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Technology gives hope for future of fight against cancer

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Technology gives hope for future of fight against cancer
By Liv Osby
The Greenville News
HEALTH WRITER
losby@greenvillenews.com

The Faces of Cancer

Kay Lee lost three precious months of treatment when traditional imaging tests
failed to detect the extent of her lymphoma.

"I went from a Stage 1 to a Stage 4 -- there's no Stage 5 -- and the MRIs did
not pick up that it had spread," said the Greenwood school teacher. "The PET
scan would have."

A PET -- for positron emission tomography -- scanner helps physicians pinpoint
cancers and determine how advanced they are. Among the latest weapons in the
arsenal oncologists employ to fight cancer, PET technology made its debut in
the Upstate last September.

"I'm absolutely delighted they got this in South Carolina," said Lee, a
59-year-old mother of two and grandmother of four who is now in remission. "I
can sleep at night when I hear the results from the PET scanner."

OWEN RILEY JR. / Staff
Technician Debbie Cathcart, supervisor of PET Scans at CencerCenters of the
Carolinas, positions Kay Lee for a positron emission tomography, or PET, scan.

Technology is among the many ways medical advances are tackling the disease
that strikes one in three Americans. There are new and less invasive surgical
techniques and a host of new treatments in use or in development, helping
change the quality of life and the long-term outlook for patients.

"We are light years from where we used to be," said Dr. W. Larry Gluck, medical
oncologist with CancerCenters of the Carolinas, which has hooked up with
Greenville Hospital System to develop a regional cancer center.

"Cancer doesn't have to be a death sentence," he said, "and the experience of
cancer doesn't have to be a near-death sentence or a 'wish I was dead'
sentence."

Traditional medical treatment involves broad-based chemotherapy, Gluck said.
Designed to attack fast-growing cancer cells, the drugs also harm other
rapidly-proliferating cells, such as hair and bone marrow.

But newer targeted therapies, developed as scientists learn more about the
cancer process, can eliminate or reduce much of that collateral damage by
selectively attacking malignant cells.

For instance, Gluck said, chemotherapy was once used to treat chronic myelogous
leukemia, a disease that typically hits middle-aged people. It was replaced by
bone marrow transplants, which are offered in an expanding program at Bon
Secour St. Francis Health System for that and other illnesses.

Then scientists discovered that the disease occurs when portions of two
chromosomes fuse to form a protein that stimulates the white-cell growth
characteristic of leukemia. Once that was understood, he said, a drug was
developed to inhibit just that protein.

"The white count goes down just like that," he said, with a snap of his
fingers. "And the response in newly diagnosed CML patients is about 95
percent."

It's not yet known whether patients will become resistant to the drug, which is
now available here, he said. But it has paved the way for more research and
elicited hope for other treatments. In fact, he said, similar proteins for
other cancers are under investigation now.

"We have not identified the genetic abnormality in all types of leukemia," he
said, "but with each passing year, we identify more and more."

Non-Hodgkin's lymphoma, also traditionally treated with chemotherapy resulting
in serious side effects, can be disabled with a monoclonal antibody, he said.
This new approach, also available in Greenville, works by triggering the immune
system to attack a protein, and thus the lymphoma, without side effects.
Combined with chemotherapy, he said, it can bring about remission.

Another monoclonal antibody inactivates growth factor receptors in certain
breast cancers, he said, noting that Greenville participated in the early
clinical trials that led to its approval.

Still another now commercially available monoclonal antibody transports a
destructive toxin to the site of the cancer, he said.

"Nanogram for nanogram, this is mean stuff with its own set of side effects,"
he said. "But it's a non-chemotherapeutic approach that...may allow additional
remission."

OWEN RILEY JR. / Staff
PET scans allow physicians to pinpoint cancers and determine how advanced they
are.

A similar therapy in clinical trials instructs the immune system to transport a
radioactive substance near lymphoma cells. Doctors are treating the first
patient in Greenville with the drug now, he said.

"These drugs...clearly increase the response rate," Gluck said. "Whether or not
they improve the long-term cure rate is not known. My guess is it's buying
quality and quantity of time, not necessarily curability."

But quality of life is an important consideration, said Susan Funk, a nurse
practitioner at CancerCenters of the Carolinas who's been working with cancer
patients for 17 years.

"When I first started in oncology, we had to admit people (to the hospital) for
chemo because they were going to have such severe nausea and vomiting," she
said. "We've gotten a lot better in controlling what happens to normal tissues
in the process of damaging cancer cells."

Today, 95 percent of all cancer treatments occur in an outpatient setting, said
Funk. A woman with breast cancer who would have been on chemotherapy for two
years a couple of decades ago would only need three months of outpatient
therapy today.

"She may have gone into the hospital every three or four weeks for two years of
her life," she said. "Now she comes here once every three weeks for four times
and she's done."

That not only means less physical damage, but less emotional trauma as well.
Patients can stay home in familiar surroundings. They can be with family and
friends. Often, they can continue working.

"All those things help patients not only in quality of life, but to recover
from treatments better," Funk said.

Nonetheless, Gluck cautions against painting all cancers with the same brush.
New therapies have improved outcomes for many patients, but not all.

"This notion of tremendous progress is absolutely true," he said. "The dilemma
is that it places a level of expectation in us that there surely has been equal
or similar progress (in all cancers)."

While colon cancer is far more treatable than it was a decade ago, little
progress has been made with pancreatic cancer in the past 30 years, he said.

And there still can be trade-offs between treatments and side effects, he said.
One patient who underwent surgery, chemotherapy and radiation for bladder
cancer survived, he said, but not without significant injury.

"Her outcome is amazing in that she's alive with no sign of cancer, but she has
paid a price in terms of bowel function and so forth," he said. "It's
counter-balancing."

Conversely, he said, by combining approaches, response rates can improve and
treatments may be less severe. Tumors can be shrunken with chemotherapy, for
example, so a patient with breast cancer needs a lumpectomy instead of a
mastectomy.

Other new therapies target angiogenesis, the process cancer cells use to
develop new blood vessels to support themselves and spread, Gluck said. And
brachytherapy, the practice of implanting tiny radioactive seeds used for years
to destroy prostate cancer, now can be used for a variety of other
malignancies, including breast, lung and cervical cancer, he said.

Much of the progress has been made in lymphoma and leukemia because science has
a better understanding of their molecular biology, he said. Other malignancies,
like brain cancer, are less understood so progress is slower. But the lessons
learned are being translated, he said.

Once thought to be only a process of uncontrolled cell growth, cancer actually
is a biological behavior in which malignant cells disobey the rules of growth
and development, said Gluck. Some proliferate rapidly, some are slow-growing
cells that refuse to die. Others are hybrids, he said.

With combined, targeted therapies, he said, it is hoped that science will one
day be able to destroy the substance that causes the cancer cell to grow
quickly as well as the one that prevents it from dying.

Meanwhile, in the coming years, Gluck said, there will be a convergence of
knowledge that will advance treatment even further. Stem cell research will
help scientists find the answers to questions about cancer's molecular
development. Genetic engineering will allow physicians to repair cancer-causing
genetic defects by reintroducing a substance in a patient that he was born
without.

"While it would be nice to makeӪ it to the Magic Bullet one day -- a medicine
that destroys cancer with no side effects -- until we get there there is likely
to be some mixture of targeted and non-targeted therapy, and it will vary from
disease to disease," said Gluck.

"On the other hand," he adds, "now that we have the Human Genome Project, and
we know what's normal, we can find abnormal. And as you dissect out the normal
growth and development, one will eventually find applicable connections to
managing malignancy."