Chemotherapy can backfire and boost cancer growth

Curveball---I agree that's why I said I would do it again and have no regrets for doing it in the first place---just crazy side effects that it.

Ruby,

I think the difference is that they have always admitted that chemo can cause "OTHER cancers", but they didn't fully investigate or raise the question of whether it could cause worsening of a particular existing cancer.

In other words, they have been sort of dancing around the issue of whether chemo can be helpful for some but could still cause worsening of the cancer one is being treated for, for others.

I apologize for posting the following repetitively if you read it in the Chemotherapy thread where I wrote it, but it really belongs in both places:

I had chemo treatment 10 years ago as a stage I and I am pleased with the new information because to me it represents a step forward for us all. I know firsthand how uncomfortable it is to be in the midst of making decisions about treatment right when new information challenges the treatments that are in place. I was diagnosed in 2002 at the time when trials were in progress for trastuzumab but not yet completed. I knew nothing about trastuzumab and in fact, even though my surgeon and onc had the HER2 testing done on my tumor and my insurance paid for it, I was never given the information that I was HER2 positive. My "caretakers" made their decision about which treatment to recommend based in part on that information, and they expected me to make a decision about my treatment without knowing anything about it.

Times of information transition are difficult, and I sympathize with those who are struggling like I did, to understand what the actual choices mean.

I told my onc at the time I wanted to participate in a clinical trial. Even though I was fully eligible for one of the trastuzumab trials, he told me nothing about any of them. So I went through CAFx6. I refused blood boosters, so that choice extended my length of treatment by about 1 1/2 months..... UGH.... but it was my choice, based on uncertainties about the effects of blood boosters.

I asked my onc at that time whether removal of the ovaries plus tamoxifen would be equal to doing chemotherapy plus tamoxifen. I did not know that a European trial had returned results indicating that CAFx6 plus tamoxifen was equal to removal of the ovaries plus tamoxifen, and my onc failed to inform me that was the case.

There has been a strong bias favoring chemotherapy in the profession, whether it is merited or not. To many people, it seems like something that powerfully poisonous must make it the best possible choice. Yet scientifically the question of whether it may also be contributing to the growth of some breast cancers is a pure and quite logical one that needs to be determined. Many people go through the trauma of chemotherapy, and some do it only to find themselves among the group for whom it does not work. They wonder why.

Because the bias has been so strong favoring chemotherapy for so long, to the point where it has become the standard for any other therapy to be judged, it falls short of true scientific rigor. An excellent example is the question about whether trastuzumab used alone for some patients may work just fine. We have not been permitted to even consider that question because of the bias favoring chemotherapy. We simply do not know, and as a result many people are undergoing all the trauma and expense and inconvenience of adding chemotherapy to trastuzumab because we are not permitted to know. I am only sorry that science has been so biased against fully investigating whether something better is effective for at least some of us.

I went through chemotherapy. I did not get trastuzumab. There is no way for me to know whether chemotherapy did anything helpful for me or whether I simply didn't need any treatment beyond surgery and perhaps radiation. But I am thankful if the new information leads to something much, much better for others.  

Hi annde ..

I feel pretty much as you do! Until the cancer started being treated with EC chemo..i felt reasonably well! After 2 EC's the se's where horrendous and i was hospitalised both times ...so the chemo was stopped..i found as soon as that chemo needle went into my body ..i have never felt very well since! My arthritis is far worse and my energy levels are c**p...I had full mx with node clearance 5 weeks ago..which i recovered very well from..only to then get a build up of fluid..which has been drained several times..the wound which looked good is now looking like an old mattress!

Now the little 'insignificant' lung nodules poo poo'ed by the onc ..have now turned out to have been growing nicely from 2 to 10..also the tumour itself grew like a tomato..very soon after 2nd chemo..now lung cancer!

My new oral chemo..means coating my hands and feet in lanolin constantly and back to hospital..if..i get the severe diarhrea (sp) plus getting burnt by rads..turning my mattress chest into...a burst wellington boot!! Bring it on!

Sorry about the moan..but most theraputic ..for me anyway..

Dulcie xxxx

AA, I'm sorry to hear about the negligent care you received, your onco sure dropped the ball. Don't feel too bad, some of us go in blind putting our trust where we think best, but eventually regret doing so. One thing I can say is that I've learned to keep my onco dancing on his toes while I tap my fingers 

Hmmm...I'm no scientist, but concluding that chemo/rads can exacerbate an existing cancer by damaging the immune system or otherwise seems to be a no brainer given that chemo/rads can actually cause secondary cancers.

