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| Snow's Prognosis |
| 2007-03-28 |
| The return of White House press secretary Tony Snow's colon cancer is an ominous development, but moderately useful treatments remain open to him, and even a cure is a remote possibility. Precise estimates of survival are not available, although several studies suggest it is about two years on average. But patients with unusually good responses to a new round of chemotherapy -- which these days usually includes "targeted" biological drugs along with older ones -- may qualify for surgery, which can further prolong life. "It is still potentially curable, even if it is recurrent. I underline the word 'potentially,' " said Dan Laheru, an oncologist at the Kimmel Cancer Center at Johns Hopkins Hospital. Martin J. Heslin, a cancer surgeon at the University of Alabama at Birmingham, echoed that assessment -- and the caveat. "You don't want to overstate the number of people who can make it into that subset," he said. "It is a relatively new concept, this idea of chemotherapy making people surgical candidates." Snow, 51, had his colon removed and underwent six months of chemotherapy when the cancer was diagnosed in 2005. Last week, he announced he would have surgery on Monday to identify a small, abnormal mass in his abdominal cavity that had been detected on a CAT scan. White House spokeswoman Dana Perino, at yesterday's briefing, said physicians had determined that the mass was colon cancer. She also said the cancer had spread to the liver. Late in the afternoon, she refined the report by saying that the liver tumors were on the surface of the organ, not inside it. Although many details were not available, this suggests that Snow's cancer has "peritoneal metastases" -- the spread of cancer cells to the translucent membrane that envelopes the abdominal cavity, called the peritoneum. The liver is covered with a similar membrane, called the capsule. Cancer cells can land on the peritoneum and the liver capsule through the same mechanism, which is probably direct seeding from the original tumor. This is different -- although no less serious -- from spreading through the bloodstream, which is how cancer cells get to the liver's interior. The cancer cells found this week originated in Snow's colon and almost certainly spread before his first operation. Only with time have they grown to form clumps large enough to be seen on a CAT scan. A major unanswered question is whether -- or how many -- other microscopic clumps are still growing and not yet visible. Among the possible treatments Snow might receive are chemotherapy drugs, such as irinotecan and oxaliplatin, that poison cells. Also available are biological treatments, such as Avastin and Erbitux, that rob tumors of their blood supply or suppress growth by blocking cell-surface receptors. Patients whose tumors shrink greatly after those treatments sometimes then undergo surgery to remove a small number (usually three or fewer) of cancer nodules that remain in the liver or elsewhere. The proportion of patients with recurrent colon cancer who ultimately qualify for surgery is small, probably no more than 15 percent. Of those who have surgery, perhaps 20 to 30 percent will survive five years -- which in the case of colon cancer strongly implies they are cured. Some patients whose tumors have spread onto their peritoneum also undergo an experimental treatment in which the abdominal cavity is flooded with hot chemotherapy drugs under general anesthesia. It may have the power to cure on occasion. Experts yesterday emphasized the great improvement in the treatment of colon cancer, which kills about 55,000 Americans a year. Godspeed, Tony. |
| Posted by:Bobby |
| #2 Monoclonal antibodies are almost passe these days. There are an incredible variety of "targeted" drug therapies available today to cancer patients. these range from deep-targeted transmitted radiation beams which penetrate tissues to a certain, specific depth and then deliver their radioactive payloads in precise doses, to microscopic beads packed with radioactive materials and specifically designed to target only specific tissues to active gene therapies designed to turn cancerous tissue cell growth off at the genetic level. Tony has a good chance. Even if the cancer has spread to his liver, they can cut the cancerous portion out and he can survive because the liver regenerates. Or, barring that, there's always the alternative of a liver transplant or other radical surgery in combination with the chemo. There is always hope! |
| Posted by: FOTSGreg 2007-03-28 16:41 |
| #1 which these days usually includes "targeted" biological drugs monoclonal antibodies? |
| Posted by: eLarson 2007-03-28 16:24 |