MEDICINE Drug extends life of brain cancer patients

The drug's side effects are mild compared with currently used drugs.
MILWAUKEE JOURNAL SENTINEL
NEW ORLEANS -- For the first time, a drug has been shown to meaningfully extend life in people with the most deadly and common form of brain cancer -- the biggest advance in treating the disease in 30 years.
Patients given low, daily doses of temozolomide along with radiation treatment were more than twice as likely to be alive two years later as those who got radiation alone, a new study found.
Experts predicted that the drug will become widely used for this type of tumor and tried on other types, too.
"It would be my new standard of care," said Harmon Eyre, the American Cancer Society's chief medical officer, who was not involved in the research.
Results were reported Monday to the American Society of Clinical Oncology at a meeting of 25,000 cancer experts in New Orleans.
The study involved glioblastoma multiforme, or GBM, which kills about 10,000 Americans each year, usually within a few months of diagnosis. Until now, drugs have improved survival by 5 percentage points at best, and with severe side effects that made many doctors reluctant to use them.
Study details
The study involved nearly 600 patients at 85 hospitals throughout Europe, Canada and Australia. Half got daily pills of temozolomide during radiation treatment and for six months afterward. The others got radiation alone.
After two years, 26 percent who got the drugs were alive vs. 10 percent who got just radiation, said Roger Stupp, a doctor at University Hospital in Lausanne, Switzerland, who led the study. It was financed by a large consortium of research centers, including the National Cancer Institute of Canada.
About one in 10 patients had mild, manageable side effects such as fatigue, nausea and low blood counts. That's vastly better than currently used drugs, which must be given in higher doses and usually make patients so sick that they can't have them more than once every four to six weeks, he said.
"This drug has some particular chemical properties that allow it to get to the target better. Many drugs do not get to where you want them to go. It crosses the blood-brain barrier," Stupp said of temozolomide.
Difficult to treat
That barrier has been the main hurdle to treating brain tumors, one of the few types of cancer that kill while still locally confined but that defy treatments typically used for locally confined cancers, Eyre said. For years, doctors have tried a host of approaches to boost the penetration of drugs or increase the effectiveness of radiation, ranging from sensitizing agents to drug-impregnated wafers implanted directly in the brain.
Despite those efforts, "we don't have a large armamentarium of drugs that are effective in the brain," he said.
Eyre said he'd be even more enthusiastic about the drug if it were one of the new generation of highly targeted drugs that attack cancer's molecular causes while sparing healthy cells.
And the drug isn't a cure. The cancer eventually proves fatal virtually all the time, he and others said.
Temozolomide is sold as Temodar by Schering-Plough. It's licensed in the United States for other brain tumors called gliomas that recur after other treatments have failed.
Reactions
The results of the study were so significant that other researchers said they will immediately start trying temozolomide against different types of brain tumors.
"I would use this drug," said Gregory Cairncross, a University of Calgary researcher who reported disappointing results from a different drug-radiation treatment at the same meeting.
About 18,000 cases of brain cancer are diagnosed in the United States each year, most of them GBM. The five-year survival rate for brain cancer overall is 33 percent, up from 22 percent in the 1970s.