This study is dated 2007: "Decoding dangerous death: how cytotoxic chemotherapy invokes inflammation, immunity or nothing at all

Chemotherapy and immunotherapy can be either synergistic or antagonistic modalities in the treatment of cancer. Cytotoxic chemotherapy not only affects the tumor but also targets dividing lymphocytes, the very cells that are required to develop an immune response"

http://www.nature.com/cdd/journal/v15/n1/full/4402255a.html

Radiation-Induced Lymphocyte-Immune Deficiency. A Factor in the Increased Visceral Metastases and Decreased Hormonal Responsiveness of Breast Cancer

http://archsurg.jamanetwork.com/article.aspx?articleid=569904

Like you say, they have been dancing around the issue. Chemo/rads damage or cause healthy cells to mutate whether this results in a new cancer or worsening of an existing cancer plus they have known about chemo resistance for a loooong time. That's why I said that, perhaps, they did not have the answer to the ‘How' question yet.....

I don't know if you've seen this study:

"the relapse-free survival curve is shifted to the right during the first 3 years and then declines. This indicates that the benefit from 1 year of trastuzumab treatment seems to last mainly for the first 3 years. Since also some of the patients with HER2/neu-positive breast cancers before the era of trastuzumab seemed to fare well, it would be desirable to analyze more closely which patients benefit from trastuzumab"

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3155034/

 Hi exbrnxgrl 

I am fairly 'dense' on most of this..i am quite new to cancer and my doc's  plus..surgeon..radio peps...have not told me much even though ..i am all 'ears'!

What is the difference please? I think i said i was Metaplastic..so they don't know much about...any..treatment.. A tumour was found by me last November...and i went 'private' just a one stop shop. I was told B9 ..all B9...i didn't get to see a letter for several months which said something quite different! Anyway..when the lung nodes where found ..one in each lung 10mm and 5 mm..now there are 10 nodes...my tumour doubled in size between last chemo of 2..and op  three weeks... I presume they are mets?

Dulcie xxxx

Hi Dulcie,

Don't worry, you'll be a walking medical dictionary before you know it. If you were told that you have metastasis or mets to your lungs, you do not have lung cancer. You have the spread of breast cancer, mets, to another part of your body. With the exception of possible surgery to your lungs, , you will still be treated for breast cancer. The cancer in your lungs "matches" the cancer in your breast. I have bone mets, but it is still breast cancer, not bone cancer. Lungs, bone, liver and brain are some of the more common sites that breast cancer travels to. My grandmother died from breast cancer due to liver mets, but not liver cancer. Metaplastic is not the same as metastatic. Perhaps you can call your doctor and really have him/her really explain it to you. NEVER be afraid to ask questions, no matter how silly you might think they are. That is their job. Best wishes to you.

Caryn

Really good questions AA.  I'm actually surprised that the results of this study actually made their way through....I'm sure similar results in the past were killed in the egg, so to speak

If the results of the OP are confirmed by further study, then even though we still don't know what the characteristics are of the group that has return of breast cancer because of chemotherapy or which patients fall into that group, we would still know that a percentage of patients do fall into that group.

The problem with your explanation is that the information given in the risk tool provides the percentages for those who:

1.  Do no other therapy (how many are alive in 10 years, how many die of cancer, and how many die of causes other than cancer)

2.  With hormonal therapy (benefit percentage)

3.  With chemotherapy (benefit percentage)

4.  With combined therapy (benefit percentage)

Each of the above choices showing additional therapy indicate that there is only additional benefit to be had with each choice.

If the Fred Hutch study proves to be correct, there would have to also be a category or percentage of additional deaths due to chemotherapy in order for patients to be given accurate information to make their choices about therapy.

If, for example, I happened to fall in the group where the benefit of adding chemotherapy was 0.1% and the missing category indicating possible detriment of adding chemotherapy was also 0.1%, I would at least have been given honest information to be able to take that into consideration when making my choice of therapies.

A.A.

Curveball, thanks - I do understand that the percentage calculated is the net benefit for those who are listed as specifically having died of a recurrence of the cancer. However, if a patient is, for example, very early stage and the net benefit is litttle or negligible or at this point unclear, then it would be especially important to know the specific percentage of risk they are taking on for chemo being the cause for recurrence. Without indicating that ANY net disadvantage potentially exists due to chemotherapy itself, the graphs would be misleading.

