Cancer: Progress But Still Heartbreak

A good friend has just lost his wife, only 37, to cancer. The case is doubly heartbreaking because they had been married just 14 months and each thought they had finally found happiness. Positive stats about cancer declining and becoming more manageable are abstract comfort to the individuals – and their loved ones – for whom cancer is still a death sentence. In fact, my friend probably sees the timing of the latest “good news” as cruel irony – at least I would.

The American Cancer Society, Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Association of Central Cancer Registries just released a report:

More Americans are surviving cancer for five years or more and cancer rates overall are steadily declining, according to the latest annual report on cancer in the United States issued on Thursday.

….Cancer remains the second leading cause of death in the United States behind heart disease. This year 1.368 million Americans will learn they have cancer and 563,700 will die of it.

The “Annual Report to the Nation on the Status of Cancer, 1975-2001” finds that cancer rates dropped 0.5 percent per year from 1991 to 2001, while death rates from all cancers combined dropped 1.1 percent per year from 1993 to 2001.

This is due to better prevention, screening that catches cancer early enough to treat it and better therapies.

Among women, lung cancer rates have been steadily increasing as rates among men fell, because women started smoking later than men did and started quitting later, too.

But the statistics show that between 1975 and 2001 the number of lung cancer cases diagnosed in women fell by 0.2 percent.

….The joint report compares five-year survival rates of cancer patients diagnosed between 1975 and 1979 to those diagnosed between 1995 and 2000.

Ten percent gains in cancer survival rates were seen for men in cancers of the prostate, colon and kidney, and non-Hodgkin lymphoma, melanoma, and leukemia.

Women made 10 percent survival gains in colon, kidney, and breast cancers and non-Hodgkin lymphoma.

But the report found that patients with the most deadly forms such as lung, pancreatic or liver cancers were only a little more likely to survive. [Reuters]

Incidence and death rates of various forms of cancer are here.

The American Society of Clinical Oncology is currently meeting in NYC – the NY Times has a report:

Brett Smith, the father of two young children, was only 26 three years ago when he was found to have advanced melanoma, a deadly skin cancer. Several drugs failed to stop the cancer, while leaving him frail, depleted and ill.

But two years ago, Mr. Smith began taking an experimental pill along with chemotherapy, and his tumors disappeared. He dropped the chemotherapy nearly a year ago but still takes the pill twice a day. And his disease, though it may return one day, is still at bay.

….The pill Mr. Smith takes, known by the awkward code name BAY 43-9006, could reach the market in one to three years. It is one of a new generation of “targeted” therapies that are transforming cancer treatment by attacking the underlying molecular mechanisms of the disease.

Some experts see Mr. Smith’s experience as a harbinger of a future in which cancer, while not cured, will be held in check for years by drugs tolerable enough to take on a continuing basis.

“Cancer will become a chronic disease that we will manage much the same way we manage high blood pressure or diabetes,” said Dr. Andrew C. von Eschenbach, the director of the National Cancer Institute.

Dr. Harold Varmus, president of the Memorial Sloan-Kettering Cancer Center in New York, warns against setting strict timetables that would create “false expectations.” But he agreed that it was now a “reasonable goal to dramatically reduce death from cancer, making it a chronic disease.”

….There have already been some heralded successes with these newer cancer drugs. Gleevec, a Novartis drug, has had striking results in chronic myelogenous leukemia and a rare gastric cancer. Avastin, a recently approved drug from Genentech that blocks the flow of blood to tumors, extended lives of colon cancer patients by about five months in a clinical trial.

The enthusiasm has also spread to the pharmaceutical industry, where cancer, once neglected, has become by some measures the most popular disease target. Biotechnology companies in particular view cancer, a disease caused by genes gone awry, as a good match for their techniques of genetic engineering and molecular biology.

Surveys over the last couple of years by the Pharmaceutical Research and Manufacturers of America found 395 drugs in clinical trials for cancer, compared with 122 for heart disease and stroke combined and 176 for neurological disorders. Another survey of only biotechnology-related drugs in clinical trials found nearly half were for cancer, far more than for any other disease.

….Still, there is a long way to go to make cancer a chronic disease. One of the biggest pieces of news at the conference here is that a targeted drug, Tarceva, extended lives of patients with advanced lung cancer. But when the results are announced, the extension is expected to be only a couple of months.

“If I saw a couple more drugs with the impact Gleevec has had I’d be much more excited,” said Dr. Otis Brawley, an oncologist and professor at Emory University in Atlanta. “I still think the targeted therapies are the right direction to go, but I think it’s important we don’t promise the American people something we don’t have.”

Virtually everyone agrees, too, that any progress will come not only from drugs, but from better means of detecting cancer early, when it is most easily treated, and by preventive steps like getting people to quit smoking.

….Targeted therapies attack molecular mechanisms that spur tumor growth, or even cause the cancer. Cancer arises after a series of genetic mutations remove the normal checks on cell growth.

Ideally, targeted therapies would be tailored to the genetic mechanisms responsible for a particular patient’s tumor. In the future, scientists say, the genes in tumors will be routinely checked when cancer is diagnosed. And cancers will be classified mainly by their genetic characteristics, not by where in the body they arise or how they look under a microscope.

….But BAY 43-9006 has not worked well against melanoma when used by itself. Dr. Flaherty, however, combined it with chemotherapy and found tumors shrank in 7 of the first 14 patients he treated, including Mr. Smith.

But does the drug work better in the patient with the RAF mutation? That is not yet clear, suggesting full understanding of this target is not yet in hand.

Mr. Smith is not troubled by such questions. “I left the science to them,” he said, “and I sit back and enjoy the benefits.”

And I am very happy for him, but there are still hundreds of thousands in the U.S. each year who are less fortunate, and virtually every one of those has people who miss them dearly. Cancer is still a terrible disease.