CHEMOTHERAPY:WHEN IT WORKS, WHEN IT DOESN’T

To attempt to separate fact from the vast fiction propagated about both orthodox and alternative treatment of cancer, we have produced a special cancer series in WDDTY. Over the next two issues, we hope to offer evidence of what works and what doesn

Chemotherapy was first proposed as a treatment for cancer right after World War II, when research on mustard gas demonstrated that it has the ability to kill living cells, particularly those which rapidly divide, such as those in the intestinal tract, bone marrow and lymph system. Doctors soon came up with the idea that they could use mustard gas to poison cancer, which constitutes the most rapidly dividing cells of all. In fact, many of the drugs we use today are close cousins of mustard gas one reason we find them so toxic (The Immortal Cell, Dr Gerald B Dermer, Avery Publishing Group, Garden City Park, 1994).

It’s probably no accident that we use the tools of war against what medicine views as the most outlaw of cells, which necessitates all out nuclear warfare of sorts against the cancer and, in the process, the patient, too with the aim of decimating every last cancer cell (The Lancet, 1994; 343: 495).

In the early 1970s, medicine discovered that certain rare cancers would respond to chemotherapy and result in a person living longer. These include combinations of drugs for Hodgkin’s disease, certain non Hodgkin lymphomas, some germ cell tumours, testicular cancer and certain cancers in children, such as Wilm’s tumour, acute lymphocytic leukemia and choriocarcinoma, in which fetal cells transform into cancer and threaten the mother’s life. However, 25 years and many billions of pounds later, chemotherapy’s modest successes are almost identical to what they were in 1971, says Ralph Moss (Questioning Chemotherapy, Equinox Press, New York, 1995).

The fact is, for most of today’s most common cancers, the ones that kill 90 per cent of cancer patients every year, chemotherapy has never been proved to do any good at all and in fact may do harm.

After surgery, giving out chemotherapy as a “just in case” measure to kill any “secret” pockets of cells has appeared to improve the survival prospects of certain groups of patients with breast, colon or lung cancer. Recurrence rates are supposed to be reduced by a third and survival improved (New Eng J Med, 1992, 326; 8: 563).

However, this evidence is only empirical (that is, only based on observation, not scientific studies). It is very likely that it was the surgery alone that helped the survival of these patients.

In one of the few reviews of all studies comparing chemotherapy against another form of treatment, chemotherapy proved no better than tamoxifen alone in women over 50 with breast cancer (The Lancet, 1996; 347: 1066-71).

Those cancers for which there is little evidence to support the use of chemotherapy include: breast, non small cell lung, colon and rectal, skin cancer, liver and pancreatic and bladder.

Chemo has been shown to increase the survival of patients with ovarian and small cell lung disease, intermediate and high grade non Hodgkin’s lymphoma, and localized cancer of the small intestines although, again, this is not proven without a shadow of a doubt (Current Op Onc, 1995; 7 (5): 457-65). Sometimes, these advantages are major, as with ovarian cancer, where it’s been shown that it may extend the lives of patients for years. More often the effect is modest, as with lung cancer patients, increasing survival by only a few months (Questioning Chemotherapy).

Another reason for this dismal failure rate may be that most cancer chemotherapy has been inadequately tested. Dr Gerald Dermer, a cancer research scientist, claims that the first models for testing the cancer drugs were transplanted lymphomas in mice (that is, a tumour which has grown on one animal which is transplanted to another). Scientists also use man made laboratory cell lines when experimenting with drugs. However, Dermer discovered in his work that cancer cells in both mediums are profoundly different than those in live human beings. Drugs that may kill transplantable tumours or cell lines have rarely been effective in humans (The Immortal Cell).

The other problem is that cancer doctors define “cure” and “response” in different terms than you or I might. In the main, oncologists look only at “response” that is, shrinking the tumour as a measure of success, without considering whether it increases survival or improves quality of life. Dr Urich Abel, a German epidemiologist, who examined virtually all the articles (several thousand in all) on chemotherapy, plus the work of some 350 scientists working on cancer therapies, has found that when a tumour mass partially or temporarily disappears, those tumour cells which are remaining and resist the effect of the chemo can sometimes grow much faster afterward. Often, patients who did not respond to chemo survive longer than those who do (Der Spiegel: 1990; 33: 174-6. See also J Otolaryn, 1995; 24(4): 242-52).

