Another Thought on CHEMO etc for BeckyG and all

[Elaine]

We've been talking about a recent article in Fortune magazine that BeckyG brought to our attention concering the lack of progess made to treat, cure and prevent cancer.

I read last week that a recent study showed that 80 per cent of oncs surveyed said they would NOT do chemo if they were DXed with cancer. That is an astouding figure, even taking into consideration that some of them would probably do it if faced with the reality of the DX and not the hypothetical.

So why is most of the dollars spent on research still going towards a treatment that doesn't really offer cure and what it does offer is often so unpleasant that the "providers" of the treatment don't want it???

Interesting to think about, at the least.

Elaine

[kimblanchard]

The myth of medical excellence is alive and well, but the “ war on cancer “ is like the “war on drugs” Research money goes into profitable drugs or advocacy diseases like AIDS.

What can one expect when diagnosed with LC? My experience has been that there is consistent lack of attention and frequent errors when dealing with medical personnel. I had a CAT scan last Wed. ,and had to threaten to jump off the machine to get the operator to check the order and to scan my chest instead of my abdomen and hips. (They gave me a $10 gift card to make up for that error. The hospital apparently has a supply of such cards, because my sister-in –law got one for complaining about a two-hour wait for a thoracentieses I had in Jan.) The onc who ordered last week’s scan went to Florida for this week and his nurses could not find the scan. After a while they did find it, but the onc. covering for my onc. seemed unsure about nodules on the adrenal glands. Now I wait for my onc to come back from vacation and decide if I need another scan and to explain the substernal pain I’ve had for a few weeks, (if I can get to see him). The good news was no visible return of my original tumor yet, if I can trust the result.

Decades of contrived scarcity by the medical establishment has forced an extreme shortage of doctors and caused outrageous costs. Working with government bureaucratic support, they have kept medical schools from expanding to fill the need and allowed drug companies to squeeze the public with absolute monopolies while keeping out new drugs. Our system has taken 'caring for the sick' from a societal routine to an economic grab bag. We pay the most, but survive at about the same rate as the people of China. It is not that so much money is spent, but that shortages are produced to drive up the cost, and people suffer for the sake of greed.

I pity the Boomers, because there is not going to be near enough MDs for them to hope for decent care. Even with the 30% we import, new Doctors cannot keep up with demand, since America has not increased the annual number of MD graduates for twenty years.

Dan

[gpawelski]

When a patient has an infection, doctors often send a sample of infected blood or tissue to a lab where they can grow the bacteria and see which antibiotics are most effective (called Bacterial Culture and Sensitivity Testing). Chemosensitivity testing is an attempt to do something similar for cancer; fresh samples of the patient's tumor from surgery or a biopsy are grown in test tubes and tested with various drugs. Drugs that are most effective in killing the cultured cells are recommended for treatment. It is highly desirable to know what drugs are effective against your particular cancer cells before highly-toxic agents are systemically administered to your body.

One approach to individualizing patient therapy is chemosensitivity testing. Chemosensitivity assay is a laboratory test that determines how effective specific chemotherapy agents are against an individual patient's cancer cells. Often, results are obtained before the patient begins treatment. This kind of testing can assist in individualizing cancer therapy by providing information about the likely response of an individual patient's tumor to proposed therapy. Chemosensitivity testing may have utility at the time of initial therapy, and in instances of severe drug hypersensitivity, failed therapy, recurrent disease, and metastatic disease, by providing assistance in selecting optimal chemotherapy regimens.

All available chemosensitivity assays are able to report drug "resistance" information. Resistance implies that when a patient's cancer cells are exposed to a particular chemotherapy agent in the laboratory, the cancer cells will continue to live and grow. Some chemosensitivity assays also are able to report drug "sensitivity" information. Sensitivity implies that when a patient's cancer cells are treated with a particular chemotherapy agent in the laboratory, that agent will kill the cancer cells or inhibit their proliferation.

The goal of all chemosensitivity tests is to determine the response of a patient's cancer cells to proposed chemotherapy agents. Knowing which chemotherapy agents the patient's cancer cells are resistant to is important. Then, these options can be eliminated, thereby avoiding the toxicity of ineffective agents. In addition, some chemosensitivity assays predict tumor cell sensitivity, or which agent would be most effective. Choosing the most effective agent can help patients to avoid the physical, emotional, and financial costs of failed therapy and experience an increased quality of life.

