Ralph W. Moss, Ph.D. Weekly CancerDecisions.com Newsletter #109 11/22/03 Last week I reported on the results of a recently published European study of the drug NeoRecormon, a synthetic form of the hormone erythropoietin, manufactured by Hoffmann-La Roche. NeoRecormon is a member of a class of drugs called epoetins, which are commonly given to cancer patients who are undergoing radiation and chemotherapy. These drugs effectively stimulate red blood cell production and raise blood hemoglobin levels - but, as the European study clearly demonstrated, patients on epoetins fare significantly worse in terms of overall survival than do patients who are not given these drugs. (Henke, M., et al. Lancet 2003, Oct. 18). The outcome of this study is clearly inimical to the economic interests of the companies that produce epoetin, including Hoffmann-La Roche, the company that sponsored the Lancet study. I therefore take my hat off to the authors, including several Hoffmann-LaRoche scientists, who had the courage to publish these carefully described, albeit negative, results. This is the way science should be practiced - but increasingly seldom is. I realize that this finding may disturb some of our readers who feel they have benefited from this drug. But while I do not for one minute belittle the importance of attending to the overall well-being of patients who are receiving cancer treatment, the alarming subtext of this study is that the cancers of patients treated with epoetin tend to recur more frequently; these patients have a higher incidence of other serious illnesses, and they die sooner than those who do not receive the hormone. Medical research such as this has a certain beauty to it. Steadfastly refusing to indulge in wishful thinking, it presents us instead with unvarnished facts, some of which may be uncomfortable. It is as if Science continually repeats to us Groucho Marx's famous quip: "Who are you going to believe: me…or your own eyes?" In this case, we are forced to reject the testimony of "our own eyes," or the facile assumptions of our intuition, and instead must accept what rigorous scientific experimentation reveals. It may be discouraging in the short term, but in the long run it will enable scientists to come up with more effective treatments. What Are Patients to Do? According to a recent article in a medical journal (Lucia 2003), about 70 percent of people with cancer report feelings of fatigue after surgery or during radiotherapy or chemotherapy. This fatigue can devastate the patient's quality of life and aggravate other symptoms such as pain and nausea. Common sense and intuition may dictate that exhausted cancer patients should get plenty of rest and avoid physical activity. However, by coincidence, in the October issue of Lancet Oncology (the Lancet's sister publication), exercise physiologists and fitness specialists discuss how to use low or moderate exercise to benefit cancer patients, reducing or even eliminating the need for drugs. The quality of life for cancer patients, they say, can be greatly improved with the right exercise program. The authors cite the example of Lance Armstrong, who bounced back from his own chemotherapy-related fatigue to win the Tour de France ("the hardest endurance race…that human beings can undertake") not just once but for the last five years in a row. "Both people with cancer and their physicians should view his achievements as a highly motivating reference and a testimony to the usefulness of exercise in promoting physiological function," the authors write. We must keep faith that there are non-pharmacological solutions to the common problems of cancer patients, although our drug-oriented mainstream media is unlikely to tell us about them during prime time. Pass This Along It is interesting to compare media coverage of the negative findings on epoetin with the somewhat positive news about letrozole (Femara), which appeared a week or so earlier. The Femara study, as you know if you've been reading this newsletter, received top billing all over the world. Even weeks after the story broke, there were still 420 articles on Femara in the news section of Google, most of them lauding the clinical trial that showed a decreased rate of breast cancer recurrence in women who took the drug after successful treatment for the disease. An article in Newsweek on the Femara "breakthrough" was typical in that it totally failed to inform readers that the drug had no significant impact on survival in the patients who were treated. By contrast, the Lancet study on epoetin has generated just four stories (derived from a total of 4,500 news sources), and none of these is in a major media outlet. Apparently, no one in a position of authority is inclined to deliver any negative news about conventional cancer treatments, not even to patients who may urgently need this sort of information. Here at The Moss Reports we are not afraid to face the facts about cancer, even if the news is not of the "feel good" variety. Every week we deliver information and analysis in a clear and balanced way to those who need it the most, as our editor, Dr Ralph Moss, has consistently done for over a quarter of a century. If you know others who need this sort of information please remember to forward the newsletter to them, with a recommendation that they subscribe. (The newsletter is free of charge.) In that way, we can help individuals get the information they need, while simultaneously building an educated public that can help redirect the faltering war on cancer. --Ralph W. Moss, PhD References: Glaser CM, Millesi W, Kornek GV, et al. Impact of hemoglobin level and use of recombinant erythropoietin on efficacy of preoperative chemoradiation therapy for squamous cell carcinoma of the oral cavity and oropharynx. Int J Radiat Oncol Biol Phys. 2001 Jul 1;50(3):705-15. Henke M, Laszig R, Rube C, et al. Erythropoietin to treat head and neck cancer patients with anaemia undergoing radiotherapy: randomised, double-blind, placebo-controlled trial. Lancet. 2003 Oct 18;362(9392):1255-60. Leyland-Jones B; BEST Investigators and Study Group. Breast cancer trial with erythropoietin terminated unexpectedly. Lancet Oncol. 2003 Aug;4(8):459-60. Littlewood TJ, Bajetta E, Nortier JW, Vercammen E, Rapoport B; Epoetin Alfa Study Group. Effects of epoetin alfa on hematologic parameters and quality of life in cancer patients receiving nonplatinum chemotherapy: results of a randomized, double-blind, placebo-controlled trial. J Clin Oncol. 2001 Jun 1;19(11):2865-74. Lucia A, Earnest C, Perez M. Cancer-related fatigue: can exercise physiology assist oncologists? Lancet Oncol. 2003 Oct;4(10):616-25. Accessed at: http://oncology.thelancet.com/journal/journal.isa#section1 FDA criticism of J&J: http://www.fda.gov/cder/biologics/adpromo/epoamg062003.htm See also: http://ragingbull.lycos.com/mboard/boards.cgi?board=JNJ&read=124 "From the Heart" advertising campaign: http://216.239.41.104/search?q=cache:EelxcHFfM4EJ:www.ogilvy.com/viewpoint/pdf/v3_lee.pdf+procrit+advertising+campaign&hl=en&ie=UTF-8 Herper, Matthew. European Woes May Hit J&J's Earnings, Forbes.com, 12/02/02. At: http://www.forbes.com/2002/12/02/cx_mh_1202jnj.html Tagliabue, John. Mystery Effect in Biotech Drug Puts Its Maker on Defensive. New York Times 2nd October, 02. At: http://www.nytimes.com/2002/10/02/business/02DRUG.html IMPORTANT DISCLAIMER The news and other items in this newsletter are intended for informational purposes only. Nothing in this newsletter is intended to be a substitute for professional medical advice. Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.