This may be why the decision-making tool has not been able to complete version 9.0.

camillegal,

I appreciate Curveball for explaining and clarifying so well too. All of us have pieces of the picture to help us all get a better understanding -- especially with so much of it changing with more information over time.

I'm not opposed to further research to try to find a way to address the protein issue successfully but at the same time, given that there may actually not be such a solution without negatively affecting something else, I'd MUCH rather see progress toward the day when a new treatment wouldn't have to be subjected to comparison only when used in combination with such minimally successful treatments as chemotherapies -- especially if it proves true that for some patients chemotherapy itself is the cause of further breast cancer.

A.A.

@AMP47,

no, I hadn't heard of Rational Therapeutics until I read your comment above. I looked up their website, and from what I read there it sounds to me as if this form of testing is in quite an early stage of development and not yet widely validated by clinical trials. That means it most likely wouldn't be covered by my health plan. Also, this method doesn't work on all drugs (see the last question in the FAQ for physicians). Two of the three drugs in the chemo regimen I'm doing are among those that can't be checked. Do you know how much this type of testing would cost out of pocket? It might be something to keep in mind, even if it isn't covered, if the test is relatively low cost.

A recent study that was described today in the New York Times might explain why chemotherapy works for some breast cancers and not for others, aside from the question of the effect that chemotherapy has on healthy cells.

Apparently, there are at least 4 distinct kinds of breast cancer. Some respond to chemotherapy, some don't, and, surprisingly, some may respond better to drugs for ovarian cancer than to the drugs for breast cancer. 

 Here's the link:

 http://www.nytimes.com/2012/09/24/health/study-finds-variations-of-breast-cancer.html?_r=1&hp

Here's an excerpt:In findings that are fundamentally reshaping the scientific understanding of breast cancer, researchers have identified four genetically distinct types of the cancer. And within those types, they found hallmark genetic changes that are driving many cancers.

These discoveries, published online on Sunday in the journal Nature, are expected to lead to new treatments with drugs already approved for cancers in other parts of the body and new ideas for more precise treatments aimed at genetic aberrations that now have no known treatment.

The study is the first comprehensive genetic analysis of breast cancer, which kills more than 35,000 women a year in the United States. The new paper, and several smaller recent studies, are electrifying the field.

...

The investigators identified at least 40 genetic alterations that might be attacked by drugs. Many of them are already being developed for other types of cancer that have the same mutations. "We now have a good view of what goes wrong in breast cancer," said Joe Gray, a genetic expert at Oregon Health & Science University, who was not involved in the study. "We haven't had that before."

The study focused on the most common types of breast cancer that are thought to arise in the milk duct. It concentrated on early breast cancers that had not yet spread to other parts of the body in order to find genetic changes that could be attacked, stopping a cancer before it metastasized.

The study's biggest surprise involved a particularly deadly breast cancer whose tumor cells resemble basal cells of the skin and sweat glands, which are in the deepest layer of the skin. These breast cells form a scaffolding for milk duct cells. This type of cancer is often called triple negative and accounts for a small percentage of breast cancer.

But researchers found that this cancer was entirely different from the other types of breast cancer and much more resembles ovarian cancer and a type of lung cancer.

"It's incredible," said Dr. James Ingle of the Mayo Clinic, one of the study's 348 authors, of the ovarian cancer connection. "It raises the possibility that there may be a common cause."

There are immediate therapeutic implications. The study gives a biologic reason to try some routine treatments for ovarian cancer instead of a common class of drugs used in breast cancer known as anthracyclines. Anthracyclines, Dr. Ellis said, "are the drugs most breast cancer patients dread because they are associated with heart damage and leukemia."

A new type of drug, PARP inhibitors, that seems to help squelch ovarian cancers, should also be tried in basal-like breast cancer, Dr. Ellis said.

Basal-like cancers are most prevalent in younger women, in African-Americans and in women with breast cancer genes BRCA1 and BRCA2.

Two other types of breast cancer, accounting for most cases of the disease, arise from the luminal cells that line milk ducts. These cancers have proteins on their surfaces that grab estrogen, fueling their growth. Just about everyone with estrogen-fueled cancer gets the same treatment. Some do well. Others do not.

The genetic analysis divided these cancers into two distinct types. Patients with luminal A cancer had good prognoses while those with luminal B did not, suggesting that perhaps patients with the first kind of tumor might do well with just hormonal therapy to block estrogen from spurring their cancers while those with the second kind might do better with chemotherapy in addition to hormonal therapy. ...