Fresh samples of the patient's tumor from surgery or a biopsy are grown in test tubes and tested with various drugs. Drugs that are most effective in killing the cultured cells are recommended for treatment. Chemosensitivity testing does have predictive value, especially in predicting what "won't" work. Patients who have been through several chemotherapy regimens and are running out of options might want to consider chemosensitivity testing. It might help you find the best option or save you from fruitless additional treatment. Today, chemosensitivity testing has progressed to the point where it is 85% - 90% effective.

Chemosensitivity testing might help you find the best option, or save you from fruitless additional treatment. Another situation where chemosensitivity testing might make particularly good sense is in rare cancers where there may not be enough experience or previous ideas of which drugs might be most effective.

Finally, there has been a veritable deluge of new approvals of cytotoxic drugs in recent years as the tortuous FDA process has been speeded and liberalized. In many cases a new drug has been approved on the basis of a single very very narrow indication. But these drugs may have many useful applications - and it's going to take years to find out. Chemosensitivity testing offers a way of seeing if any of these new drugs might apply to your specific cancer.

Another Name

Cell Culture Drug Resistance Testing (Chemotherapy Sensitivity and Resistance Assays) refers to laboratory testing of a patient's own cancer cells with drugs that may be used to treat the patient's cancer. A group of lab tests known as human tumor assay systems (HTAS) can aid oncologists in deciding which chemotherapies work best in battling an individual patient's form of cancer. The assay is a lab test performed on a biopsy specimen containing living cancer cells. It's used to determine the sensitivity or resistance of malignant cells to individual chemotherapy agents. Depending on how well the tumor cells respond to each chemotherapy agent, they are rated as sensitive, resistant or intermediate to chemotherapy. The concept is that you are better off using a chemotherapy drug that your tumor reacts to strongly than one your tumor resists.

There have been over 40 publications in peer-reviewed medical literature showing correlations between cell-death assay test results and the results of clinical chemotherapy in more than 2,000 patients. In every single study, patients treated with drugs active in the assays had a higher response rate than the entire group of patients as a whole. In every single study, patients treated with drugs inactive in the assays had lower response rates than the entire group of patients. In every single study, patients treated with active drugs were much more likely to respond than patients treated with inactive drugs, with assay-active drugs being 7 to 9 times more likely to work than assay-inactive drugs. A large number of peer-review publications also reported that patients treated with assay-tested "active" drugs enjoyed significantly longer survival of cancer than patients with assay-tested "negative" drugs.

Listing of "Reputable" Labs USA:

These labs will provide you and your physician with in depth information and research on the testing they provide.

Analytical Biosystems, Inc., Providence, Rhode Island. Ken Blackman, PhD. Solid Tumors Only. 1-800-262-6520

Anticancer, Inc., San Diego, CA. Robert Hoffman, PhD. Solid Tumors Only. 1-619-654-2555

Impath, Inc., New York, NY. David Kern, MD Solid Tumors and Hematologics. 1-800-447-8881

Oncotech, Inc., Irvine, CA. John Fruehauf, MD. Solid Tumors and Hematologics. 1-714-474-9262 / FAX 1-714-474-8147

Sylvester Cancer Institute, Miami, FL. Bernd-Uwe Sevin, MD. Solid Tumors Only. (especially GYN). 1-305-547-6875

Human Tumor Cloning Laboratory, San Antonio, TX. Daniel D. Von Hoff, MD. Solid Tumors Only. 1-210-677-3827

Oncovation LLC, New York, N.Y. Howard Bruckner, M.D. Solid Tumors Only. 1-212-514-2422

Rational Therapeutics Institute, Long Beach, CA. Robert A. Nagourney, MD Solid Tumors and Hematologics. 1-562-989-6455

DiaTech Oncology, Brentwood, TN. Vladimir D. Kravtsov, MD, PhD Medical Director 1-615-294-9033

Weisenthal Cancer Group, Huntington Beach, CA. Larry M. Weisenthal, MD, PhD. Solid Tumors and Hematologics. 1-714-894-0011 / FAX 1-714-893-3659

[Nushka]

Gregory,

Very informative post. Thanks for sharing with us.

