Checkup

Advances in Cancer Treatments Sow Years of Living

Arlene Dunlop is a breast and ovarian cancer survivor whose treatments have kept her well and out enjoying life.

On a sunny day in April, Arlene Dunlop plants geraniums in her yard in Neptune Beach, Fla. Moving the dirt with her spade and pushing the roots into their new foundation, she revels in the warmth of the sun, the vibrant colors of the blooms and the feel of the breeze in her hair.

After battling cancer for eight years, Dunlop, 75, does not take days like these for granted.

"I'm just so happy to be here," she says. Dunlop was diagnosed with stage II breast cancer in 1997. She underwent a mastectomy and four sessions of chemotherapy combined with tamoxifen, a drug that reduces breast cancer recurrence by blocking estrogen receptors. The treatment was a success, and her cancer went into remission. But in the spring of 1999, a routine follow-up blood test detected something amiss. Subsequent tests determined she had cancer in her ovaries, pelvis and the lymph nodes inside her chest. The cancer most likely had spread either from the original breast cancer or from a separate ovarian cancer. Her therapy was switched from tamoxifen to an aromatase inhibitor, which is considered a more effective hormonal treatment in postmenopausal women with breast cancer.

With no history of either cancer in her family, Dunlop was surprised by the diagnosis. But the number of treatment options she had available to her and the positive outlook she and her oncologist shared carried her through. Now her cancers are in remission, and she is spending as much time as she can in her garden.

Thanks to advances in treatments over the past few years, many cancer patients are getting back to what's important in their lives, too. What used to be a dire diagnosis now is often one of much hope because of the promising drugs and therapies oncologists can offer.

"A diagnosis of a metastatic cancer used to be thought of as equivalent to a death sentence 30 years ago," says Dr. Gerardo Colon-Otero, chair of Hematology/Oncology. "That is not the case any more. We have more treatment options these days. Instead of seeing patients with short survival, more and more are having prolonged survival that includes multiple treatments over time."

Many new drugs are designed to cut cancer off at the source. For example, a drug approved for colorectal cancer blocks the process known as angiogenesis, the growth of new blood vessels. Since tumors need new blood vessels to develop, this agent works by stunting the tumor's growth. Another new drug blocks the lung cancer growth factor. While it doesn't seem to shrink the tumors, Colon says, it slows their development.

"These agents are designed to inhibit a protein involved in the growth of the cancer, targeted to that particular protein," says Colon. "It's sort of like weed killer that just attacks the weeds and doesn't kill the grass."

Scientists also are looking into ways to interfere with the growth signals that are transmitted to the nucleus of cells. The process, called signal transduction, has been disrupted in some forms of leukemia with a new drug. More tests are being done to try to duplicate the disruption for other forms of cancer.

It's not just new medicines, but also proof gathered over time that certain combinations of treatments are successful. Chemotherapy is more effective today and, combined with targeted tumor therapy, often works well on cancers that have recurred. Because there are many options, drug types and combinations available, what doesn't work the first time might be followed by something that does.

"The size of the tumor and how far it has spread are the main determinants of quality of life and effectiveness of treatment," Colon says. "Different tumors are treated with different agent combinations with different success."

All cancers cannot be treated equally. They grow at varying rates and respond to different treatments, which makes it so important for oncologists to tailor treatments specifically to each patient.

Arlene Dunlop says her optimism has helped her live with cancer.

"You can eradicate the cancer if you get to it early, but sometimes you are not able to diagnose that soon," says Mayo Clinic oncologist Dr. Winston Tan. "For those patients, though, survival rates have gone up because there are better treatment options now to control the disease."

Neil Steele of Palm Coast, Fla., is living proof. He was first diagnosed with prostate cancer in December 1992 at age 57. For several weeks, he underwent external beam radiation therapy that killed the cancer cells and put him in remission. He had no problems for many years. In late 2001, the cancer returned. This time, oncologists treated him with hormone therapy to shrink the tumor by inhibiting testosterone production. He responded well, but the second part of his two-part treatment — the implantation of radioactive seeds in the prostate (brachytherapy) — had to be put on hold when a CT scan showed a cancerous mass in his left kidney.

"Finding that out was rough," says Steele.

The cancerous kidney was removed, and he recovered for several months before receiving brachytherapy. Since then, he says, the prostate cancer has been under control, and his prostate-specific antigen (PSA) level, which rises in the presence of cancer or an infection, has been undetectable. Unfortunately, the renal cancer returned in the fall of 2004 in his remaining kidney, and doctors found that it had spread to his lungs and a rib. The good news is that the chemotherapy Steele's receiving seems to be working. Monthly scans show the tumor hasn't grown, but it hasn't gotten smaller either.

"I'm feeling good," says Steele, now 70. "I'm walking close to 10 miles a day. I'm out playing golf again. There are times when it gets a little rough, but it hasn't been all that bad."

Back in November, doctors gave him six to 12 months to live. As each month of treatment passes, his chance of beating the odds grows.

"Time will tell," says Tan. "Mr. Steele has metastatic disease, but he is responding to his treatment. It's about setting realistic goals and improving quality of life. We can now do a good job controlling the disease so patients can go on with their lives."

Above all, cancer patients will tell you, staying positive is just as important as the treatment regimen — and it's the one thing they can control.

"I'm the type of person who thinks positively," Dunlop says, "and things just fall into place. I think being optimistic makes a big difference, too."

Info:
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