In 1947, children who developed acute lymphocytic leukemia died. Dr. Sidney Farber, a pathologist at Boston Children's Hospital, was so distressed doing autopsies on these children that he moved into the clinic and, against the advice of more conservative colleagues, began treating children with aminopterin, a highly toxic drug that starved their cancerous white blood cells of critical nutrients.
Miraculously, for many, the disease went into remission ... only to recur months later; but Farber's last-ditch attempt to save these children began an era of ultimately remarkable progress -- decades of clinical trials of progressively complex treatments that now cure nearly 90 percent of children with leukemia.
Olivia Blair of Baltimore, who will be 3 in May, is showing the benefits of this progress. After her T-cell acute lymphocytic leukemia was diagnosed when she was 17 months old, Olivia has weathered more than a year of treatment at Johns Hopkins' Sidney Kimmel Comprehensive Cancer Center in Maryland. She has had 15 drugs and radiation treatments on her brain and spine.
With her disease undetectable months later, she is in a study of an experimental drug to help maintain the remission and is back to a near-normal childhood, a thriving, happy toddler who plays with other children, goes to day care and accompanies her mother grocery shopping.
Kelly Blair, Olivia's mother, said, "It was very hard for us to decide to participate in the new study, but we finally thought that even if it didn't help Olivia, it's going to help other kids."
The tortuous road to the kind of treatments saving more than half of all cancer patients is graphically depicted in a six-hour series, Cancer: The Emperor of All Maladies, produced by Ken Burns, to be broadcast by AETN in three parts airing at 8 p.m. today, Tuesday and Wednesday.
The series is based on a Pulitzer Prize-winning book, The Emperor of All Maladies: A Biography of Cancer, by an Indian-born American oncologist, Dr. Siddhartha Mukherjee, who provides telling commentary throughout.
"The outcome in children is so stunning because 80 to 90 percent of young patients participate in clinical trials," Mukherjee, of Columbia University, said. "Every trial taught doctors something that led
to further trials and better results."
But only about 5 percent of adults with cancer enter a clinical trial. "That's not nearly enough to move cancer medicine forward," he said. "No matter what you do in the lab or in basic science, the ultimate proof of which cancer medicines work comes from clinical trials."
ADULT SUBJECTS MISSING
Although the backbone of today's successful cancer treatments, clinical trials are poorly understood by the public.
Those who participate are randomly assigned to receive the innovative treatment being studied or the current standard of care. Through such trials, for example, highly disfiguring radical mastectomies for breast cancer have been abandoned in favor of simple mastectomies or lumpectomies, typically followed by radiation and chemotherapy, with less trauma and far better survival rates.
Even metastatic cancer, cancer that has spread to a body part not directly connected to the original tumor, now sometimes yields to treatments being tested in clinical trials.
Doug Rogers of Lexington, N.C., was 58 in 2011 when he was found to have melanoma that, despite the best available chemotherapy, had spread throughout his leg and adjacent lymph nodes. He enrolled in a study at the National Cancer Institute, where Dr. Steven Rosenberg and colleagues are testing an immunological remedy in which the patient's own cancer-fighting T-cells are harvested, grown in a lab to billions strong and then given back to the patient.
Rogers, who is also featured in the TV series, said that repeated scans had shown no spread of his cancer and that he was "back to doing almost everything a 62-year-old man can do."
WHERE TO LOOK
Although it was once challenging to find and join a clinical trial, patients and families can now find studies and determine their eligibility without going through a doctor. The Stand Up to Cancer website offers free information and access to about 7,000 cancer trials in the United States and Canada. Or you can call the American Association for Cancer Research at (877) 769-4829.
The American Cancer Society, at cancer.org/clinicaltrials, maintains a clinical trials matching service that is also free and can help locate studies most appropriate to a patient's medical and personal circumstances.
And the National Cancer Institute offers up-to-date descriptions of more than 12,000 trials accepting participants, as well as recent trial results by type of cancer, the costs involved and questions to ask about participation. The institute also has a 10-step guide to finding a cancer trial.
SOONER IS BETTER
The best time to explore participation in a clinical trial is often right after a cancer diagnosis and before receiving any treatment. Some trials won't accept patients who have already been treated, and sometimes, the best chance for success lies in receiving the most effective treatment first. But there are also trials for patients already treated elsewhere without success.
Mukherjee recommends asking about a trial's aim. Is it to test safety or effectiveness of a treatment? Why is the trial being done? What were the data that led to the trial in the first place?
"Knowing the answers to such questions allows people to manage their hopes," he said. "If patients go into a trial with the wrong expectations, they can set themselves up for disappointment."
ActiveStyle on 03/30/2015
Print Headline: Too few adults in cancer clinical trials