What we heard that was new or interesting: 1) Zoledronate, 3rd generation bisphosphonate as a potent inhibitor of osteoclastic function. (two orders of magnitude more potent than pamidronate). Administered as a five-minute infusion at 4-8mg. Side effects were similar to pamidronate(Aredia), i.e. bone pain, eye irritation, flu-like symptoms and fever. Zoledrontate inhibited osteclastic bone resorption in cancer patients as assessed by measurement of urinary pyridionoline, etc. A dose of 8mg or higher was more effective than 90mg pamidronate. NOTE: These drugs are used to fight bone metastases. 2) TNP470- slow to get study going. May be already obsolete as newer anti-angiogenic drugs are stronger and may work better, i.e. endostatin, angiostatin. This substance takes a long time to show results and initial studies were discontinued before anything was seen. I had the opportunity to speak with Judah Folkman in the hallway. He discussed a one-year delay until angiostatin or endostatin would come to the marketplace in the U.S. He said the pharmaceutical company did not feel an urgent need to bring it forward, citing costs. 3) Letrozole(Femara)- showed superior response rate compared to megestrol acetate and aminoglutethimide. It is better tolerated, and "perhaps offers a modest survival advantage in the treatment of advanced breast cancer to postmenopausal women." Richard Ellege stated that there is a potential acceleration of bone loss or adverse lipids and cardiovascular mortality. He also said it was showing a reduced rate of fracture and slowed first episode and the need for radiation but not showing prolongation of survival. 4) Many speakers referred to modest success. Gabriel Hortobagy suggested that "we have to stop this mindless reshuffling of agents just because we can." Additional data is needed. Dose intensification with growth factors support may improve efficacy of adjuvant regimens. Single cycle high dose adjuvant remains uncertain. "It is of the utmost importance to complete the appropriate randomized trials to determine the incremental yield of dose-intense or dose-dense therapies over standard dose treatment programs, and to build on that knowledge to improve the efficacy of the regimen." 5) An oncology nurse I spoke with suggested that a chamomile product(chemoprevention item) could be used for mucositis very successfully. 6) Toremifene's clinical efficacy in metastatic breast cancer was discussed. Conclusion: "These data suggest similar activity and toxicity between tamoxifen and toremifene 60mg daily. Further evaluation of toremifene in the adjuvant setting is currently underway." There is evidence that toremifene may be less carcinogenic than tamoxifen in that it causes significantly fewer DNA adducts and has not been associated with the induction of liver cancer in rats. 7) From a talk on Informatics for the Clinical Oncologist-"Managed competition and clinical trials research demand more intense recording of medical documentation, while our reimbursements and time available for each patient is curtailed. Our clinical trials must not only show progression-free and overall survival benefits, but now must display cost-effectiveness and patient satisfaction. 8) Muggia reported on Doxil as "an attractive agent for the treatment of refractory ovarian cancer, based on its activity comparable to other agents such as topetecan and paclitaxel. The responses obtained were particularly durable in spite of dose-attenuation required for skin and mucosal toxicities. In our experience, these toxicities are not life-threatening, and are less likely to be observed in patients experiencing a prompt progression, thus reinforcing the safety of attempting such salvage therapy. 9) Bernard Fisher spoke about preop chemotherapy. Patients who received preop were more likely to undergo a lumpectomy. "...about 25% of patients who achieved a complete clinical response were found to have no residual tumor on histological examination of the resected specimen: an additional 11%^ were found to have only intraductal carcinoma without evidence of invasive component." 10) Many mentioned immunotherapy and vaccines as a way for the future. Ezra Greenspan, foundation director spoke about the dilemma of present-day oncologist "whether agents that appear so promising now in selected neoplasms should be given prior to chemotherapy or without chemotherapy. There is no "gold standard" for the oncologist to follow, and the timing relation of chemotherapy versus immunotherapy or simultaneously with immunotherapy is critical. It is relatively easy for the medical oncologist to look favorably on immunotherapy in patients with notoriously resistant cancers such as melanoma and renal cancer, but the dilemma of which method to employ in dealing with lymphomas, breast, ovarian and colon cancers persists. 