For a metastatic breast cancer patient, whose median survival rate is two to three years, she's not kidding when she says, “I feel like I've been very successful in this little war.”
Unbelievable as Carol Turtur's story is, she's not alone. While advances in oncology today can seem like a lot of little skirmishes, a new revolution in smart therapies is turning what was once a death sentence into a manageable disease.
The greatest triumph has been with chronic myelogenous (or myeloid) leukemia (CML). That story started one spring day in Oregon, the same year Herceptin arrived on the market, as Brian Druker, MD, lingered by the hospital bed of Robert “Bud” Romine, who was rapidly dying of CML. Romine, a 68-year-old former conductor on the Southern Pacific railway, had volunteered to be the “first guinea pig” two years earlier and had no further treatment options available. Neither fact, however, calmed Druker's nerves as he administered the experimental drug, Gleevec, designed to target a specific protein in leukemia cells.
Druker spent most of that day by Romine's bedside, watching his patient's every reaction. Romine's blustery humor stood him in good stead. He had already outlived his original prognosis by a year, holding on so he could try the new “miracle.” When Druker tested his vitals every few hours, Romine would assure him, “Don't worry. I'm still here.”
Romine didn't explode or expire on the spot, but the drug also didn't decrease his abnormally high white blood cell count, a telltale sign of CML. Druker couldn't believe he had let down this man who'd had so much faith in him, but was forced, according to the study's protocol, to move on to the next patient and to give a higher dose. Twelve subjects along, white blood cell counts began dropping to healthy levels and staying there. “By February or March, my patients were sharing stories of hope being restored,” Druker says. “They were planning for the future again. There were tears, including my own.”
Because of the startlingly positive success, Druker was able to convince Novartis, the makers of Gleevec, to let Romine back on the drug. Three weeks after the first treatment at the new dosage, Druker couldn't sit still while he waited for the results, pacing around, leaning against the wall. Finally, he left the room and came in again grinning ear to ear. He handed the blood count printout to Romine's wife, Yvonne. She couldn't make sense of the numbers. “What?” she asked.
“He's in the normal range,” Druker told them.
Studies would soon show that Gleevec keeps a whopping 83 percent of patients in full remission at five years—and it helped Romine for even longer. “Hell's bells,” he said when asked about Druker. “He brought me back to life.” When Romine died last May, it was from heart disease.
To date, at least 14 targeted therapies have been approved, and dozens more are in the pipeline. Challenges remain. Given that the oldest of these drugs is only nine years old, doctors still don't fully understand the long-term effects. Thanks to recent research, we now know that heart failure can be a complication in about 2 to 4 percent of subjects taking Herceptin, and a reduction in heart function in 10 percent. Heart trouble might also be a rare side effect of Gleevec, according to new research, although Druker hasn't observed it in any of his patients. (“We think Bud had early heart failure before he started the Gleevec,” he says.) And for a very few, Avastin and chemo (now approved for lung cancer) can cause fatal bleeding in the lungs.
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