Doctors attempt to reduce chemotherapy

Craig Gustafson

When two University doctors treated 8-year-old Nina Herrera’s sickle cell disease, they saved the girl a month of agonizing chemotherapy treatment.
Under normal circumstances, a sickle-cell patient would endure 40 days of chemotherapy and radiation prior to a bone-marrow transplant. But an experimental treatment used by University physicians cut the intense therapy to 10 days.
University Cancer Center researchers and physicians are trying to protect others from the brutal chemotherapy used to treat the disease.
Chemotherapy weakens the body by destroying normal blood cells along with cancerous cells. It is one of most severe forms of disease treatment available. Side effects include nausea, vomiting, hair loss, fatigue, low blood-cell counts, sterility and possible death.
The cancer center has several projects — including clinical trials and experimental procedures — in the works to reduce the need for chemotherapy.
“Trying to find alternative methods of treating cancer is a big push,” said Dr. Lakshmanan Krishnamurti, a University associate professor of pediatrics.
Krishnamurti said most of the methods involve lowering the toxicity of the chemicals used, thereby lowering the amount of damage to the patient.
Last August, Krishnamurti took part in one such attempt.
Along with Dr. John Wagner, Krishnamurti used an experimental bone-marrow treatment to cure Herrera.
The doctors used chemotherapy to destroy a portion of her marrow before inserting marrow from her brother. The two marrows then mixed in a process called engraftment.
Her brother’s marrow slowly took over the blood cell-producing duties.
Doctors consider a transplant successful when the donor’s marrow produces 5 to 10 percent of the blood cells.
As of Wednesday, the donor marrow that Herrera received is producing more than 95 percent of the cells, and she is “doing great.”
Reducing chemo in the brain
Chemotherapy treatment is different for every disease. A reduction of chemotherapy wouldn’t work in every case because different cancers require different types of drug treatments. In those cases, less-toxic drugs need to be substituted.
Among these cases are brain tumors. Currently, doctors treat brain-tumor patients by removing the tumor and then administering radiation and chemotherapy. Patients with certain forms of brain cancer are expected to live for little more than a year after the healing process because of the drugs’ toxicity.
Leading a team of researchers, University professor Dr. Walter Hall is studying the effects of Interleukin 4-toxin, a form of bacteria, that kills brain tumors. Hall’s team is one of nine teams participating nationwide.
“We’re trying to totally change the way brain tumors are treated,” Hall said.
The project will attempt to reduce or totally eliminate the need for chemotherapy in brain cancer.
Researchers just completed phase one: determining the correct dosage of the less-toxic drug in human subjects.
In December, Hall expects to begin phase two: implementing the less-toxic drug.
Scientists insert the new drug directly into the tumor using a catheter. The idea is that the drug will bind to the tumor and release a poison to destroy it without affecting the healthy cells around it.
Beating chemo in breast cancer
University researchers’ most recent attempt to battle chemotherapy is a study using a combination of two drugs that enable the body’s immune system to target and kill breast-cancer cells in advanced cases.
The researchers said they hope the drugs will replace the current method of chemotherapy treatment.
“If chemotherapy was going to cure breast cancer, it would have done it by now,” said Tanya Repka, an associate professor at the cancer center. “This may be one way we can get away from chemotherapy.”
The two drugs used are Interleukin 2, which increases the number of a patient’s cancer-killing cells, and Herceptin.
Herceptin, approved by the Food and Drug Administration in September 1998, is used to combat advanced breast cancer. It is particularly successful in patients with tumors possessing large amounts of a protein that reproduces cancer cells. Herceptin attaches to the protein and inhibits the cancer’s growth.
University associate professor Jeffrey Miller, who is also working on the study, said that most of their research involves immunotherapy, giving the immune system a boost so that it defends itself.
The FDA approved a seven-week clinical trial at the University to test the new method. Researchers will study breast-cancer patients who have an excess amount of the protein in their system. An estimated 25 to 30 percent of breast-cancer patients fit that description.
A troubled past and a funded future
Prior to the 1950s, diagnosis of leukemia or other cancers meant certain death.
But in 1947, scientists discovered that chemical compounds found in a poisonous gas called nitrogen mustard made tumors shrink. The first chemotherapy drugs were born.
Further work in the 1950s and 1960s showed that while the chemicals killed cancer, they also had toxic side effects on the digestive system, blood and bone marrow.
Now more than 40 different drugs are used in chemotherapy, and new drugs are currently being invented nationwide.
The National Cancer Institute named the University Cancer Center a “comprehensive cancer center,” one of only 35 institutions with that distinction.
The cancer center receives more than $50 million in grants each year from organizations like the Cancer Institute, the American Cancer Society and the National Science Foundation.
Coleen Southwell, director of cancer center communications, said the competition for the distinction is heated, although the recognition isn’t the University’s primary goal.
“We need to do better to improve survival, to have more options when standard therapies don’t work and to reduce side effects,” she said.

Craig Gustafson covers the Medical School and welcomes comments at [email protected] He can also be reached at (612) 627-4070 x3233.