Faculty Bibliography

At a meeting of the American Society of Clinical Oncology in San Francisco, scientists reported that Gleevec had also worked in about 60 per cent of nearly 200 cases with [Todd Hendrickson]'s type of cancer, known as GIST for gastrointestinal stromal tumour. But it is too early to know how long patients will need to take Gleevec. Gleevec, for example, inhibits three different proteins involved in the cell's internal signalling system. Many cancer cells divide incessantly because their internal signalling systems have been thrown into hyper-drive by some genetic accident. Gleevec cuts off this signalling by slipping into a pocket on the surface of the signalling protein. This pocket is meant to be occupied by another protein known as ATP. With the pocket jammed, the protein can no longer function. Cancer cells are daunting to treat because they often have a number of genetic mutations. They quickly develop resistance to the drugs thrown at them, suggesting that no one drug will ever be much use by itself. The unexpected success of Gleevec has raised oncologists' hopes that other drugs like Gleevec, alone or in combination, may bring down many different types of tumours. If the drugs do not cure the cancer, they may allow people to live with it as a chronic disease

Last week at a meeting of the American Society of Clinical Oncology here, scientists reported that Gleevec had also worked in about 60 percent of nearly 200 cases with Mr. [Todd Hendrickson]'s type of cancer, known as GIST for gastrointestinal stromal tumor. But it is too early to know how long the remissions will last and how long patients will need to take Gleevec. Gleevec, for example, inhibits three different proteins involved in the cell's internal signaling system. Many cancer cells divide incessantly because their internal signaling systems have been thrown into hyper-drive by some genetic accident. Gleevec cuts off this signaling by slipping into a pocket on the surface of the signaling protein. This pocket is meant to be occupied by another protein known as ATP. With the pocket jammed, the protein can no longer function. Cancer cells are daunting to treat because they often have a number of genetic mutations. They quickly develop resistance to the drugs that are thrown at them, suggesting that no one drug will ever be much use in itself. The unexpected success of Gleevec has raised oncologists' hopes that other drugs like Gleevec, alone or in combination, may bring down many different types of tumors. If the drugs do not cure the cancer, they may allow people to live with it as a chronic disease

Dr. [Ronald B. Natale]'s team used a combination known as MVAC (pronounced EM-vack) for its four components: methotrexate, vinblastine, doxorubicin and cisplatin. Side effects included hair loss, mouth sores, nausea, vomiting and low blood counts. But the preoperative chemotherapy did not interfere with the patients' ability to tolerate the major surgery of bladder removal, Dr. Natale said. The study hinted that chemotherapy alone might be effective in some patients with bladder cancer. In 38 percent of patients in the study, a pathologist could find no evidence of cancer in bladders removed from people who had chemotherapy. Now, Dr. Natale said, doctors can address the question of whether they can forgo bladder removal, or at least delay removal, for many patients. Such a step would require further study. Dr. Natale's paper was selected for presentation at the meeting's only full session. In a scheduled debate that followed, Dr. Dean F. Bajorin of Memorial Sloan-Kettering Cancer Center in New York City supported the validity of Dr. Natale's team's findings and his team's recommendations

Of 86 patients who took Gleevec for three or more months in a study last summer reported by Dr. Charles D. Blanke of the Oregon Health and Science University in Portland, the GIST went into remission in 51 of them, or 59 percent. Although the average follow-up was four and a half months, ''no patient still taking the drug and achieving remission has relapsed,'' Dr. Blanke said. Still, Dr. Blanke and other scientists warned that Gleevec failed in a number of GIST patients and that doctors did not know if GIST cells would develop resistance to Gleevec. Although the food and drug agency approved Gleevec only for chronic myelogenous leukemia, doctors can prescribe it, like any marketed drug, for other conditions in a practice known as off-label use. But Dr. Blanke and Dr. Allan T. van Oosterom of the University of Leuven in Belgium, who led a smaller European trial, cautioned doctors and patients not to do so

