As in most things, it comes down to individualization. There are clearly situations where high dose therapy reliably produces cures, while low dose therapy does not. Diseases such as testicular cancer, Hodgkin's disease, childhood leukemia, etc. The problem has been the tendency to apply the lessons of these diseases to all forms of cancer.

I don't think claiming that low dose therapy is to be preferred, anymore than claiming that high dose therapy is to be preferred. If one has a highly effective drug or drug regimen, then this should be given at the optimum dose to achieve whatever it is supposed to achieve.

If what it has the capacity to achieve is to destroy the tumor cells directly, then sufficient drug should be given to achieve this goal. If the drug does not have the capacity to destroy the tumor cell, and the drug works through an effect on angiogenesis, then the drug should be given at a dose consistent with this aim.

For example, some ovarian cancer patients do have tumors which are equisitely sensitive to platinum. These patients should be treated with aggressive platinum dosing, because you have a good shot at getting a very long term survival. But giving high dose platinum to patients with intrinsically resistant disease doubtless causes more hurt than help.

 

There appears to be a number of patients who have had long-term survival after high dose therapy, but there are a number of patients whose tumors are responsive to chemotherapy who have had long-term remissions from low dose therapy, as well as a number who show no difference in survival when treated with low-dose or high-dose therapy.

 

You may want to reserve aggressive therapy for those patients who will derive more benefit than harm, while identifying the most promising treatment regimens for everyone. In patients with tumors very resistant to cytotoxic chemotherapy, the most promising treatments may be angiogenesis inhibitors, growth factor inhibitors, or more integrative medicine approaches.

 

It may be better not to give more aggressive and toxic, mutagenic and immunosuppressive combinations, but to give "targeted" single agents, or give least toxic mutagenic synergistic combinations. Although somthing may be an above-average regimen in some patients, it may not be a highly active regimen in others.

 

More emphasis should be put on matching treatment to the patient, through the use of individualized pre-testing, having more respect for minimal partial response or stable disease, when it can be achieved through use of the least toxic and mutagenic drug regimens, and reserve the use of higher dose therapy or aggressive combination chemotherapy to those patients with tumor biologies most amenable to attack and destroy by these treatments.

 

Trying to mate a notoriously heterogeneous disease into one-size-fits-all treatments is disingenuous to all who are inflicted with it. And the criticism remains: All of the clinical trials resources have gone toward driving a square peg (one-size-fits-all chemotherapy) into a round hole (notoriously heterogeneous disease).

 

The basic criterion for approval of a new drug is that its benefits outweigh its associated risks. So benefits must be considered in light of the drug's toxicity and potential safety problems. The FDA weighs the tradeoff between safety and access.

 

Denise

 

I was a spouse/caregiver to a cancer patient. I became intensely interested in cancer by virtue of working through, enduring and surviving my wife's illness. I've gotten a street education by virtue of voluminous reading and hundreds of hours of past and ongoing personal communication with noted authorities in the field.

 

As a cancer patient advocate, I've been interested in and studied the aspects of cell function analysis (harken back to my college days studying biology) for a number of years, like anyone would have an interest in molecular science or biological science. My point with respect to cell function analysis is to educate patients and others that such science and technology exists, and might be very valuable.

 

I get nothing out of my endeavors except the satisfaction of knowing that I've helped to increase the knowledge of informed consent. I get no pay, no lectureships, no junkets, not even any free meals. To paraphrase Martin Luther King, Jr., "a scientific communication should be judged on the quality of its content and only secondarily, or not at all, on the qualifications of its author (I have no prefix to my name).

 

SapphireSkies

 

It's always going to be a case of what works best for you, after you performed extensive research and study. Your life depends on all the information you can muster. This is called informed consent. You must be aware of all possible "problems" as well as the "benefits." In addition, the physician "informing" a patient needs to spend enough time to make sure that the patient understands well enough that the "consent" is truly "informed."

Thank you for this, Denise. Although I sincerely appreciate the experiences shared here, it is extremely scary as someone who will soon be switched to Taxol to come across this thread.

 

I guess as with any drug, there are going to be some severe reactions with some individuals. But if this drug is helping more than it's hurting, well...I guess I'll take my chances. I'm going to trust my oncologist on this one... after I ask her some more questions. ;)

The ability of readers to leave comments in an interactive format is probably the most important part of most blogs and discussion boards. The interactive format allows rapid responses to medical and health care issues which frequently intertwine moral, ethical and legal concerns, and provides valuable feedback and commentary not available through traditional media.

 

Blogs and discussion boards are increasing the visibility of laypeople medical experts, who share tips about treatment and care giving from personal experience, and others have relied on them for straight talk about their health issues and bloggers often provide links to other blogs they favor.

 

Until Abraxane came about the only solvent that could be dissolve paclitaxel and docetaxel was cremaphor. Abraxis discovered and patented nab paclitaxel after some controversy but they did. So we are stuck with the situation for now.

Taxotere (docetaxel), which doesn't need to be dissolved in the castor oil solution that Taxol, might work 1% better in each clinical trial so that the highly remunerative Taxotere can be viewed as the new "standard" therapy. Who does this serve? The patients? Or the clinical investigators and the clinical oncologists?

 

Abraxane is just a new form of Taxol. Abraxane also does not need to be dissolved in the castor oil solution that Taxol does, and does not require special equipment to be given to patients. The delivery mechanism is different, however, they are basically the same drug.

 

Abraxane mixes the same active ingredient as Taxol in protein particles to make it more tolerable. Abraxane combines the drug paclitaxel with Albumin, a protein found in human blood, where Taxol combines paclitaxel with Cremophor, a combination of castor oil and alcohol.

 

Patients taking Abraxane do not need to take a steroid or antihistamine, and can be given at higher doses than Taxol. However, more of the women on Abraxane had numbness and tingling in their hands and feet. And more suffered nausea and vomiting, diarrhea, muscle and joint pain and anemia.

Dr. Ramaswamy Govindan, a Washington University professor who was co-author of a December 2006 article in the Annals of Oncology about Abraxane and other, as-yet-unapproved Cremophor-free versions of Taxol, said that none of the new drugs had shown significant advantages over the older medicine. In general, the novel formulations so far have not stood out as distinctly superior.

I respectfully disagree with the last statement in your post that novel formulations are not superior.

Abraxane is a novel formulation. It can be used in patients who are allergic to cremaphor and thus cannot be given Taxol. Is it not superior thus?

By the way Taxotere is dissolved in polysorbate and ethanol. Certain patients develop hyper sensitivity to polysorbate also.