Vincent DeVita, director of the National Cancer Institute, issued the following statement in response to the first Washington Post article concerning the use of experimental drugs to fight cancer:
The article by Ted Gup and Jonathan Neumann in the Post October 18 presented a tragic lack of understanding of cancer treatment and the national program to develop drugs that are effective in treating cancer.
It bears repeating that cancer patients -- and the doctors treating them -- have as their first ogal the successful treatment of the disease. In this context, many patients feel that it is worthwhile putting up with side effects of treatment knowing that the treatment may prolong their lives or provide a cure. All of us who work on the cancer problem wish there were no side effects related to treatment, and much of our work now is to develop treatments that are effective without causing side effects.
It also bears repeating that, contrary to the impression left by the article, much progress has been made in treating cancer. Of the 785,000 patients diagnosed with serious cancers in 1980, 356,000 -- 45 percent -- are potentially curable. This includes 220,000 patients curable with the oldest treatment, surgery; 90,000 patients curable by surgery combined with radiation therapy, a treatment that has come into its own only since 1947; and about 46,000 curable as the result of adding chemotherapy, the newest form of cancer treatment.
The article did not mention that cancer mortality rates are falling in the age group under 45 years old. It did not mention that survival rates have increased significantly for seven of the 10 major forms of cancer in whites and six of the 10 in blacks. These major gains are among cancers of the breast, colon, rectum, bladder and prostate, to mention some. In addition, survival gains for cancers striking young Americans are even more substantial. These cancers include childhood leukemia, Hodgkin's disease, testicular cancer and others. Unfortunately, not all patients with any type of cancer are cured so it is essential to continue research to develop better treatments.
Several points need to be made about the distortions in the article:
One, Gup and Neumann totally missed the concept that anticancer drugs are meant to be used in combination with other forms of treatment, such as surgery and radiation, and that they are expected to be most effective in treating early cancers. For ethical reasons, all drugs are first tested against advanced cancers afflicting patients for whom no other hope exists. Even a few responses against advanced cancers can mean major effect against early cancers, particularly when the drugs are used in conjunction with surgery and radiation therapy.
Two, the writers state that they have documented 620 cases where experimental drugs were implicated in the deaths of cancer patients. Any death associated with treatment causes anguish to the family of the patient, to those who were providing the care, and to those of us who are working to help all cancer patients. The fact remains, however, that such cases are unusual. Gup and Neumann did not mention that hundreds of thousands of patients have participated in our research programs to develop anticancer drugs. Remember also that 46,000 patients are cured every year because of anticancer drugs. The contrast between lives saved and risks taken is striking.
Three, the article did not make clear that most drugs side effects are temporary, predictable, and manageable with standard techniques. Different patients experience different effects, and some experience no side effects at all. As I noted above, much research now is devoted to reducing side effects and developing new drugs with few side effects.
Four, the article implied that studies of particular anticancer agents are carried on long after the compounds have been shown to be toxic and after they were shown to have little effect in treating particular types of cancer. Again, Gup and Neumann missed or are ignoring the fact that specific anticancer drugs often work only against a specific type of tumor. When a drug is tested in patients it is done at many different dose levels, schedules of administration, and against a variety of different cancers. If a drug proves to be ineffective against one or more types of cancer, it does not mean it will not be effective against other cancers. Cisplatin, a drug whose success the writers described, is not effective against all cancers. In other words, early discouraging results do not mean an experimental drug will not be effective against another tumor yet to be tested.
Five, Gup and Neumann repeatedly referred to my 1979 list of high-priority drugs. But they twisted the meaning of that list, implying that I was predicting these drugs would have great beneficial effect in patients. My 1979 list was of drugs that had performed well in animal tests, and therefore had high priority for human testing. There were no predictions that any of those compounds would become miracle drugs for treating people.
Six, in discussing particular anticancer drugs, such as MeCCNU, Gup and Neumann point to side effects of renal failure and acute leukemia. These are delayed side effects that develop slowly and are difficult to detect and difficult to predict with any animal testing. The kidney problems with MeCCNU, for example, showed up as an acute, or immediate, effect in the animals, but did not show up as an immediate problem among patients who received the experimental drug. The first case in humans was not detected until more than a year after the patient had stopped receiving the drug and after several years of use with patients. Under such circumstances, the development of kidney damage in a cancer patient with a long history of the disease and many treatments can be difficult to link with any one drug when the observation is made for the first time.
Seven, Gup and Neumann imply and quote a cancer expert as saying that Phase I studies provide patients no potential for cure. This is clearly a distortion of what occurs. Phase I studies do sometimes result in significant responses, and the drug vincristine provides a striking example. Potential for beneficial effect exists and is an important part of the ethical base for conducting such studies.
Eight, Gup and Neumann consistently make the point that only six drugs are effective in treating cancer. That, too, is just plain wrong. There are more than 40.
In summary, it is unfortunate that the Post, particularly now that Washington is a one-newspaper city, has chosen to present such a slanted and distorted view of cancer research. Gup and Neumann should keep in mind one important point: cancer is lethal if left untreated. The possibility of treatment side effects and the small but real chance of drug-related death has to be balanced against the nearly 100 percent chance of death if experimental therapy is not attempted for the advanced cancer patients who participate in our studies. All cancer patients experience anxieties and doubts at one time or another during treatment. It would be tragic if cancer patients who read this article, and those that will follow, turn away from their treatment.