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Chemotherapy has been a necessary evil since the 1940’s when it was first put into wide use. Usually delivered to an ailing patient intravenously, chemotherapy is basically a poison that is just strong enough to kill cells that are multiplying and leave the patient alive. It has been effective in treating many types of cancer, and there are some who have had their lives saved by this drastic procedure.
Most every time it is used, chemotherapy comes with side effects. The most common is a depression of the immune system, thus the possibility of dangerous, even deadly, infection or sepsis. Nausea is very common, and often dissuades patients from eating, further reducing their reserves of strength to fight the disease. Constipation or diarrhea are common. Then there is the possibility of hair-loss, Cardiotoxicity, Hepatotoxicity, Nephrotoxicity, Ototoxicity, or a second cancer springing up where healthy tissue was damaged by the treatment.
But now, at least for those with illness in the lungs, there is a way to target chemotherapy to get a higher yield and fewer side effects.
Osteosarcoma is a type of cancer that begins in the bones, and is fatal in about 90% of cases where the disease spreads to the lungs. Traditionally the most effective treatment has been chemotherapy, however the fact that this type of cancer affects mostly children makes the this a particularly difficult malaise with which to deal.
Now there are experimental treatments being used in Osteosarcoma patients where the chemo is being delivered via breathing. The patient is placed in a small tent, the medicine is nebulized, and then breathed in, delivering the chemo directly to the lungs. Less of the chemo gets into the bloodstream, thus most of the side effects are drastically reduced if not outright averted. And the tumor formation in the lungs is still halted effectively.
As of yet, the new treatment is still experimental, and not approved for sole use— a reduced treatment of conventional chemotherapy is still called for. However, it a promising step in the treatment of cancer: to aim at the illness, and not at the person.
Suggested by Estela
Further reading:
Article on Inhaled Chemo
Video about Inhaled Chemo
Wikipedia on Chemotherapy
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I can hear a million medical researchers slapping their foreheads in unison.
Would this work with lung cancer (I think its called bronchogenic carcinoma) or just osteosarcoma?
Vibilo said: “Would this work with lung cancer (I think its called bronchogenic carcinoma) or just osteosarcoma?”
I believe it probably will
Presumedly this would then work with any cancer of the mouth and throat aswell then? Seems rather hyprocritical that we view some old time medicines (like trepanation to cure headaches and depression) as being barbaric, in that they seem to involve unnecessary damage to the body, yet we still effectivley poison patients in order to make them ‘better’. I wonder if in a few hundred years people will look back at 21st century medicine and see it as crude and unnecessarily harmful to patients.
Toom said: “I can hear a million medical researchers slapping their foreheads in unison.”
doesn’t seem THAT bad of an idea. . .
Stuart said: “Seems rather hyprocritical that we view some old time medicines (like trepanation to cure headaches and depression) as being barbaric, in that they seem to involve unnecessary damage to the body, yet we still effectivley poison patients in order to make them ‘better’. I wonder if in a few hundred years people will look back at 21st century medicine and see it as crude and unnecessarily harmful to patients.”
Almost definitely – sad thing is, it’s generally the only option (whereas trepaning is probably bottom of the list of treatment options for depression and headaches). It’s also been statistically proven to be effective.
Interestingly, we’ve made big inroads into cancer treatment – but the cost has been so enormous as to make it questionable as to the value. In the 1980’s we could extend survival for a colon cancer victim by 12 months, at a cost of $1,000. Now, we can extend survival by 24 months – 50% more! – but at a cost of $50,000 (at least 10x more, even in adjusted dollars).
This months’ Australian Prescriber featured a fascinating article on the benefit that chemotherapy adds to patients with solid tumours (as opposed to leukaemias and lymphomas), discussing the claim that chemo only contributes about 3% of the increased survival rate in adult cancers.
The link is here:
http://www.australianprescriber.com/upload/pdf/articles/759.pdf
What’s ototoxicity?
Oh I just found out — it’s to do with the ear, especially its nerve supply.
Stuart said: “Presumedly this would then work with any cancer of the mouth and throat aswell then? Seems rather hyprocritical that we view some old time medicines (like trepanation to cure headaches and depression) as being barbaric, in that they seem to involve unnecessary damage to the body, yet we still effectivley poison patients in order to make them ‘better’. I wonder if in a few hundred years people will look back at 21st century medicine and see it as crude and unnecessarily harmful to patients.”
