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Inhalation Treatment for Lung Cancer Restores Woman's Hope

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http://www.abqjournal.com/health/450263 ... -10-06.htm

By Julie Medina

Journal Staff Writer

Kathryn Eisert was 68 years old and enjoying life after a hysterectomy to treat her endometrial cancer.

She and her husband moved to Santa Fe to be near their daughter. She volunteered at the Georgia O'Keeffe Museum, and she enjoyed spending time with her dogs in the natural surroundings of her mountainside home.

Her endometrial cancer was a thing of the past. So when the coughing started, she didn't even think about mentioning it to the doctors.

Several years later, she was still coughing. Treatments for allergies and asthma did not help. After exhausting other options, her doctor in 2001 recommended the X-ray that found cancer in her lungs.

Eisert's endometrial cancer had spread.

"It was a complete surprise when it came back," she said. "I didn't have any symptoms."

Her oncologist recommended that they wait and watch the tumor. Other doctors told her there was no cure. Nobody offered her any hope to fight the cancer— until she met Dr. Claire Verschraegen at the University of Texas M.D. Anderson Cancer Center in Houston.

Verschraegen was just starting Phase I of a clinical trial to test a cancer inhalation treatment, and Eisert was one of the first to sign up.

"Our original oncologist just thought it was a waste of time to even try it at all," she said. "They were all for just waiting and seeing how much it grows.

"Then, I don't know what they would have done."

Eisert's husband, Gene, said, "We've always decided that we were not going to just wait and see. We are going to do the best treatment with the best people available."

The trial is now in Phase II at the University of New Mexico Cancer Research and Treatment Center in collaboration with the Lovelace Respiratory Research Institute.

The treatment converts Camptothecian, a cancer-fighting medication, into an aerosol form that can be inhaled straight into the lungs.

"The Camptothecian in the lab seemed a very promising class of anti-cancer agent," Verschraegen said. "For the first time, we could really see cure of a single agent in mice transplanted with human tumors."

One of the drug's unique qualities is that it can be given in different ways, not just as a pill or through the blood, Verschraegen said. A derivative was designed for the same kind of nebulizer used for asthma treatments. The machine forces oxygen through a tube to a vial containing the medicine.

The patient breathes through a mouthpiece and inhales the fine droplets of medication, mixed with oxygen, straight into the lungs.

The more the better

Hugh Smyth, a UNM pharmacist who also is working on the study, explained that the typical treatment for cancer is to inject the medication through an IV into the bloodstream. Only a portion ever reaches the lungs.

With inhaled therapy, the medication directly targets the lungs so the chemotherapy is less toxic and causes fewer side effects.

This is one of a handful of trials under way worldwide to find an inhaled medication that can treat cancer.

"Chemotherapy generally works on a dose-dependent basis," Smyth said. "The more you give, the better it works. The limitation for a lot of people is that they can only tolerate a dose that is not quite effective for them."

The first phase of the trial was to determine the highest dose that can be tolerated.

Eisert reached that point one week into the treatments. She developed hiccups and couldn't swallow. She had to stop treatments for a week so her throat could heal. Afterward, the dose was modified, and treatments continued for eight weeks.

The Phase I study showed that inhalation patients could be given 10 percent of the amount of the drug given orally and it would be just as effective with fewer side effects.

"I was a little tired at the end," Eisert said, "but I was still able to function. I was not nauseous."

After the eight weeks of treatment, Eisert's tumor had shrunk to one-third of its size, at which point it could be surgically removed.

Of the 10 patients in the first phase, none had the tumor completely disappear with the inhalation treatment.

The cancers that responded best to treatment were lung cancer and endometrial cancer that had spread.

Easier to carry on

At the end of Phase I, Verschraegen moved from Texas to Albuquerque and brought the studies with her to UNM. Phase II, which began in 2003, was supposed to take three years, but it has been difficult to find patients who qualify.

They must be able to breathe deeply enough so the medicine can reach all parts of the lungs. For endometrial cancer, patients must be in an advanced stage where the cancer has spread.

Two of the six patients who have participated in the Phase II lung cancer study have seen their cancer stabilize. One of four patients with endometrial cancer has responded.

However, each study must have a minimum of nine patients before conclusions can be drawn.

In 2003, after two years of Eisert being cancer free, doctors found another small growth in her right lung that could not be surgically removed.

She began her second round of inhalation treatments. However, the cancer had become resistant to that treatment— it shrunk by only 25 percent.

Eisert switched to a new radiation treatment. That, combined with regular chemotherapy, cleared up the tumor.

In July 2005, doctors found a growth in Eisert's left lung. This time, she was able to have it surgically removed without chemotherapy.

She is currently clear of cancer.

Verschraegen said it is rare to have an endometrial cancer patient with a metastasizing disease still alive years later.

The inhalation approach— compared to other kinds of cancer treatment— made it "easier to carry on with life," Eisert said. "The inhalation treatment doesn't slow you down terribly."

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