Nushka

[gpawelski]

The clinical utility and clinical accuracy of cell culture drug resistance testing (chemosensitivity testing) with cell-death endpoints has now been proven beyond doubt.

Data on it may be reviewed at

http://www.htaj.com/chemosensitivity_an ... esting.wmv (a 27 minute video on .wmv format)

and http://weisenthal.org/faqw.htm

The cost of drugs is enormous. Patients are followed with serial CT scans, MRIs and even Pet Scans, just to see if a tumor is growing or shrinking. Not to mention the hospitalizations for toxicity, bone marrow transfusions, etc. The point is, the cost of ineffective therapy is truly enormous and assay-testing is particulary good at identifying ineffective therapy.

[karen335]

Greg,

Thanks for all the information. Please keep the info coming. It is very much appreciated...

God Bless,

Kren

[kimblanchard]

Gregory,

Great information.

Kim

[Carla]

Well, this seems to make a lot of sense -- so why aren't they doing it more? Too new and radical? Granted, I am no doctor, but seems like if you could figure out in advance what might work and most things don't, why wouldn't you?

[-Cheryl-]

Hey Elaine et al,

Tissue samples of the cancer must be available to send off for the chemo sensitivity testing. If the sample comes from within the lung then the patient is put at a high risk to confirm a diagnosis, much less get a sample of a tumor for chemo sensitivity testing. So, I am all for the testing and it makes perfectly good sense to me to have samples taken early on when all the tests are going on to stage and diagnose a person; or to take a sample of tissue if surgery is planned and adjunctive chemo is needed to mop up any cancer cells possibly still there.

I met wth my onc today, and asked him if he would do chemo if he had was diagnosed with cancer. His response was, "It depends on the cancer and the chemo. I would have done exactly the treatment you have done thus far. Some cancers can be cured with chemo alone, lung cancer is not one of them. Chemo may only buy you a couple of months more. Something will come along. Besides, the oncologist in the poll you speak of haven't had cancer. There opinions would change entirely if the shoe were on the other foot!" Oh, and I also asked him about payment out of pocket for GVAX. He said the vaccine is covered by the trial; although, insurace is expected to pay for tests and bloodwork since it is a gov. trial.

Becky G. had planned on chemo sensitivity testing. I wonder if she had a sample of tumor taken during the bronchoscopy? Didn't this pocedure cause her lung to collapse and compromised her breathing even more? I am still so stunned by her death. I, like many of you, wish I had more answers. I just feel like every doctor failed her, then her own lungs gave out on her. I am so sad for Curtis and baby girl. God please hear our prayers and find a cure for this awful disease.

Cheryl

[gpawelski]

All patients with cancer should be managed on the basis of information provided by chemosensitivity testing (or cell culture drug resistance testing). There is no proven "standard" first line therapy which has been shown to be superior to the many other choices which exist. The same situation exists in the setting of 2nd, 3rd, 4th line therapy. Therapies are equivalent on a population basis, but not on an individual basis.

The testing does require a fresh tumor biopsy or collection of tumor containing pleural fluid. Sometimes this is feasible (at the time of primary or 2nd look surgery or when drawing off fluid or with a laparoscopic biopsy) and sometimes it is not feasible.

Insurance depends on the individual plan -- often it is covered. Medicare typically pays about 1/3 of the (typical) $2,000 cost of extensive testing (costs are indexed to the number of drugs tested, typically a great many drugs can be and should be tested). In general, approximately 70% of payments come from non-patient sources (insurance or hospitals) and the remainder comes from patients. Costs associated with testing should, of course, be balanced against costs of even one cycle of ineffective treatment.

[-Cheryl-]

Gregoery,

Thaks for the info. I feel strongly that it should be done with intial diagnosis. If only more people knew about it. I quickly educated myself on lung cancer 101 after my diagnosis. Most people don't have this information and doctors don't volunteer it. Shockingly, when I was having treatment and would ask people about their diagnosis, few even knew the type of cancer or stage it was in! Chemosensitivity testing should be standard procedure!!!!!!!!!

Cheryl