Well Stuart, there was an interesting show on TV several weeks ago starring William Shatner (aka Capt. Kirk) about how he changed the world we live in. While by himself he may not have been responsible, many of the concepts that were introduced on Star Trek (almost 30 years ago now) have in some cases become reality. For example…communicators have become cell phones and computers (need I even explain)? So, now put the same twist on the medical concepts that were presented in the show. “Bones” had all kinds of little gizmos and gadgets to diagnose a patient. Most cures where in the form of an injection. Body vitals were displayed without any “connection” to the body. Is it possible? Yes. In our lifetime…we’ll have to wait and see what medicine and technology can work out. Anything is possible, but it all comes at a price. On the down side…how many more persons will have to suffer because we just haven’t got all the answers….yet.
Ming_of_Mongo said: “In the 1980’s we could extend survival for a colon cancer victim by 12 months, at a cost of $1,000. Now, we can extend survival by 24 months – 50% more! – but at a cost of $50,000 (at least 10x more, even in adjusted dollars).”
Thats actually 100% more (50% more would be 18months) but your point still stands.
‘What’s ototoxicity?’
Toxic to the ear. Probably refers to vestibular and/or auditory cell loss.
the ideal od inhalation of the drug is brilliant as it proves a new route of entry into the body.
the implications are that potentially a drug that has poor level of injectibility and is poorly absorbed from a tablet but is an effective anti cancer medicine could be used if inhaled. it’s a reason why a drug will fail to make it to the market place so by altering the route of entry we could see if any of these rejected compounds might work. the use of inhalation could be useful new method.
in relation to ototoxicity some of the medicines (depending on the genetics of the person) are able to cause deafness or a significant hearing loss, the drug … some antibotics are used in a life or death situation as a final option in bacterial meniginitious (can’t spell) or serious infection. the deafness is an awful side effect but it’s rare but occurs in families after individuals were exposed to a given drug so a good history can reduce the chance.
for leukemia and lymphoma, it isn’t really chemotherapy, but bone marrow transplant that is curative. for solid tumors like lung cancer and colon cancer and osteosarcoma, again, chemotherapy is rarely curative. the definitive treatment is surgical resection.
when you’re talking about osteosarcoma in the lung, you’re talking about metastases, and pretty much regardless of whatever cancer you have, if you have metastases, then (at least for now) you’re pretty much beyond cure.
the thing that’s great about inhaled chemo is that you don’t further shorten the person’s already attenuated lifespan. they do the same thing in uncurable liver cancer: instead of giving systemic chemo, they go in with a catheter and try to target the tumor itself (the procedure is called TACE, which stands for transcatheter arterial chemoembolization.) for the most part, these things are done for palliation and not cure—for example, in osteosarcoma, if you can’t breathe because it’s obstructing the airway or taking up too much space in the chest cavity; or in liver cancer, if the tumor is compressing portal veins causing back-pressure and the risk of uncontrollable bleeding from esophageal varices.
in the future, the hope is that we develop more drugs that are molecularly targetted to cancers. one of the most useful ones so far is rituximab, which specifically targets leukemias and lymphomas and is for the most part relatively benign in terms of side effects, although you typically use it in combination with more toxic drugs. and with regards to metastases, drugs that target VEGF, which is a growth factor that allows cancers to grow their own blood vessels and facilitate seeding of metastases, are being exhaustively studied, with some of them in clinical trials.
Ok – maybe this is a dumb question – but then don’t you end up with everything in the nebulizer tent being irradiated/ radiologically contiminated?
I can just see this being an enviromental thing because under current laws you can’t just dump medical waste.. and now you can’t incinerate the sheets etc. either because the radiological contiminants may get into in the air..
Maybe this stuff is mild – but its still is probably not quite nice either.. Anyone have any thoughts?
Ironclaw said: “Ok – maybe this is a dumb question – but then don’t you end up with everything in the nebulizer tent being irradiated/ radiologically contiminated?”
It’s a common misconception/misunderstanding that chemotherapy is radioactive. Chemo is just a chemical poison treatment, and radiation therapy is a completely different procedure.
