MEDICINE
Chemo in Question
Higher doses may not
help breast cancer—yet
For a woman, perhaps the only news worse
than "you've got breast cancer" is the diagnosis "and it's spread." Hearing
those words, thousands of women in the last decade have chosen aggressive,
debilitating treatment—ultrahigh doses of chemotherapy, followed by a
bone-marrow transplant . Common sense dictates that chemotherapy at five to 30
times the normal dose should kill more cancer cells and increase survival, but
there's a worrisome lack of supporting research. Results released last week from
five trials did little to quell those concerns. Four of the five studies showed
no significant increase in survival rates after high-dose therapy—discouraging
news to desperate patients.
These results, however, are far from the final verdict. Only one of the
trials released by the American Society for Clinical Oncology compared a
high-dose treatment with a standard-dose regimen, and that study found that
five-year survival rates for the high-dose patients were twice as good . For
ethical reasons, the other four studies all gave control-group patients somewhat
enhanced doses—although less than the transplant patients received. Perhaps as a
result, the largest study found roughly equal survival rates in the two groups.
And both groups had better survival rates than typical patients—a finding that
Dr. William Peters of Detroit's Karmanos Cancer Institute, the study's lead
investigator, says he hopes will encourage more women to enroll in clinical
trials. At this point, he's unwilling to give up on high doses. "We've only done
follow-up for three years," he says. "In another three years, the high-dose
group may show better survival rates."
In the meantime, HMOs do not seem inclined to curtail coverage. "These
findings are not conclusive enough to warrant a change in policy," says
spokesperson Lisa Haines of California's Foundation Health Systems. After all,
the five trials involved only 2,000 women. It took 144 trials and 77,000 women
before doctors decided that chemotherapy improved breast-cancer survival at all.
For now, all we really know is that we need more research.
Anne Underwood
Newsweek, April 26, 1999
