Cancer Decisions - Free Newsletter -September 9, 2007

HERE AT THE MOSS REPORTS

Back in April I published a two-part discussion of new research showing that radiation treatment given to women as a follow-up to breast cancer surgery increases the risk of heart damage and subsequent cardiovascular disease. This research was published in the March 7th, 2007 issue of the Journal of the National Cancer Institute (Hooning 2007).

(To read my previous newsletters on this topic, please click or go to:
http://www.cancerdecisions.com/041507.html
http://www.cancerdecisions.com/042207.html )

It is widely assumed that modern radiation delivery procedures have largely eliminated the danger of incidental damage to the heart. The www.breastcancer.org, Web site, for example, issues this soothing reassurance:

"Radiation therapy techniques have changed dramatically....New technology allows doctors to use the lowest dose of radiation possible. They can also more precisely target the radiation to the breast and away from the heart - so the heart receives a minimal amount or none at all."

But within the past month a study published in the Journal of Clinical Oncology has once again raised concerns about the risks of radiation-associated heart damage in women given adjuvant radiation following surgery for early breast cancer.

In this study, researchers found that the risk of cardiac abnormalities, and in particular damage to the left anterior ascending coronary artery, was very significantly raised among women who had received left sided breast irradiation for stage I and II breast cancer (Correa 2007).

CONSTANTLY MONITORING NEW RESEARCH

During my long career in the field of cancer I have witnessed many instances of new research forcing a re-examination of the entrenched therapeutic assumptions of the past. By constantly monitoring the scientific literature I aim to provide my readers with the best possible synopsis of the current state of knowledge in the world of cancer treatment and prevention. My goal, and that of my organization, Cancer Communications, Inc., is to maintain the sort of consistent, reliably objective analytical standard that will allow my readers to make truly informed decisions.

In the past 30 years I have written and published extensively on the subject of cancer and its treatment, and have compiled a comprehensive series of more than 200 individual reports on different cancer diagnoses - The Moss Reports - each one of which examines both the standard treatment options that are likely to be offered for a particular cancer diagnosis, and the possible alternative and complementary approaches that may prove most useful.

If you would like to order a Moss Report for yourself or someone you love, you can do so securely and easily from our Web site, www.cancerdecisions.com, or by calling 1-800-980-1234 (814-238-3367 from outside the US).

I also offer phone consultations to clients who have purchased a Moss Report. A phone consultation can be enormously helpful in drawing up an effective treatment strategy and getting one's options clearly prioritized.

A recent phone consultation client wrote:

"I'm the former editor of a natural health magazine, and so I have some background in researching health problems. But when I was diagnosed with a high-grade nasopharyngeal cancer in 1999, I was nearly overwhelmed by the range of alternative therapies and supplements and conventional treatments I could undertake. I ordered a Moss Report at that time. It proved extremely helpful in allowing me to pinpoint treatments that would best serve me. The report was exhaustive; it carefully examined the most promising conventional and alternative treatments available. Dr. Moss candidly presents both positive and negative aspects of each protocol; he has no axe to grind that I could detect.

"Now eight years later, needing to make adjustments in my program, I have recently had a telephone consult with Dr. Moss. Once again, his insights have been invaluable. We discussed several protocols that appear to be most suitable for me at this time, and he helped me zero in on a plan of action that gives me confidence.

"The first thing that I recommend to any new cancer patient: Order a Moss Report. It will save you time. It will empower you and give you peace of mind. It may even save your life." - BT

To schedule a phone consultation, please call 1-800-980-1234 (814-238-3367 from outside the US) or send an email to Jacquie@cancerdecisions.com.

We look forward to helping you.

CURRENT TOPICS

Also available from our Web site are our Current Topics reports - a series of in-depth reviews of important cancer-related subjects and controversies. Currently available are the following:

On Guard - Gardasil (An in-depth discussion of the anti-cervical cancer vaccine Gardasil)
Do Antioxidants and Chemotherapy Conflict?
Mammography, Biopsy and the Diagnosis of Breast Cancer
Herceptin or Deceptin? (An evaluation of the use of Herceptin in breast cancer)
Avastin: Your Money Or Your Life. (A clear-eyed look at the targeted drug Avastin)
The Politics of Hope: Andrew von Eschenbach and the Decline of the National Cancer Institute
The Mexican Cancer Clinics in the Era of Evidence-Based Medicine

AUDIO NEWSLETTER

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NEW DOUBTS ON SAFETY OF 'TARGETED' DRUGS - PART II

(This week we conclude, with references, the article we began last week on the dangers associated with the class of drugs known as angiogenesis inhibitors.)

One of the most pressing concerns surrounding current angiogenesis inhibitors is the fact that they are associated with an increased risk of thrombosis (blood clots). Why does this happen? UCLA Prof. Luisa Iruela-Arispe's study in the August 24, 2007 issue of Cell throws light on this urgent question.

"I believe the survival function of VEGF signaling is mediated from both outside and inside the cell. When we block it from the inside, the outside signaling cannot compensate. But when we block it from the outside, maybe the inside signaling can compensate. That would explain the lesser side effects found when using drugs such as Avastin, which block the extracellular signaling."

