time for oncologists to step up efforts to individualize the

treatment of all patients - and to seriously examine the use of nontoxic

treatments from the realm of complementary and alternative medicine?

--Ralph W. Moss, Ph.D.

References: Casarella WJ. A patient's viewpoint on a current controversy.

Radiology 2002;224:927

DF, Thor AD, Dressler LG, et al. HER2 and Response to Paclitaxel in

Node-Positive Breast Cancer. N Engl J Med 2007;357:1496-1506.

FDA tabulation of Taxol side effects:

http://www.fda.gov/cder/foi/label/1998/20262s24lbl.pdf

" Red death " attribution is taken from Jerome Groopman's book, How Doctors Think.

Available at:

http://buybox.amazon.com/exec/obidos/redirect?tag=cancerdecisio-20 & link_code=

xsc & creative=23424 & camp=2025 & path=/dt/assoc/tg/aa/xml/assoc/-/0618610030/

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Bazell's report on the problems facing the use of Adriamycin can be found

at:

http://www.nbc11.com/msnbchealth/13470863/detail.html

My book, Questioning Chemotherapy, is available in bookstores or from Amazon:

http://buybox.amazon.com/exec/obidos/redirect?tag=cancerdecisio-20 & link_code=

xsc & creative=23424 & camp=2025 & path=/dt/assoc/tg/aa/xml/assoc/-/188102525X/

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Article URL: http://www.cancerdecisions.com/110407_page.html