Yesterday, scientists reported that Gleevec had produced complete remissions among more than 180 GIST patients who received the drug in trials in the United States, Belgium, England, the Netherlands and Finland. The deck was stacked against the drug because the tests were conducted among patients with a tumor that had spread or had not responded to surgery. Of 86 patients who had taken Gleevec for three or more months in a study last summer reported by Dr. Charles D. Blanke of the Oregon Health & Science University in Portland, the GIST went into remission in 51 of them, or 59 percent. Although the average follow-up in his study was 4 1/2 months, 'no patient still taking the drug and achieving remission has relapsed,' Blanke said. Still, Blanke and other scientists warned that Gleevec failed in a number of GIST patients and that doctors did not know if GIST cells would develop resistance to Gleevec

[Charles D. Blanke] and other scientists said that Gleevec failed in a number of GIST patients and that doctors did not know if GIST cells would develop resistance to Gleevec

Yesterday, researchers told participants at a meeting of the American Society of Clinical Oncology that Gleevec was producing equally striking benefits among patients with advanced cases of an intestinal cancer known as GIST, for gastrointestinal stromal tumor. Of 86 patients who had taken Gleevec for three or more months in a study last summer reported by Dr. Charles D. Blanke of the Oregon Health & Science University in Portland, the GIST went into remission in 51 of them, or 59 percent. Still, Blanke and other scientists warned that Gleevec failed in a number of GIST patients and that doctors did not know if GIST cells would develop resistance to Gleevec

His team's findings support the growing view that oncologists continue to prescribe chemotherapy for too many cancer patients when clinical evidence indicates they are in the terminal stages of the disease. There are no guidelines for the appropriate use of chemotherapy at the end of life based on scientifically controlled trials or consensus statements, Dr. [Ezekiel J. Emanuel] said in an interview. Dr. Emanuel's team from Boston University and Stanford University linked information from death certificates in Massachusetts and Medicare billing records. The researchers used standard textbooks to classify whether different cancers were generally responsive or unresponsive to chemotherapy. Responsive cancers included in the study were breast, colon and ovarian. Unresponsive cancers included gallbladder, kidney, liver and pancreatic cancer and melanoma. Additional studies are needed before such findings can be confirmed nationally and to develop guidelines on when chemotheraphy should be stopped in terminal cases, Dr. Emanuel said. He also urged studies to determine how much managed care and traditional fee-for-service practices influenced the timing of chemotherapy. In addition, he said, studies are needed to better understand how the interaction among doctors, patients and families influence the use of chemotherapy in terminal stages of cancer

His team's findings support the growing view that oncologists continue to prescribe chemotherapy for too many cancer patients when clinical evidence indicates they are in the terminal stages of the disease. There are no guidelines for the appropriate use of chemotherapy at the end of life based on scientifically controlled trials or consensus statements, [Ezekiel J. Emanuel] said in an interview. The researchers used standard textbooks to classify whether different cancers were generally responsive or unresponsive to chemotherapy. Responsive cancers included in the study were breast, colon and ovarian. Unresponsive cancers included gallbladder, kidney, liver, pancreatic and melanoma. Additional studies are needed in order to confirm such findings nationally and to develop guidelines for when chemotherapy should be stopped in terminal cases, Emanuel said. He also urged studies to determine how much managed care and traditional fee-for-service practices influenced the timing of chemotherapy

His team's findings support the growing view that oncologists continue to prescribe chemotherapy for too many cancer patients when clinical evidence indicates they are in the terminal stages of the disease. There are no guidelines for the appropriate use of chemotherapy at the end of life based on scientifically controlled trials or consensus statements, [Ezekiel Emanuel] said. The researchers used standard textbooks to classify whether different cancers were generally responsive or unresponsive to chemotherapy. Responsive cancers included in the study were breast, colon and ovarian. Unresponsive cancers included gallbladder, kidney, liver, pancreatic and melanoma. This summer, [Michael Glantz] will start work at the Barrow Institute in Phoenix, and he said his team would begin studies to determine whether marriage counseling or other types of counseling can help patients with brain tumors and their spouses cope with the disease. Depression and fatigue are frequent problems of patients undergoing chemotherapy, and a common notion among cancer doctors is that they are linked. But in a study by Dr. Gary Morrow's team from the University of Rochester Cancer Center, they were found not to be linked