Dr Moss describes a textbook on medicine, in which a top NCI scientist said that for most forms of cancer, many patients may initially respond. But in only three forms of cancer ovarian, small cell lung cancer, acute nonlymphocytic leukemia did any appreciable percentage survive without disease, and even then it was, at best, less than a sixth of the total group of patients. In all the other types of cancer, disease free survival was rare.

Shrinkage of solid tumours should not be overinterpreted, as it often has little or no survival benefit, according to oncology consultant GM Mead of the Royal South Hants Hospital (BMJ, January 28, 1995). Major chemo manufacturer Bristol Myers discloses that only 11 per cent of patients taking the carboplatin and 15 per cent of patients taking cisplatin had a complete response to the drugs; remission lasted on average, about a year, and both types of patients survived, on average, only two years. And this is for the two major drugs given primarily for ovarian cancer, which is one of the cancers which most responds to chemotherapy! (Physician’s Desk Reference, 1995).

In the majority of studies, the most important question of all does chemo help you to live any longer than you would if you didn’t get the treatment is never even asked! (Questioning Chemotherapy). In the rush to be seen to be doing something about cancer, the US Food and Drug Administration has now officially sanctioned that new drugs for cancer can be fast tracked on the market so long as they show they shrink tumours. There is no need to show that they lengthen the survival of cancer patients (BMJ, 1996; 312: 886).

The latest treatments are termed “rescue”, as in rescuing you from the brink of death. Doctors harvest bone marrow from the patient before launching into treatment, then administer high dose chemotherapy in the hope that replanting the bone marrow will somehow rescue the patient from death from the drugs!

Says oncologist Dr Albert Braverman (The Lancet, April 13, 1991): “. . . many medical oncologists recommend chemotherapy for virtually any tumour, with a hopefulness undiscouraged by almost invariable failure.”

After the success with Hodgkin’s disease, with a multi drug approach using cancer killing drugs and steroids, medicine has applied this protocol to all other types of cancer, even though there is no evidence that it does any good at all. In oncology, more is always considered better.

In non Hodgkin’s lymphoma, one such protocol, ProMACECYTA-BOM, uses 10 powerful chemotherapeutic agents, when there is no solid evidence that even a single agent significantly saves lives.

However, for many forms of cancer, multiple use of drugs is no more effective than single drugs, which carry many fewer side effects. In one of the only studies of its type, reported at a meeting in Dallas of the American Society of Clinical Oncologist, a double dose of chemotherapy given to breast cancer patients was no more effective than the standard dose (Int Herald Trib, May 19, 1994).

Many patients are blasted with unnecessary single or combination chemotherapy even after their cancer has been removed surgically and the site irradiated. Although 91 per cent of women with very early breast cancer survive after five years on surgery alone, doctors persist in administering just in case chemo, sometimes for many months (Questioning Chemotherapy).

But even when medicine admits that drugs haven’t a prayer of curing, chemotherapy is given as palliative care (that is, to improve the time the patient has left). This argument, of course, ignores the terrible effects of chemotherapy, which can hardly be said to improve the quality of life.

One of the most used chemotherapy drugs is cyclophosphamide, which comes from mustard gas. It can cause nausea, vomiting, hair loss, anorexia, and damage the blood, heart and lungs. Another drug, cisplastin (Platinol), made of the heavy metal platinum, can damage nerves, kidneys, and cause hearing loss and seizures. It can also cause deafness, irreversible loss of motor function, bone marrow suppression, anemia and blindness.

Mechlorethamine, an analogue of mustard gas (the “M” of MOPP treatment, the standard procotol for Hodgkin’s disease), is so toxic that those administering the drug are advised to wear rubber gloves and avoid inhaling it! This drug is known to cause thrombosis, jaundice, hair loss, nausea and vomiting. Merck, its manufacturer, warns in the PDR that “the margin of safety in therapy with MUSTARGEN is narrow and considerable care must be exercised in the matter of dosage. Repeated examinations of blood are mandatory as a guide to subsequent therapy. ”

A most dreaded complication is mucositis (or inflammation of mucus membranes, particularly of the gut and mouth), possibly leading to life threatening infection (Cur Op Onc, 1995; 7 (4): 320-4). Various types of chemotherapy can cause heart problems, destroy bile ducts, cause bone tissue death, restrict growth, cause infertility, lower white and red cell counts and lead to intestinal and lactose malabsorption. All for a category of drugs which don’t work more than 90 per cent of the time.