[MOL] Chemo in Question for Breast Cancer [01068] Medicine On Line

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[MOL] Chemo in Question for Breast Cancer

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

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