Can cancer keep spreading while on chemotherapy?

MPapailiou

Hi all...
I just wondered if anyone knew the answer to this question: can cancer keep spreading while the patient is on chemotherapy?

I guess that it depends on how good the patient responds to chemo. My mother (64, NSCLC 4 with bone & liver metastasis) is on chemo and seems okay. We have 3 more weeks before running new tests. Could their results be really bad?

Thank you all...
Mandy

mikes · Senior User Joined: 25 Jul 2005 Posts: 158

Mandy,

Unfortunatly, it can. That is why the periodic tests are run.

MPapailiou

Thanks for the responce. I guess I allready knew the answer but I'm seeing her so good - acting and feeling normally and I have this hope (unrealistic, I know) that things will go back to the way they were and that this whole thing is a terrible mistake...
Thanks again...

gdpawel

An article in the May 2005 issue of Oncology News International (Vol. 14, No.5) reports that neoadjuvant chemotheray with paclitaxel (a taxane) causes a massive release of cancer cells into the circulation. Katharina Pachmann, M.D., of Friedrich-Schiller University in Germany said that ironically, paclitaxel produces the greatest degree of tumor shrinkage but also the greatest release of circulating tumor cells.

Dr. Pachmann said that this observaton corresponds with results found in patients, that tumor response does not mean increased survival. In three different paclitaxel-containing regimens, circulating cell numbers massively increased, whereas tumor size decreased. The results indicate that monitoring of circulating tumor cells can contribute to understanding of tumor-blood interactions and may provide a valuable tool for therapy monitoring in solid tumors.

Another study reported in the American Journal of Clinical Oncology (2002;63:6-15) by Christos Kosmas, M.D., of the Medical Onoclogy Unit at Helena-Venizelou Hospital, Greece said that Carcinomatous Meningitis (or Leptomeningeal Carcinomatous) after a major response to front-line taxane-based regimens represents a grave disease manifestation and its incidence appears increased when compared retrospectively to non-taxane-treated patients.

Results of these kinds of studies are coming out slowly and quietly (now that taxol is off-patent) and indicate that taxol-containing regimens didn't prolong survival over other more conventional and less expensive cytotoxic drugs. It may indeed give clinical response (tumor shrinkage, not cure), sometimes impressive, however, these are mostly short-lived and relapses after a response to taxanes are often dramatic.

Even if one or more chemotherapy regimen is identified as being likely to work on a particular cancer, has the science advanced to tell us whether application of the chosen chemotherapy regimen will not cause other changes that also cause cancer to later return and perhaps be even harder to treat? Is it a case of chemotherapy being bad, in cases where it apparently works? Tradiational chemotherapy is mutagenic (changes in form), you might kill off a whole lot of cancer, only to cause a mutation in the remaining cancer, such that the remaining cancer behaves in a more aggressive fashion.

MPapailiou

gdpawel, thank you for your response!
This information is really interesting and has helped me to have more research and answers from my mom's doctors.
They have told us from the very beggining that chemo won't cure her, or extend her life prognosis more than a few months - IF she responds well to it. The chemo could probably help her feel better for a period of time and stop the pain, etc. Till now, it seems to work like that.
I just keep thinking... If I become a cancer patient, now that I know all these, would I choose to go on chemo (if that was the only option in my case), or just "leave" it? And what about all these patients that are told that they have just a few months to live and then they get treatment and chemo and bit all the odds living for many - many years? I don't know... maybe it's all about psychology... Maybe our mind is the most important factor in treating cancer...

gdpawel

MPapailiou, you have asked very thought provoking questions. They are difficult questions to answer. There is a need for changes in our approach to the chemotherapy of the most common forms of adult cancers. The experience in metastatic breast cancer shows that back in the early 70s, the median survival for metastatic breast cancer was just under two years. Today, it is just under two years. Despite scores of prospective randomized trials involving tens of thousands of patients, showing that response rates have gone up, yet the overall survival rates have not improved.

You give more aggressive chemotherapy by utilizing combinations, high dose therapy, etc, in diseases like metastatic breast, lung and ovarian cancer and you increase response rates, but you don't improve overall survival. The true situation is that ineffective, aggressive chemotherapy can diminish not just quality of life but also quantity of life, through organ toxicity, immunosuppression, and inducing genetic mutations. The result is no improvement in the treatment of the most common forms of metastatic cancer over the past 30 years.

You may want to reserve aggressive therapy for those patients who will derive more benefit than harm, while identifying the most promising treatment regimens for everyone. In patients with tumors very resistant to cytotoxic chemotherapy in general, the most promising treatments may include angiogenesis inhibitors, growth factor inhibitors, or more integrative holistic therapy approaches.

A better approach may be not to give more aggressive and toxic and mutagenic and immunosuppressive combinations, but to give targeted single agents, or to give the least toxic and mutagenic "active" combinations. Higher response rates don't necessarily lead to improved clinical outcomes.

The era of empiric, aggressive multi-agent cytotoxic chemotherapy for adult solid tumors should come to an end. We should put much more emphasis on matching the treatment to patient, though the use individualized testing, have more respect for minimal partial response or stable disease, when it can be achieved through the use of the least toxic and mutagenic drug regimens, and reserve the use of higher dose therapy or agressive combination chemotherapy to those fortunate patients with tumor biologies most amenable to attack and total or near-total destruction by these aggressive treatments.

What a cancer patient would like ideally, is to know whether they would benefit from adjuvant chemotherapy. If so, which active drugs have the highest probability of working and are relatively non-toxic in a given patient.

The technologies are there. Gene Expression assays are panels of markers that can predict the likelihood of cancer recurrence in various populations. Chemotherapy Sensitivity and Resistance Assay is a test for drug activity against a tumor. Pharmacogenomic testing is a test to identify patients who are likely to have the most (or least) toxicity.

The question is, is cancer medicine willing to utilize these technologies? Or will they continue to used outdated paradigms of cancer treatment?

zoi · New User Joined: 27 Sep 2005 Posts: 2 Location: Greece

Hi! I am Greek as well. My mom has lung cancer with metastasis in bone and adrenal glands. She is 55 and was diagnosed last March. She is on chemotherspy since April but the tumors do not go away and have also grown a little bit. However last June she fixed the bone matastasis in her leg by using a new method that infuses hard material inside the hole in the bone by a pin. The cancer was gone fom this part but she still hurts when walking.

If this last chemo that she is having now does not work we will proceed to new methods like biological vaccines etc. I do not know your doctor but I would suggests if you haven't done it to contact Mr Georgoulias from the University of Crete.

Good luck!

MPapailiou

Hi Zoi!
Many many thanks for the info! I'll keep what you said in mind. I hope that your mom is doing better.
Mandy

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