This aspect of angiogenesis inhibitors troubles Iruela-Arispe. Avastin, like most angiogenesis inhibitors, is generally infused systemically (i.e., given via a vein directly into the bloodstream). But Iruela-Arispe, who continues to believe in the therapeutic potential of angiogenesis inhibitors, thinks they could be made safer and more effective if they were delivered in a more tumor-focused way. "There is enough smoke in the sky here to make me feel there may be a fire," she added, ominously.

Personally, I share her concerns. Over the past six years, in this newsletter, I have frequently expressed skepticism about many of the best-publicized 'targeted' drugs. My reluctance to jump on the targeted therapy bandwagon has been based on my reading of the medical literature. Simply put, the current approach, at least with the present generation of anti-angiogenic drugs, is not particularly effective. As to toxicity, while these drugs were initially promoted as non-toxic magic bullets, there is now accumulating evidence of toxicity and sometimes lethal side effects.

The interested reader can find dozens of my articles on targeted therapies by searching for terms such as Avastin, Erbitux and Iressa at my Web site, www.cancerdecisions.com.

Avastin

Since Dr. Iruela-Arispe cited the example of Avastin, let us look briefly at its track record of safety and effectiveness. In February 2004, the US Food and Drug Administration (FDA) approved Avastin (whose scientific name is bevacizumab) for advanced colorectal cancer. On October 11, 2006, FDA further approved the drug for use in combination with carboplatin and paclitaxel, for advanced or recurrent non-small cell lung cancer (NSCLC).

Approval for lung cancer was based on what FDA officials called a "significant improvement in overall survival (OS)" (Cohen 2007). An Eastern Cooperative Oncology Group (ECOG) study showed that in patients who had received no prior chemotherapy, the overall survival was 10.3 months in those receiving conventional chemotherapy vs. 12.3 months in those also receiving Avastin. One little-publicized fact was that women given Avastin showed no survival benefit at all - which will doubtless come as a shock to the families of the many women who have been given the drug nonetheless. Also notice that the test group had received no prior chemotherapy, which makes them more likely to achieve a favorable outcome: those whose disease is progressing despite having previously received chemotherapy start off in a less favorable category.

Meanwhile, about one-quarter of those receiving the combined therapy faced severe or life-threatening adverse events. Patients receiving Avastin had a four times greater chance of pulmonary hemorrhage, for example. They also faced a significantly heightened risk of gastrointestinal perforation and hemorrhage, central nervous system infarction, gastrointestinal perforation, and myocardial infarction.

The most common adverse events in patients receiving Avastin are weakness, pain, headache, hypertension, diarrhea, nausea, vomiting, anorexia, mouth sores (stomatitis), constipation, upper respiratory infection, difficulty breathing (dyspnea), extreme rashes (exfoliative dermatitis), and protein in the urine (proteinurea), according to the FDA (Cohen 2006).

All this for the possibility of two months' increased survival. And this is not to mention the stress engendered by the expense of the drug: Avastin costs approximately $8,800 per month.

The phrase 'targeted therapy' certainly has a nice ring to it. But the fact that these drugs can cause so many devastating adverse effects yet still be called 'targeted' represents a triumph of public relations over science.

--Ralph W. Moss, Ph.D.

References:

Berenson, Alex. A cancer drug shows promise, at a price that many can't pay. New York Times, Feb. 15, 2006.

Cohen MH, Gootenberg J, Keegan P, Pazdur R. FDA drug approval summary: bevacizumab (Avastin) plus Carboplatin and Paclitaxel as first-line treatment of advanced/metastatic recurrent nonsquamous non-small cell lung cancer. Oncologist. 2007;12:713-718.

Cooke, Robert. Dr. Folkman's War: Angiogenesis and the Struggle to Defeat Cancer. New York: Random House, 2001.

Correa CR, Litt HI, Hwang WT, et al. Coronary artery findings after left-sided compared with right-sided radiation treatment for early-stage breast cancer. J Clin Oncol 2007;25(21):3031-7.

Folkman J, Merler E, Abernathy C, Williams G. Isolation of a tumor factor responsible for angiogenesis. J Exp Med. 1971;133:275-88.

Hooning MJ, Botma A, Aleman BM, et al. Long-term risk of cardiovascular disease in 10-year survivors of breast cancer. J Natl Cancer Inst. 2007;99:365-375.+-

Irwin, Kim. Study finds blocking angiogenesis signaling from inside cell may lead to serious health problems. UCLA Press Release, August 23, 2007. Available at:
http://www.eurekalert.org/pub_releases/2007-08/uoc--sfb082207.php

Lee S, Chen TT, Barber CL, et al. Autocrine VEGF signaling is required for vascular homeostasis. Cell. 2007;130:691-703.

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IMPORTANT DISCLAIMER

The news and other items in this newsletter are intended for informational purposes only. Nothing in this newsletter is intended to be a substitute for professional medical advice.