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CANCER Clinical trials may give stage-IV patients more time
Cancer tr
BY GEORGE KOVACIK
For as long as I can remember, my grandfather smoked cigars. Unless he was in church, he usually had one lit up. Then one day he developed a cough he couldn’t shake.
He knew something was wrong when he didn’t have the energy to play golf every day — something he did for more than 20 years. Doctors told him he had stage-IV lung cancer, and after a short, painful battle, he passed away.
Stage IV is the most advanced stage of any cancer because it has spread (metastasized) to the bones or other organs. Survival rates, unfortunately, are very low at this stage. Most stage-IV lung cancer patients, for example, do not last a year, while those with kidney cancer may survive for up to five years.
Researchers at The Methodist Hospital are conducting new studies for advanced cancer that may benefit stage-IV patients like my grandfather Ben Russotto. He probably wouldn’t have been cured, but he certainlywould have had a little more time in life if he had been on the right side of a breakthrough in this field.
Researchers are testing the drug EC-145 in studies designed to treat people with stageIV lung cancer; and advanced and recurrent ovarian and endometrial cancer. Made up of components that prevent changes in DNA that may lead to cancer and anticancer drugs that inhibit cancer cell growth, EC-145 targets the tumor and kills cancer cells.
Dr. Shanda Blackmon
rials may give stage-IV patients more time
The drug then quickly filters out through the kidneys, reducing toxicity to the rest of the body. Researchers liken EC-145 to the video game Pac-Man. The drug weaves its way through the body’s maze and chases down cancer cells. Once it finds them, it grabs and eats them, Pac-Man style.
LUNG CANCER
Lung cancer kills more people than any other cancer. The American Cancer Society estimates that in 2006, lung cancer accounted for 13 percent of all new cases in males and 12 percent of the new cancer cases in women. In more than 90 percent of the cases, smoking is responsible.
The lung cancer trial, led by Dr. Shanda Blackmon, a Methodist thoracic surgeon, is testing the effectiveness of EC-145 along with a drug called EC-20. Given to patients before they take an imaging scan, EC-20 causes the tumor to “light up.” Doctors then correlate the picture of the scan with a CT scan that was taken prior to the drug combination to see which part is highlighted and where the tumor is located.
“Conventional chemotherapy circulates throughout the entire body and can cause toxic side effects,” said Blackmon, an assistant professor of surgery at Weill Cornell Medical College. “The hope is that EC-20 will act as a guide for us to direct the EC-145 drug to the tumor and kill just the cancer cells.”
Researchers hope to enroll 20 patients who have failed at least two chemotherapy regimens. “We are trying to design clinical trials that don’t affect the work already being done by oncologists,” Blackmon said. “We are trying to fill gaps and offer other types of therapy to patients who are running out of options and time.”
OVARIAN CANCER
There is no known cause for ovarian cancer and very few cases are caught before it has spread because it is difficult to diagnose early. Many of its symptoms — weight loss, diarrhea and discomfort in the lower abdomen — may be ignored because they resemble other conditions or medical problems.
More than 30 different types of ovarian tumors have been identified, some of which are benign. Normal ovarian cells can begin to grow in an uncontrolled, abnormal manner and produce tumors in one or both ovaries.
The five-year survival rate is more than 90 percent for ovarian cancer patients who are diagnosed early.
More than 20,000 women will be diagnosed this year, and about 15,000 will die. But for the 25 percent of patients who are diagnosed early, the five-year survival rate is more than 90 percent.
Dr. Alan Kaplan, chairman of Methodist’s Department of Obstetrics and Gynecology, along with Methodist principal investigator Dr. Tri Dinh and his fellow researchers were pleased with Phase I of the trial. Patients who took EC-145 exhibited only minimal toxicity. During Phase II, which began recently, the goal is to enroll 40 patients with advanced and recurrent ovarian and endometrial cancer.
“We are encouraged by the early results and are hopeful that we can provide better outcomes for these patients,” said Kaplan, a professor of obstetrics and gynecology at Weill Cornell.
Dr. Robert Amato
KIDNEY CANCER
Kidney cancer is another of the silent cancers. Like pancreatic cancer, patients experience very few, if any, symptoms. The only real sign that something is wrong may be blood in the urine.
In most cases, the tumor is located in the back of the abdomen, making it hard to detect. It can grow quite large before it is discovered, and in more than 30 to 50 percent of patients, the cancer has already spread to other parts of the body.
The disease hits men harder than women and smokers are twice as likely as nonsmokers to contract kidney cancer.
Researchers led by Dr. Robert Amato, medical director of the Genitourinary Oncology Program at Methodist, are examining the effectiveness of an experimental vaccine designed to control the spread of cancer cells in people with stageIV kidney cancer.
The goal of the TroVax Renal Immunotherapy Survival Trial (TRIST) is to determine whether the TroVax vaccine, working in concert with standard kidney cancer treatments (low dose Interleukin 2, Interferon Alpha or Sunitinib), can prolong
the lives of these patients, who are usually given only 11 to 12 months to live at the time of diagnosis.
The experimental vaccine is made up of the virus found in the smallpox vaccine. Researchers have taken the virus and combined it with a gene for the protein called 5T4, which is found on kidney cancer cells. The vaccine is designed to “turn on” the body’s production of antibodies and kill cancer cells in a similar fashion to the way the body fights bacteria or other viruses.
An early result in more than 50 patients has shown that the vaccine has been effective in killing the kidney cancer cells and prolonging the lives of patients. This worldwide study is looking for 700 stage-IV kidney cancer patients over a two-year period. Amato also is conducting a similar trial for prostate cancer.
“Once kidney cancer has spread to the rest of the body, the best we can hope for is to slow the progression of the disease,” he said. “The hope is that the TroVax vaccine will do just that and give these patients a little more time to be with their loved ones.”
The cutting-edge research being conducted at The Methodist Hospital is not only breaking new ground and looking for cures, it also is providing hope to people who just might not have any left.
Rate Per 100,000 Population 100
80
60
5-YEAR SURVIVAL RATES 1996-2003 LUNG, KIDNEY AND OVARIAN CANCERS
OVARIAN KIDNEY LUNG
40
20
ALL STAGES LOCALIZED REGIONAL
Localized: limited to one area within a region Regional: extends to an adjacent area within a region Distant: metastasized Unstaged: undiagnosed
Source: SEER Cancer Statistics Review, National Cancer Institute
DISTANT UNSTAGED
My grandfather had a license plate that read “Let Me Tell You about My Grandchildren.” If he would have been part of one of these trials, who knows — he might still be doing just that.
To find out more about the TRIST study, call 713.441.7949.
