Antidote: Treating Hodgkins disease and other cancers

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Last month, a 13 year old with Hodgkins disease, one of the most treatment-responsive cancers known, ran away to Mexico and was reported by the news media to be considering alternative treatment. Luckily for him, he ultimately returned home and is now responding to treatment.                                            

This story points up the bad press that treatments for cancer have received. Long considered debilitating poison, successful outcomes are too often downplayed. Fortunately, the newest treatments hold promise for a revolution in cancer care that may well reverse the public relations problem just as they revolutionize the industry.                                                                                                              

The problem with trying to treat cancer has always been that the body does not accept cancer as something foreign. It is hard to target a tumor for destruction if you don't recognize cancer as an invader. So traditional chemotherapies have been based on the idea that cancer is rapidly growing, and to use drugs that inhibit growth. Unfortunately, these drugs may also damage rapidly growing normal cells, leading to side effects and the bad publicity.                                                                                      

But the latest treatments are based on the realization genetic differences that lead to the production of certain abnormal proteins that promote cancer growth. Certain cancers, such as melanoma, are antigenic, meaning they have surface proteins that can be used to trigger our body's immune system in ways that can shrink the cancer.                                

These new treatments are less toxic. Once you convince the body that cancer is foreign, you can then provoke the immune system to fight it.

Here are some of the latest treatments being investigated: Herceptin, a very successful drug already in regular use for breast cancer, is now being studied in stomach cancer. Herceptin targets a protein, (HER2) has now been found in high amounts in 22 percent of patients with stomach cancer. In a study out of Belgium, Herceptin used in stomach cancer patients with high amounts of this abnormal protein lived three months longer than those who weren't treated.

In women with extensive breast cancer, another new option was found to be useful. PARP inhibitors are chemicals which keep cancer from repairing its damaged genes. Breast cancer patients who received this lived twice as long, an average of 9.2 months, even with extensive cancer.

Third, a cancer vaccine has been developed against lymphoma, using the body's own immune cells to fight the cancer, was shown with a small group of patients to keep them in remission for 44 months compared to 31 months for those who didn't receive it.

These studies represent progress. By using tailored treatments that take into account the specifics of a patient's cancer, you may get a better result than the shotgun poisons of chemotherapy. The direction cancer research is taking should be interesting to drug manufacturers, the world of patients, and the news media alike. Looking down the road, it is becoming clear that our entire concept of what cancer is and how best to cure it, is just about to change.

Marc Siegel, MD, is an internist and professor of medicine at New York University and the author of False Alarm: The Truth About the Epidemic of Fear
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