Volume 5 Issue 2 - Dr. Julian Kenyon

Originally published in Issue 2 2006 icon

Julian Kenyon

Q:
I am a 45 year old female with secondary bone cancer, having had breast cancer eight years ago. I attended a talk by Chris Woollams in Melbourne a year ago and was very impressed with the information he gave us. I have since used his books to develop an alternative programme for myself at home. However, I continue to see my oncologist monthly and he recently (3 months ago) prescribed 500mg Provera daily. Since being on this, my tumour markers have come down significantly but I have had some shocking side effects. These include significant weight gain (due to increase in appetite and fluid retention), bleeding daily for 3 months, change in hair texture, and most importantly, increase in blood pressure with shortness of breath and regular heart palpitations.

I have discussed this with my doctor and he has just prescribed a diuretic to overcome the fluid retention. However, I would like to have your opinion on the use of Provera in the treatment of metastatic breast cancer.

At this stage I am considering telling my doctor that I will be choosing not to continue with the Provera but am keen to make sure that this is the right decision. What do you suggest?

A:
There are good studies on the use of Provera in the treatment of metastatic breast cancer. However it is not the only treatment available. There are a range of other possible approaches, and in my view, your quality of life is so severely affected by this drug, that you would be better in finding an alternative option. You should go back to your oncologist and say you are not going to continue with Provera due to quality of life issues, and would like to consider a change.

There are also other options you may want to consider, such as Photodynamic therapy using an agent which also responds to ultra sound as well as to red light, therefore opening up the possibility of treating bone secondaries. This treatment approach has not been fully researched yet, although it is definitely safe. There is a clinic in Melbourne that uses this.

Q:
I have a stage 4 cancer and have been told that I have limited treatment possibilities. I have read recently about a new cancer drug called Avastin and wonder whether this might help me?

A:
Avastin is a monoclonal antibody that latches on to a protein released by cancer cells called vascular endothelial growth factor. This causes nearby blood vessels to sprout and supply the tumour. If the blood supply to the tumour can be reduced, then the tumour will grow less quickly.

This drug looks like being extremely expensive, in the region of 70-80,000 annually.

In the study of Avastin in advanced cancer patients, two groups were asked to assess the data from the study. The first group was the randomised controlled trial investigators, who were also the final authors of the papers on Avastin and the second group was an independent review facility and was hired by the sponsoring pharmaceutical company to present the scientific community with a valuation free of any potential conflict of interest.

The two groups of experts looking at the same data differed profoundly in their evaluation of the overall response. In general the company affiliated investigating authors thought that more patients responded to treatment, particularly to Avastin. The Independent evaluators saw far fewer responses. Much of the argument was on what the end points of the study were. These end points were unclear and therefore for these reasons, surely the most reliable measure of benefit is overall survival, in other words how many patients are alive in each group at the end of the study. On that basis there can be little disagreement as to whether or not a particular person is alive or dead. It turned out that median overall survival of patients in this Avastin study was not significantly different between the two groups. Therefore, Avastin should not be hailed as a wonder drug, but is certainly an interesting new development.

Q:
I have breast cancer and am struggling to get Herceptin. How much will Herceptin help me?

A:
Herceptin is a monoclonal antibody and will fit onto a particular protein in the body like a lock and key and stop that protein producing its effect.

There has been huge hype surrounding Herceptin recently. The studies show that Herceptin shrinks tumours in around 15% of cases and in combination with chemotherapy it extends life by an average of about 5 months against chemotherapy alone. This is for advanced breast cancers.

It has been tested in early breast cancer and studies here show an advance in treatment in only a minority of women with breast cancer.

Herceptin is a very expensive drug and the hype surrounding it is unjustified. This was largely generated by senior American oncologists responding to clinical trial results. It’s interesting to note that one of these doctors is a paid Consultant with Genentech, Herceptin’s US distributor.

Therefore in conclusion, one of the most fitting comments on Herceptin, written in the Lancet, is that it is ’profoundly misleading to suggest that Herceptin may be indicative of any cure of breast cancer’.

Advice from The Cancer Experts - your questions answered
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