Alan Bellows said: “It’s a common misconception/misunderstanding that chemotherapy is radioactive. Chemo is just a chemical poison treatment, and radiation therapy is a completely different procedure.”
While chemotherapy isn’t radioactive, certain chemo drugs can be so toxic as to cause harm to healthy individuals if they even so much as touch contaminated linen, equipment, bodily wastes etc.
Of course cytotoxicity varies from drug to drug, but it would be interesting to see the safety guidelines for using nebulized chemo.
I bet the next big thing is going to be drinking the medecine, or applying anti cancer cream near the malignant cells :P
lahuard said: “I bet the next big thing is going to be drinking the medecine, or applying anti cancer cream near the malignant cells :P”
I know you laugh (metaphorically) but that would probably be true in only fifty to sixty years. I’m sure that cutting cancer cell out of the body makes the remaining ones to become even more malignent, but thats just what I heard off a biology student.
Progress in understanding malignancy in the past 70 years is nothing short of amazing. True, we generally still use metabolic poisons but realize, the first chemotherapy came out of WWII and is well described in a book I believe is titled “Bari”. It was nitrogen mustard and added greatly to the life span in leukemia. Before that surgery and radiation were the only treatments. Now, many cancers are cured, especially childhood leukemias. Drugs for cancer are increasingly being specifically targeted to the specific cancer. Realize cancer is not a single disease, it is literally hundreds of different diseases. Scientists are looking at the genome in many of these and at surface receptors in others to determine which treatment will be most effective. True, the costs are high but the cost of the research to produce new medications is extraordinarily high. Big Pharma is usually blamed but without Big Pharma, few of the new medications would be developed. Additionally, the unnecessary costs of government regulationadd greatly to the cost of medical care. The HIPAA regulations, a bureaucratic answer to a non-problem added at least 20 billion to the annual cost of medical care.
There are new chemo therapies that will prove to be far less toxic. Those targeting telomerase which is expressed in adults in cancer cells and not in most normal somatic cells might be part of the next generation and are already in human trials. In addition to chemo, there are also telomerase anti-cancer vaccines which cause the body to attack cancerous cells.
Cool. I’d also heard that insulin with chemo (Insulin Potentiation Therapy?) helps the toxins of the chemo to mainly hit the cancer cells… getting it where its needed is key. Sometimes it’s needed everywhere, as in the case of my brother’s kids. Here’s a hurrah for chemo, bone-marrow donors, and the lives they save .. :)
I’m sorry, but the large price tags associated with all these treatments still concerns me that there might be more motivation in maintaining the status quo than progressing any in medicine. As it has been said, there are a lot more people making a living off of treating cancer than are dying from it. One can only hope that is not the case.
That being said, it seems to me that it is the body’s natural response to kill off malignancies within the body. Perhaps if we stopped poisoning ourselves in our environments (chlorine, flourides, molds, mildews, fungus’, formaldehydes, etc), eating ourselves to death with processed foods, and effectively weakening our immune systems we wouldn’t have such a problem with it. Most everything I have seen shows pretty emphatically that treatments approaching disease, especially cancers, from a nutritional and immunity boosting standpoint as opposed to just traditional dousing with chemicals and radiation have a much higher survivability rate.
But that’s just my humble opinion.
I know very few people who haven’t lost someone to cancer – either from a distance (“Your Uncle Don died of cancer…”) or up close and personal. My father has a tumor “the size of a lemon” in the upper lobe of his left lung, WAY up there. It is considered inoperable not just due to the location, but due to his overall health and age (not great, and 85). Even if he were younger and fitter, ShenWolf’s comments about the cost associated ring in my ears – they’d preclude my dad from treatment, even if it was available now. Seems there are those with health care and there are those with health care AND a lot of money. When my uncle died he mentioned if he’d only had the half million to get the new, fancy prostate cancer operation he needed: instead, his insurer decided it was far better treatment (read: actuarially correct and affordable) to perform the typical surgery that left him incontinent, impotent, and eventually we discovered, riddled with cancer.
