Begley, Sharon, Newsweek
Byline: Sharon Begley
What treatable tumors can teach us about improving the odds in the deadliest cases.
Given a choice, no one would opt to get cancer. And it's cruelly insensitive to tell patients how fortunate they are to have a particular cancer. Yet there is no question that the 33-year-old man who walked into oncologist George Bosl's office at Memorial Sloan-Kettering Cancer Center in New York in 2001 was lucky. He had testicular cancer.
He was lucky because the vast majority of such men are cured, sometimes with surgery alone, sometimes with radiation or chemotherapy as well. By "cured," we don't mean that a patient has cancer cells scattered throughout his body that will need to be kept in check by a lifetime of chemotherapy. We mean cured: the cancer is gone. Even men whose testicular cancer has metastasized--in the case of Bosl's patient, it had spread to the lungs and abdomen--have at least a 70 percent chance of being rid of their cancer forever, which is what this man has every reason to expect: nine years after testicular surgery, 12 weeks of treatment with the chemotherapy agents cisplatin and etoposide (both of which are decades old, not new miracle drugs), and an operation to remove the metastases in his lungs and abdomen, he remains free of cancer. "No matter how widespread testicular cancer is at the time of diagnosis, a patient has some chance of being cured," says Bosl. "The cure rate for men diagnosed in 2010 will be 90 to 95 percent," and even if a patient relapses twice, which usually means the cancer has returned in a form resistant to treatment, he has a fighting chance.
"Cured" is not a word you hear much from oncologists. Indeed, the hoary phrase "a cure for cancer" now sounds bitterly ironic, since scientists discovered no such thing after President Nixon declared war on the disease in 1971. Metastatic melanoma, lung cancer, pancreatic cancer, and esophageal cancer are often death sentences, with the result that cancer will kill 569,490 people in the United States this year, projects the American Cancer Society. But there is a glimmer of hope in this bleak picture.
Some cancers are curable. Almost 90 percent of children with the most common form of pediatric leukemia will be cured; women whose estrogen-receptor-positive cancer responds to tamoxifen or aromatase inhibitors will often be truly rid of their disease, as will women with HER2-positive breast cancer, which responds to herceptin. Other cancers are treatable, in the sense that although patients have to take drugs for the rest of their lives (as diabetics must take insulin forever), at least they're alive and healthy. The best example of a treatable cancer is CML (chronic myelogenous leukemia), which can be held in check by Gleevec and related drugs. And now, says Bosl, cancer researchers are asking, "Can we use information about what makes some cancers curable to design treatments for the others?" The answer is an emphatic yes, says his Sloan-Kettering colleague Charles Sawyers, whose research was instrumental in developing Gleevec: "I feel like I've seen the future."
Pediatric oncologists saw it first. Although the search for a cancer cure has long centered on discovering new drugs, astonishing advances in pediatric leukemia have come with drugs that were developed from the 1950s to the 1970s. In the 1960s, the cure rate for ALL (acute lymphoblastic leukemia, the most common childhood form) was 5 percent, says oncologist Ching-Hon Pui of St. Jude Children's Research Hospital in Memphis. The reason it is now 90 percent lies in how those drugs are given and how patients are cared for.
Put simply, the kids are blasted with the highest doses of the most chemotherapy drugs they can stand--steroids and vinca alkaloids, asparaginase and anthracyclines and more. They are almost all treated at academic medical centers that specialize in pediatric cancer, not at community hospitals that set broken bones. …