- ORLANDO, FL (AP) -
No one could have been more surprised than the doctors themselves. They
were just hoping to relieve the symptoms of a deadly blood disorder - and
ended up treating the disease itself. In nearly half of the people who
took the experimental drug, the cancer became undetectable.
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- Specialists said Revlimid now looks like a breakthrough
and the first effective treatment for many people with myelodysplastic
syndrome, or MDS, which is even more common than leukemia.
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- ''It may be, if not eradicating the disease, putting
it into what I would call deep remission,'' said Dr. David Johnson, a cancer
specialist at Vanderbilt-Ingram Cancer Center who is familiar with but
had no role in the research.
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- Revlimid ''is not yet on the market but almost certainly
will be'' because of these findings, he said.
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- MDS refers to a group of disorders caused by the bone
marrow not making enough healthy, mature blood cells. About 15,000 to 20,000
new cases are diagnosed each year in the United States, and as many as
50,000 Americans have it now. They usually suffer anemia and fatigue and
need blood transfusions about every eight weeks to stay alive.
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- ''It's a serious problem, it tends to occur in older
people, and it's fatal for most,'' said Dr. Herman Kattlove, a blood disorder
specialist at the American Cancer Society.
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- Revlimid is similar to thalidomide, a drug notorious
for the birth defects it caused decades ago but that in recent years has
proved effective against another blood cancer, multiple myeloma. Researchers
don't really know how it works other than that it boosts the immune system
in a number of ways.
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- In small studies, Revlimid also showed promise and with
far fewer side effects. In a new study, doctors tested it on 115 people
with MDS who have the most common chromosome abnormality that causes the
disease.
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- After about six months on the drug, 66 percent no longer
needed blood transfusions, said the study's leader, Dr. Alan List of the
H. Lee Moffitt Cancer Center in Tampa, Fla. A year later, three-fourths
of them still don't need transfusions.
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- But the big surprise was that signs of the genetic mutation
fueling the disease diminished in 81 patients and vanished in 51.
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- ''The chromosome abnormality completely disappeared,
something we've never seen before'' from a drug aimed just at boosting
red blood cells, List said.
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- Dr. Bruce Johnson of the Dana-Farber Cancer Institute
in Boston compared it with what doctors saw in early tests of the drug
Gleevec on people with chronic myelogenous leukemia several years ago.
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- ''If you extrapolate what they saw, it's one of the signs
for long remission,'' he said of the abnormality's disappearance.
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- Dr. Jasmine Zain, a blood specialist from the City of
Hope Cancer Center in New York, said the results warrant further testing
on the drug.
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- ''Nowhere do you see 60 to 70 percent responses,'' she
said.
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- About one-third of people on the drug had temporary drops
in other blood cells and clotting components, fixed by briefly interrupting
treatment or lowering the dose.
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- The study was sponsored by Celgene Corp., which makes
Revlimid. List is a consultant for the company and reported results Sunday
at a meeting of the American Society of Clinical Oncology in Orlando.
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- In other news at the conference:
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- - A five-year study of cancer care in America concluded
that most people get good care but that quality differs from region to
region.
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- The oncology society commissioned the study by Harvard
University and the RAND Corporation after a 2000 Institute of Medicine
report said that not all Americans were getting good cancer care and that
this seemed to be a substantial problem.
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- Researchers measured more than 100 factors affecting
breast and colon cancer care, such as whether women were appropriately
prescribed tamoxifen and whether radiation doses were correct. They concluded
that 86 percent of people with breast cancer and 78 percent with colon
cancer got good care, higher than what other studies have found for other
diseases.
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- However, ''these numbers range all over the place'' for
the five cities studied - Atlanta, Cleveland, Houston, Kansas City and
Los Angeles - said Dr. Ezekiel Emanuel, a National Institutes of Health
physician who headed the study. (Individual measures for each city were
not released).
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- - Another study found that surgery and follow-up tests
for stomach cancer are inadequate in most U.S. hospitals. Three out of
four patients don't have enough lymph nodes removed to check for cancer,
and this made a big impact on survival rates, said Dr. Natalie Coburn of
Princess Margaret Hospital in Toronto who used a federal cancer database
for her study.
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- Five-year survival was more than twice as high in Hawaii
than in Utah, where surgery was poorest.
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- ''I'm not suggesting you fly from Utah to Hawaii to have
your surgery done,'' but patients need to know the qualifications of their
surgeon, said Dr. David Johnson, who is president of the oncology society.
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- ''If that's true for gastric cancer, we know it's true
for other cancers like lung surgery, breast surgery and the like,'' he
added.
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- Nearly 22,000 new cases of stomach cancer and 11,550
deaths are expected in the United States this year.
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