The Meaningless Shrinkage of Tumor

Mark (not real name) is a 34-year old male. Sometime in September 2006 he had coughs which led to the diagnosis of lung cancer. A CT scan on 18 December 2006 showed a 5 x 5 cm mass at the right upper lobe of this lung. The right lung also had fluid (pleural effusion). In addition, there were several metastatic lesions in the partially collapsed right mid and lower lobes of the lung. The left lung was clear. Unfortunately the cancer had already spread to the fourth and sixth ribs.
A core biopsy of the lung mass indicated a moderately differentiated papillary adenocarcinoma.
From December 2006 to February 2007, Mark underwent chemotherapy with Gemzar and cisplatin. Two cycles were given each month and he received a total of six cycles. The cost of each cycle was around RM 4,000. The oncologist told him that there would be no cure but the size of the tumor could be reduced by the treatment.
After the chemotherapy was completed, a CT scan on 7 March 2007 showed right lung severely collapsed with a mass lesion measuring 6 cm over the hilum. Mark had to undergo a procedure to re-inflate his lung.
Mark was told that chemotherapy was not effective. He was asked to take the oral drug, Tarceva which cost RM 270 / pill. The progress of the treatment responses are as follows:
1. CT scan on 9 March 2007 showed a 7.5 cm x 6 cm mass and a daughter nodule measuring 4.5 cm x 3.5 cm.
2. CT scan on 31 May 2007 showed a mass measuring 4 cm x 2 cm, a significant reduction in size of the right lung mass.
3. CT scan on 13 September 2007 showed no significant change compared to the previous CXR.
4. CT scan on 13 November 2007 showed a larger mass measuring 8 x 6 x 4 cm. There was fibrosis in the right apex and the right lung base. There was destruction of one of the lower left rib suggestive of bony metastasis.
While on Tarceva, Mark was told that initially the tumour had shrunk to about eighty percent of its initial size. Unfortunately this shrinkage did not last. After eight months of Tarceva (costing him approximately RM 64,000) it was clear that the treatment had failed. Mark was told the disappointing news that the tumour had grown bigger again. Tarceva was not effective. In addition, the bony metastasis got worse. Mark was on Bonefos since his diagnosis and this medication cost about RM 400 per month.
Mark and his wife came to see us on December 2007. They wanted to know if by taking the herbs the tumour would shrink and how long would it take for the herbs to be able to do this. Honestly and frankly my respond was: "I am sorry I don't know."
Comments
Mark and his wife came to us to seek an assurance that herbs can help him. We have lung cancer patients who were told by their doctors that they only had six months to live, but after taking the herbs they went on to lead a normal life for another two to three years before they eventually succumb to the cancer. A man with bone cancer was told: Go home and prepare your will. You only have six months to live. He declined Bonefos medication, took herbs and is still alive to this day - almost seven years now. However, it is absolutely wrong on our part to claim that herbs can cure cancer. Unfortunately when Mark came to see us, I was unable to provide him the guarantee that herbs can cure anything if that was what he and his wife came to see me for. I told them, we could only do our best to help.
I am reminded by what Randall Fitzgerald said (in The Hundred Years Lie): " "For many people who grew by and dependent on technology and the laboratory drugs of Western medicine, breaking free of that paradigm or even considering the use of strange-sounding treatments from other cultures, requires a leap of faith." " "For many of us, before we can discover natural healing alternatives, we must first experience the desperation of having exhausted the entire range of synthetic chemical remedies offered by modern medicine."
However, for some people even the experience of failure does not bring any message. The sad truth about advanced stage lung cancer is that there is no cure for it - not even with chemotherapy or Tarceva.
Stephen Spiro and Joanna Porter in an article: Lung cancer- where are we today? (American J. Respiratory and Critical Care Medicine. 166:1166-1196, 2000), wrote that "although chemotherapy may be a logical approach, there is virtually no evidence that it can cure NSCLC (non-small cell lung cancer)."
Ronald Feld et al. (in Lung. Clinical Oncology. 2nd ed. Harcourt Asia) summed up the present scenario: "Despite this large patient base for clinical trials, the role of systemic chemotherapy in the management of NSCLC remains one of the most controversial issues in medical oncology today."
Dr. Jeffrey Tobias and Kay Eaton (in Living with Cancer) were more explicit when they wrote " "For patients with NSCLC ...(treatment) in truth is likely to be more valuable for palliation of symptoms rather than a treatment with a real prospect of cure... a cure couldn't realistically be attempted." " "the early dramatic response to chemotherapy is rarely beyond a year or two ... perhaps six months later (there is) clear evidence of the return of the cancer."
What is Bonefos?
Bonefos is used in some cancers to reduce bone destruction that could result in bone pain and fractures. Its chemical name is Clodronate disodium belonging to a class of drugs called bisphosphonates. It stops the calcium from coming out of the bone which makes it weaker and hence increasing the risk of fractures and pain besides increasing calcium blood levels. Nowhere is it stated that it cures bone cancer. And in this case, Bonefos was not effective.
What is Tarceva?
Go into the website and find some hard truth about this oral drug. According to the company's website, http://www.tarceva.net/survivalresults.aspx, Tarceva is the first and only oral HER1/EGFR tyrosine kinase inhibitor proven to significantly prolong survival. It significantly increased overall survival by 37% and demonstrated significant symptom benefits by prolonging the time to progression of symptoms.
This write-up is very impressive. But as always, let me caution patients to read information using some common sense. Ask what does increased survival by 37% means in real term? The data presented by the company are as below:
1. Median survival was 9.5 months with Tarceva versus 6.7 months with placebo. In real terms Tarceva only increased survival by 2.8 months. Mathematically it is very correct to say that the increased survival due to Tarceva is 41.8%. Definitely 41.8% increased survival sounds very attractive indeed.
2. Tarceva significantly prolonged progression-free survival (PFS) by 82%. The actual figures are: PFS 3.6 months with Tarceva versus 1.8 months with placebo.
Nowhere in the medical literature is there a claim that Tarceva cures lung cancer! Patients need to decide if it is worth spending RM 8,000 each month on medication that was shown to only prolong life by 2.8 months. In this case, Mark had already spent RM 64,000, and found out that Tarceva had failed him.