11)James Holland, Mt. Sinai Medical Center, NY again spoke about the 38% of women with virus-related mammary cancer. He suggested that we contact his office for a copy of his papers, one in 1995 and another in January 1997. 12) Savio Woo from the Institute for Gene Therapy and Molecular Medicine(Mt. Sinai, NY) discussed Gene Suicide therapy. Using a virus delivery system to bring GVC(ganciclovir) to the tumor. It is incorporated into the cancer cells causing apoptosis(cell death). Tumor regression has been shown in brain, colon, breast, prostate, bladder, skin and head and neck. This is in animal models. A Phase I/II trial is being done at Baylor College of Medicine in Houston and at Mt. Sinai School of Medicine in New York. "This suicide gene strategy, however, aims only at the destruction of local or regional tumors. For metastatic disease(they)developed a combination suicide and cytokine gene therapy strategy that not only destroyed the primary tumor, but also induced an effective systemic anti-tumoral immune response in the treated animals." Life expectancy doubled in the animals but all died of their disease. He speculated that if they can maintain anti-tumor immunity, they could extend survival. 13) There was a discussion of photo-dynamic therapy(currently in Phase III trial for breast cancer, as used in the esophagus by Stephen Heier, New York Medical College. This process, done as an IV attacks vasculature. Lasers are used after the IV sensitizes the tumor. Patients must stay out of the sun. It is approved for use in esophagus cancer as early treatment, after treatment or instead of surgery. There is off-label use. 14) Dr.Henrik Rasmussen, British Biotech, Inc. Annapolis, MD spoke about Matrix Metalloproteinases and their inhibition by batimastat and Marimastat. These substances have been tested in ovarian, breast, lung, colon, gastric, and brain cancers. Marimastat is available orally so has been pursued. It is not a cytotoxic agent and has been tested in healthy volunteers. Over 600 patients in Phase I and II studies have been treated. reduction in blood markers has been used as the surrogate end point. "Meta-analysis of these studies(5)...indicated that Marimastat treatment significantly reduced all 4 CSA rise rates in a dose-dependent fashion." 15) Substances being used as adjuvant therapy to chemotherapy include GM-CSF(granulyte macrophage colony stimulating factor) which has shown promise for prolonged survival in melanoma patients. It has been used in an adjuvant surgical setting with this result. Interferon has been used this way with lymphomas. It is thought there may be a role for these agents in breast, ovarian, colon and lung cancers. Neupogen is a growth factor support agent being used in a Phase III trial, SWOG 9623 currently accruing. 16) Samuel Waxman discussed Steve Gore's of Johns Hopkins use of phenylbutrate as treatment for AML(the leukemia caused by breast cancer chemo treatment). He suggested that stability of disease and patient well-being can be achieved. It was done through continuous infusion but an synthetic oral PB is now being studied in clinical trial. 17)Sandra Swain, Comprehensive Breast Center Greater Washington Area, Washington, D.C. spoke about an analog of EDTA(chelating agent) Dexrazoxane(DZR) used to ameliorate cardiotoxicity(with doxirubicin aka adriamycin). Patients were able to receive more cycles and higher cumulative doses of doxirubicin. There were NO differences in response rates, progression -free disease or overall survival. This is interesting because EDTA is usually considered an "alternative" therapy for arteriolosclerosis and diabetes induced gangrene or amputation problems. Abstract available: Volume 16, Supplement 1 of Cancer Investigation $15.00, Chemotherapy Foundation, 183 Madison Avenue, Suite 403, NY NY 10016 (212)213-9292 Thanks in part to a grant from The Breast Cancer Fund, San Francisco, CA. From the booklet (handed out at this conference) entitled: What Every Woman and Her Doctor Should Discuss about Ovarian Cancer-"The prognosis for life in any stage in almost all patients depends on prompt, aggressive optimal methods of surgery and chemotherapy, since less than 10% of ovarian cancers now fail to show some important response to initial chemotherapy with the drugs available in 1997." Ann introduced the idea of using the new plasma marker LPA for ovarian patients. No-one knew of it but the comment from the podium was that markers are not useful for discovery. Hopefully more will become known about this blood test. UPDATE: 1999 It looks really good for this blood test. It is going through larger scale study but continues to be impressive. The LPA test seems able to detect ovarian cancer at very early stages. Most ovarian cancer is found at Stage III or later due to the difficulty in identifying symptoms and the fact that there is no single reliable test. Even using a combination of tests, it still can be difficult to diagnose this disease. Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.