Tuesday, September 9, 2008

Cocktail hour

Greg's comment below reminded me of this Wall Street Journal article from last year. It emphasizes childhood tumors, but also features some adult cancer patients who are pursuing a "cocktail" approach to chemotherapy.

Neil Hutchison, 45, isn't a doctor. A defense-contractor recruiter, he's part of a growing underground pushing the edge of medicine to find combinations of anticancer agents to save themselves or loved ones. Many of the medicines Sam takes haven't been tested in clinical trials for his disease. Some are meant for other illnesses; others are still in animal testing for safety and efficacy. But the fact is that Sam, who suffers a rare and often-deadly cancer of the nerves, is otherwise almost certain to die. Hence Mr. Hutchinson's decision, as he puts it, to play "lab rat" with his son.


But Mr. Hutchison is pursuing what many researchers believe is the most promising approach for curing or curbing cancer, which killed about 565,000 people in the U.S. last year. Because cancer seems to eventually overcome most individual therapies, researchers for a decade have advocated using combinations of new, targeted therapies on the theory that the best hope lies in cutting off all known avenues for the cancer to grow.

Trials of such methods have been slow to gain traction. "Everyone knows the future of cancer treatment lies in cancer cocktails," says David Kessler, dean of the school of medicine at the University of California, San Francisco. Dr. Kessler says the Food and Drug Administration needs to undertake an effort similar to one it did when he was commissioner in the 1990s, when it amended the drug-approval process to speed approval of AIDS-drug combinations. "What's missing today is leadership."

1 comment:

Greg Pawelski said...

Instead of "blindly" mixing and matching drugs to individual cancer patients, what would be more beneficial is to sort out what's the best profile in terms of which patients benefit from this drug or any other drug. Can they be combined? What's the proper way to work with these new drugs?

If a drug works extremely well for a certain percentage of cancer patients, identify which ones. If one drug or another is working for some people (not average populations) then obviously there are others out there who would also benefit.

What's good for the group (population) may not be good for the individual, affirms that in the tactic of using "fresh" biopsied cells to predict which cancer treatments will work best for the individual patient, these "smart" drugs have to get inside the cells in order to "target" anything.

If the "targeted" drug either won't "get in" in the first place or if it gets pumped out/extruded or if it gets immediately metabolized inside the cell, it just isn't going to work. Each of these new "targeted" drugs are not for everybody. Even when the disease is the same type, different patients' tumors respond differently to the same agent.

Upgrading clinical therapy by using drug sensitivity assays measuring "cell death" of three dimensional microclusters of live "fresh" tumor cells, can improve the situation by allowing more drugs to be considered. The more drug types there are in the selective arsenal, the more likely the system is to prove beneficial.

Drug sensitivity tests support the idea that a marginal benefit in terms of overall survival is observed in cancer patients with normal prognoses, but there are marked survival benefits for cancer patients with poor prognoses.

Every cancer patient should have his/her own unique chemotherapy based on consultation of pathogenic profiles and drug sensitivity testing data. Having some foreknowledge of a given agent's expected result before its administration would benefit the individual patient.