It leaves me torn: as much as I like to think the medical arts industry if screaming through the stratosphere of new discovery (trepanation to aspirin took hundreds (thousands?) of years; Interferon (sp?) to nebulized, direct application of medicine to lung tissues in a few decades (pardon my ignorance: it SEEMS this way), preventative medicine is still a subjective matter of argument typically limited to diet, smoking, drinking, and a series of new wonder drugs that (think Vioxx) make you sicker than when you started, and even after the lawsuits settle the drug company makes a (pun?) killing.
My dad’s supposed to be dead already. He’s actually feeling better than when I saw him last a few weeks ago (we’re on different coasts in the states). And worst of all he’s an example of everything I just wrote about: he’s smoked since he was 12 – that’s 73 years worth of cigarettes. Whether you believe cigarettes are carcinogenic or wholesome, I suspect that CAN’T be a good thing.
I have read that my children, aged 2 and 4, will live to be 200, if medicine keeps learning from it’s successes and mistakes. I may live to be 60, unless I make it long enough to stay on the medical marvel bus. My dad, we hope, will make it closer to 86, but that’s as far as he goes. And there’s a kid sitting in a tent right now possibly benefiting from the history that will eventually kill us all, sooner or later. Nobody gets out of here alive.
Wow. THAT was a dumb-ass rant. Sorry everyone. Whiny sniffling here.
Psyanide said: “doesn’t seem THAT bad of an idea. . .”
I don’t think Toom meant that it was a bad idea. I think it’s more of a “why didn’t we think of this sooner?” thing.
lp said: “I don’t think Toom meant that it was a bad idea. I think it’s more of a “why didn’t we think of this sooner?” thing.”
ahh gotcha
My question is…well, not so much a question, I guess. But four years ago, my father participated in an experimental nebulizer chemotherapy treatment, but for melanoma. Same thing? Or have they, through experimentation, narrowed down what it treats best to this particular type of cancer?
What about the previous cancer article regarding treating cancer with viruses?
EvilResident, Dr Bob, you guys sound like you may be doctors, or just really into medicine, but what level of effort is being pushed into this field of research?
We recently lost a coworker to brain, liver and lung cancer. She had been in remission for a year from breast cancer and awoke one morning disoriented with blood in her urine. I knew as soon as they told me her lungs were covered it was a done deal. It’s very sad; I’ve lost 4 family members from cancer, brain, esophageal, lung, and it’s so sad they haven’t gotten any further with treatments. The virus research just sounds so promising, I would hope they are putting considerable efforts into it.
is anyone here actually a doctor, or are they just surfing google to make themselves sound smart?
ShenWolf said: “As it has been said, there are a lot more people making a living off of treating cancer than are dying from it. One can only hope that is not the case.
I don’t understand. I’m sure you don’t mean that a higher number of cancer patients should die in order to justify the number of people who work to heal them. But I am trying to figure out what you do mean. I can think of many heroic professions that aren’t paid what they are worth, but does the idea that so many cancer researchers and doctors do make a living trying to find a cure make them somehow less nobel? My mom is a four-time cancer survivor and a public school teacher. She is a hero, as are those who have saved her. I can’t imagine what medicine in the US would be like if doctors and researchers were compensated like she is. I must have totally missed what you’d intended to say. Any clarifications?
hooray for science! however, would the chemo that is nebbulised affect the skin? particulary in any areas that are open, e.g. wounds or rashes? or even bedsores?
ShenWolf said: “As it has been said, there are a lot more people making a living off of treating cancer than are dying from it. One can only hope that is not the case.”
supernovia said: “I don’t understand. I’m sure you don’t mean that a higher number of cancer patients should die in order to justify the number of people who work to heal them. But I am trying to figure out what you do mean.”
It seems to me that the number of doctors actually treating cancer need not be equal to or higher than those suffering from it, because one doctor can take care of more than one patient. Where the personnel are really needed is in researching better treatments. In that case, the more bodies you have working toward a solution, the better.
to-be-betrayed said: “hooray for science! however, would the chemo that is nebbulised affect the skin? particulary in any areas that are open, e.g. wounds or rashes? or even bedsores?”
What I’m not clear on is the need for the tent. Typically nebulized treatments are inhaled directly from the end of a plastic tube, with little of the medicine escaping into the air. Unless this treament deviates from that practice significantly then I would not expect to see any problematic skin reactions. Perhaps the tent is there only to protect medical personnel from coming into unnecessary contact with stray vapors?