[MOL] A new concern [01082] Medicine On Line


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[MOL] A new concern



Marty, thanks for the information. It has been my understanding that
most chemotherapy had side effects other than killing cancer cells. It
is simply a matter weighing the risks against the benefits. You could
not have done otherwise with the information you had then. Any person
who has had a cancer diagnosis and chemotherapy has to be watchful but
not fearful. You have done very well and we are in awe of your
dedication to keeping Barb well. We have all benefited from your
research.  God bless and a big hug to you both, Jeanne

Martin Auslander wrote:
> 
> Good Morning All,
> 
> I just learned this very dreadful and alarming news.  My Barb had 30
> treatments of Platinum based chemotherapy in 3 plus years and now we
> learn that this could lead to secondary cancer...leukemia. Now I learn
> and wonder why we weren't told at the time she was administered. The way
> to keep an eye on symptoms is to do a cbc (complete blood test) each
> month and watch for lowering of platelets and white blood cells. I dont
> believe we can avoid this but maybe nip in the bud if that is the case
> that one would develop this secondary disease as a result of long term
> chemotherapy....as had Barb. Pls say your prayers that this does not
> develop.....G-d willing.
> 
> http://www.pslgroup.com/dg/e133e.htm
> 
> God bless All,
> marty auslander
> 
>     ---------------------------------------------------------------
> 
>  [Table Of Contents Global Edition]
>                                       [Doctor's Guide E-mail Edition, Information]
>            [Departments]
>                                      ----------------------------------------------
>              What's New
>                                         [Doctor's Guide to Medical & Other News]
>             Medical News
>               & Alerts
> 
>             Conferences                     Platinum-Based        DG Quick Survey
>              & Meetings                Chemotherapy For Ovarian
>                                        Cancer Carries Increased     In the past
>                                            Risk Of Leukemia         month, what
>              [Editions]                    ----------------        percentage of
>                                                --------            your patients
>          [Other Editiions]                                          brought you
>                                       WASHINGTON, DC -- Feb. 3,   health-related
>          [Patient's Guide]            1999 -- A report in           information
>                                       tomorrow’s issue of the      they found on
>             [Resources]               New England Journal of      the Internet ?
>                                       Medicine concludes that
>            Other Medical              women who were treated
>              Resources                for ovarian cancer with     0%
>                                       platinum-based              1-5%
>           [Opportunities]             chemotherapy (cisplatin     6-10%
>                                       or carboplatin) have a      11-20%
>              Employment               two to eight times          21-25%
>            Opportunities              greater chance of           More than 25%
>                                       developing leukemia.
>              Partnering
>            Opportunities              Larger doses and longer
>                                       treatments resulted in
>              [Warning]                higher risks of acute        View Results
>                                       and/or myeloid leukemia.
> 
>                                       Although a number of
>                                       small case reports have
>  ----------------------------------   linked platinum-based       Click here for
>                                       chemotherapy regimens to    a free medical
>    [Back to the top of the page]      secondary leukemia, this      newsletter
>                                       is the first large-scale,
>                                       multinational study to
>                                       quantify the risk.
>                                       Platinum compounds have       E-mail this
>                                       served as standard               page
>                                       treatment for ovarian       to a friend or
>                                       cancer for two decades        colleague!
>                                       and are also used to
>                                       treat other cancers,
>                                       including testicular,        To print, use
>                                       bladder, lung,               this version
>                                       endometrial and head and
>                                       neck cancers.
> 
>                                       Because platinum drugs
>                                       are widely used, Lois
>                                       Travis, M.D., Sc.D., of
>                                       the National Cancer
>                                       Institute's division of
>                                       cancer epidemiology and
>                                       genetics in Bethesda,
>                                       MD., and first author of
>                                       the study, said that the
>                                       finding may be important
>                                       for clinicians in other
>                                       therapeutic settings.
>                                       But, she emphasised that
>                                       the risks needed to be
>                                       weighed against the
>                                       substantial benefits of
>                                       the drugs.
> 
>                                       "Before platinum-based
>                                       treatment, only about 40
>                                       percent of patients with
>                                       advanced ovarian cancer
>                                       responded to therapy and
>                                       the median survival was
>                                       one year," said Travis,
>                                       citing recently published
>                                       statistics. "Now with
>                                       platinum therapies, the
>                                       clinical response rate is
>                                       between 60 percent and 70
>                                       percent, with a five-year
>                                       survival of up to 20
>                                       percent to 30 percent.
> 
>                                       “It's clear that the
>                                       significant improvements
>                                       in patient survival far
>                                       outweigh the relatively
>                                       small excess risk of
>                                       secondary leukemia."
> 
>                                       Travis also believes that
>                                       the study may have
>                                       important implications
>                                       for clinicians who are
>                                       considering the optimal
>                                       dose of platinum to treat
>                                       ovarian cancer. The
>                                       researchers were able to
>                                       evaluate the risk of
>                                       leukemia over a wide
>                                       range of platinum doses
>                                       and found a clear
>                                       relationship between risk
>                                       and dose. At cumulative
>                                       doses less than 500 mg,
>                                       women were almost twice
>                                       as likely to develop
>                                       leukemia whereas at doses
>                                       of 1,000 mg or more, the
>                                       risk was between seven to
