The Science of Cancer Treatment
One piece of good news for cancer patients is that treatment is increasingly individualized, according to Dr. Robert Rufo of Arizona Oncology at its Sedona location.
"The newest and biggest technologies we're using are medical genomics and molecular profiling." Rufo said. "We know what genomes consist of now and so the treatments we give are based on each patient's tumor, targeted to certain enzymes and to tumor supressor genes."
In the past, heavy-handed treatment was applied across the board in the hopes of a direct hit.
"That meant certain types of chemo hit everything--good cells, bad cells, everything." Rufo said.
In addition to having genomics as a tool, the Oncologist said mathematical models are helping as well, including one from Adjuvant Online.
"This is relatively new software that gives doctors and their patients with early breast, colon and melanoma cancers a tool to discuss the risks and benefits of getting certain types of other therapies," Rufo said. "It's basically an online calculator that uses a patient's age, their tumor size, nodal involvement and other present morbidities to assess the risk of recurrence. For breast cancer there are additional factors involoved."
As a result, patients have the advantage of knowing statistics surrounding their outcomes, with and without therapy and also the risks of the side effects of the therapy.
Monoclonal antibodies have been refined as a therapy and are increasingly used to treat cancer.
"Cancer cells are capable of repairing themselves after they've been hit with chemo drugs," Rufo explained. "The antibodies prevent that process."
One of the diagnostic tests that excites Rufo is called Oncotype DX, which was developed to avoid both overtreatment and undertreatment.
"For women with breast cancer, this analyzes 21 genes," Rufo said. "The results place each patient into one of three risk categories: low, intermediate and high."
Men with prostate cancer are also benefiting from new technologies.
Prostatectomies performed by hand require an 8-10 inch incision.
Now, they can be performed using a da Vinci robot, requiring only dime-sized incisions.
For most patients, Rufo said that means far less pain, shorter recovery times, less scarring, a smaller risk of infection and lower incidence of impotence and incontinence.
While these and other advances have already been made in the detection and treatment of cancer, far more could be accomplished if a greater number of patients agreed to participate in clinical studies.
"That's the biggest problem we have in the U.S." Rufo said. "Only 1 to 2 percent of those eligible go on the studies."
Seventy percent of the new drugs approved by FDA for Oncological treatments have been developed by U.S. Oncology protocols.
Arizona Oncology is a subsidiary of U.S. Oncology.
In the past, studies typically consisted of two groups, one given experimental drugs and the other given either no treatment or less effective treatment.
Fear of winding up in the no treatment group turned patients off.
Today, studies still typically have two groups; however, the control group is now given therapy known to be effective while the other group is given therapy that's hoped to be super effective.
"New treatments can't be developed unless there are people willing to participate, " he said. "You don't have to go to far away places for this; there are studies available right here in the community that allow access to the newest and most innovative therapies."
Red Rock News, Sedona, Arizona. Reported by: Susan Johnson