Cancer Care Advances in 2007 Offer Hope
TUESDAY Dec. 18, 2007 -- Advances in breast cancer screening and new treatments for liver, kidney, head and neck and lung cancers are among this year's most important breakthroughs in cancer care, the American Society of Clinical Oncology says in a new report.
However, while treatment is improving the lives of many cancer patients, flat federal funding for research and clinical trials threatens to stall future progress, the report added.
"Overall, this is a very hopeful picture," said Dr. Julie Gralow, director of breast medical oncology at the University of Washington School of Medicine and Fred Hutchinson Cancer Research Center in Seattle, and an executive editor of the report. "We have made advances and there is hope that we will make more advances as we enter this new molecular-targeted treatment era."
But, Gralow added, funding for cancer research has reached a critical point.
"The only way we get new drugs approved, the only way we can study what's better or worse for patients is to do clinical trials," she said. "But where we have really struggled in the past seven years is in reductions in federal money for clinical trials."
Among gains cited by the ASCO report, titled Clinical Cancer Advances 2007: Major Research Advances in Cancer Treatment, Prevention, and Screening, is the first systemic treatment for liver cancer. A large study found that patients who took the targeted therapy sorafenib (Nexavar) for advanced liver cancer lived about 44 percent longer, compared with patients who didn't get the therapy. This is the first effective non-surgical treatment for liver cancer, the report said.
In a similar vein, treating kidney cancer with bevacizumab (Avastin) along with standard treatment nearly doubled patients' progression-free survival.
The report also noted that this year, based on findings from several studies, new guidelines recommend for the first time that MRIs can be effective in screening the 1.4 million U.S. women at high risk for breast cancer. MRIs are still not yet recommended for most women as a breast cancer screening tool, the report added.
Other important news: Two studies this year confirmed that the significant drop in breast cancer rates is linked to fewer menopausal women taking hormone replacement therapy, following the 2002 Women's Health Initiative finding that uncovered the connection.
"It's quite clear in breast cancer that we have had steady reductions in deaths due to breast cancer over the last decade," Gralow said. "We have metastatic patients living longer."
Also, two studies this year showed that the human papillomavirus (HPV), the virus present in almost all cervical cancers, may play a role in head and neck cancers. HPV was found in 72 percent of several types of head and neck cancers and, interestingly, the presence of the virus was linked to better treatment results.
These findings suggest that the new HPV vaccine, which is recommended for 11- and 12-year-old girls to prevent cervical cancer, may prevent head and neck cancers, but more research is needed, the report said.
Also, for the first time, researchers found that "whole brain" radiation therapy, given to patients with advanced small cell lung cancer, reduces the risk of the cancer spreading to the brain by about two-thirds. This treatment was able to double the one-year survival rate, according to the report.
But the report's editors expressed concern that budgets for the U.S. National Institutes of Health and the U.S. National Cancer Institute have not changed in four years. This is the longest period of flat funding for cancer research in U.S. history, the report said.
To address this problem, ASCO is calling for substantial increases in government funding that, at a minimum, would keep pace with inflation in medical care.
"This has really been a decrease in funding, which has had an impact on the number of clinical trials and the number of patients enrolling in trials," Gralow said. "It's really a wrong message."
The report also calls for public and private insurers to cover the costs of patients in clinical trails. Some insurers don't cover clinical trials because they are classified as "experimental." But some states have passed legislation or have agreements that require health plans to pay for routine medical care for patients in clinical trials. The report urges more states to do the same, and for Medicare to continue to cover patients' costs in clinical trials.
Dr. Otis Brawley, chief medical officer at the American Cancer Society, applauds the progress in the fight against cancer, but adds that much remains to be done.
"These are important advances," Brawley said, citing those gains contained in the ASCO report. "But, I admit when I say that, it's a shame in many of those diseases we are talking about prolonging people's lives by months, sometimes weeks. We shouldn't rest on our laurels. We still need to do a lot of work."
Brawley agrees that more money is needed for research. The flat National Institutes of Health budget "is negatively affecting our efforts to try to do better than improving survival by two or three months," he said. "Progress is slower than it could be. You delay findings substantially by not making the investment in clinical trials."
To read the full report, visit the American Society of Clinical Oncology.
Posted: December 2007
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