>                                       eight times greater than
>                                       patients who did not
>                                       receive platinum agents.
> 
>                                       "If these findings are
>                                       confirmed in other
>                                       studies it is very
>                                       important that any
>                                       therapeutic benefit from
>                                       increasing amounts of
>                                       platinum be carefully
>                                       weighed against the
>                                       corresponding risk of
>                                       subsequent leukemia,"
>                                       Travis said.
> 
>                                       The risk of leukemia was
>                                       calculated by following
>                                       over 28,000 women in
>                                       North America
>                                       (Connecticut, Iowa, New
>                                       Jersey and Ontario) and
>                                       Europe (Denmark, Finland
>                                       and Sweden) who were
>                                       diagnosed with ovarian
>                                       cancer between 1980 and
>                                       1993. Leukemia developed
>                                       in 96 women who were then
>                                       matched with 272 control
>                                       patients. Most were
>                                       diagnosed with acute
>                                       myeloid leukemia or
>                                       myelodysplastic syndrome.
>                                       The average time to
>                                       develop leukemia was four
>                                       years. The median
>                                       survival time after
>                                       diagnosis of secondary
>                                       leukemia was only three
>                                       months; most secondary
>                                       leukemias are resistant
>                                       to therapy.
> 
>                                       Based on these
>                                       observations and the drug
>                                       regimens used in their
>                                       study, the authors
>                                       estimated that out of
>                                       10,000 ovarian cancer
>                                       patients treated for six
>                                       months with 500 mg to
>                                       1,000 mg of cisplatin, an
>                                       excess of 21 leukemias
>                                       might be expected to
>                                       occur in the following
>                                       decade. At doses of 1,000
>                                       mg and greater, an excess
>                                       of 71 leukemias might be
>                                       expected.
> 
>                                       Typical therapy for
>                                       advanced ovarian cancer
>                                       during the time frame of
>                                       the study included a
>                                       combination of an
>                                       alkylating agent, usually
>                                       cyclophosphamide and a
>                                       platinum complex, either
>                                       cisplatin or carboplatin.
>                                       Another alkylating agent,
>                                       melphalan, was also used.
>                                       Today, since the approval
>                                       of Taxol (paclitaxel),
>                                       therapy commonly includes
>                                       paclitaxel and platinum.
> 
>                                       Increased risks of
>                                       secondary leukemia have
>                                       been well-documented for
>                                       several other
>                                       chemotherapeutic drugs,
>                                       especially the alkylating
>                                       agents --
>                                       mechlorethamine,
>                                       chorambucil, melphalan
>                                       and busulfan. Because the
>                                       platinum drugs and
>                                       alkylating agents have
>                                       similar mechanisms of
>                                       action in the cell --
>                                       cross-linking strand(s)
>                                       of DNA – the increased
>                                       risks associated with
>                                       platinum-based therapy
>                                       regimens were not
>                                       surprising.
> 
>                                       The researchers in the
>                                       current study also looked
>                                       at the risks of leukemia
>                                       associated with
>                                       melphalan, an alkylating
>                                       agent known to be linked
>                                       to increased risks of
>                                       leukemia and corroborated
>                                       previous findings;
>                                       intravenous melphalan was
>                                       six times more
>                                       leukemogenic than
>                                       platinum. The authors
>                                       pointed out that the
>                                       lower risks of leukemia
>                                       associated with platinum
>                                       compared with melphalan
>                                       should provide
>                                       reassurance to ovarian
>                                       cancer patients and
>                                       clinicians because
>                                       platinum-based
>                                       chemotherapy is currently
>                                       considered optimal
>                                       therapy for most patients
>                                       with advanced disease.
> 
>                                       Another new finding in
>                                       the current study was
>                                       that radiation therapy
>                                       may enhance the risk of
>                                       leukemia associated with
>                                       platinum drugs. The
>                                       researchers recommended
>                                       that additional studies
>                                       be done to investigate
>                                       the possibility that the
>                                       risk of leukemia may be
>                                       heightened when radiation
>                                       is combined with platinum
>                                       to treat patients with
>                                       other cancers, especially
>                                       cancers of the testis,
>                                       bladder, or head and
>                                       neck.
> 
>                                       Related Links: New
>                                       England Journal of
>                                       Medicine
> 
>              [Image]
> 
>       [Image]                                       [Image]
> 
>              [Image]
> 
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