November 4, 1997 in Nation/World

Cancer Treatment Debated Bone Marrow Transplants Save Women’s Lives, Doctor Says

Knight-Ridder
 

A major debate over how to treat potentially deadly breast cancer spilled into an international breast-cancer conference Monday, with a Detroit doctor arguing bone-marrow transplants give women the best chance of being alive five years later.

“This saves more lives than any form of chemotherapy,” argued Dr. William Peters, chairman and chief executive officer of the Barbara Ann Karmanos Cancer Institute.

But Dr. Craig Henderson, a prominent cancer doctor, took issue with Peters, saying women given the transplants live longer only because they are healthier than comparison groups of women getting standard chemotherapy.

The debate between Peters and Henderson highlighted the “Era of Hope” breast cancer conference at Washington’s Renaissance Hotel. The conference is the first report to the nation about breast cancer by the Department of Defense, which has funded $600 million in breast cancer research since 1992.

The bone marrow discussion is a simmering national debate because while more breast cancer is being found early, it still is diagnosed at potentially lethal stages in thousands of women. This year, 44,000 women and men will die of the disease - one every 12 minutes. It is the leading cancer in American women.

The disease is particularly deadly when it advances to 10 or more lymph nodes under the arm.

In many states, insurance plans have refused to pay for the transplants, saying they are experimental.

Bone marrow and related stem cell transplants are adding years to the lives of women, Peters told the audience, and even may hold hope for a cure for some. The therapies involve high doses of chemotherapy, followed by infusions of bone marrow or a blood product called stem cells to repair immune system damage caused by the highly toxic drugs.

Peters presented data showing 70 percent of women with 10 or more positive lymph nodes who receive bone marrow transplants, as they are generically called, are alive 10 years later, compared to 40 percent getting conventional doses of chemotherapy.

Among women with the most advanced type of breast cancer - metastatic tumors that have spread beyond the breast to the lungs, brain or another organ - 40 percent are alive nine years after a bone marrow transplant, compared to 5 percent getting standard chemotherapy, Peters said.

Peters agreed better studies need to be conducted but pointed out women with more aggressive tumors often don’t want to be included in studies that assign them to a comparison group getting only standard chemotherapy. He agreed patients are selected for good health, no sign of cancer after initial rounds of chemotherapy and other factors but said such selection criteria are used for any treatment.

Henderson, however, argued this selection bias largely explains the survival differences. Studies of conventional chemotherapy include older patients eligible for transplants now, as well as women who may not have had remissions of cancer from chemotherapy. Once these factors are considered, women with cancer in 10 or more lymph nodes have the same odds of being alive in five years as those getting a bone marrow transplant.


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