July 27, 2007
IU Cancer Doctor Curing Even More
By Shari Rudavsky, The Indianapolis Star
Jul. 26--Indiana University's Dr. Lawrence Einhorn, who pioneered a cure for the majority of men with testicular cancer and cured Lance Armstrong, has developed a way to treat the small percentage of patients who do not respond to initial therapy.
He is the Lance Armstrong Foundation professor of oncology at Indiana University Medical Center.
After joining IU, he began studying the effects of chemotherapy on testicular cancer in 1974.
A 1965 graduate of Indiana University, Einhorn also is a member of the National Academy of Sciences and the American Philosophical Society.
Einhorn combined high doses of chemotherapy with a transplant of patients' stem cells to combat the disease. The results appear in today's New England Journal of Medicine and could further cement IU's reputation as the go-to place for the cancer that affects about one in 400 men.
More than 60 percent of the 184 patients whom Einhorn and his IU colleagues treated with this regimen saw their tumors disappear.
"Just as it's overwhelming to be told you have cancer, what's even more overwhelming is to go through a very difficult three months of chemotherapy only to be told the cancer has come back," said Einhorn, Lance Armstrong professor of oncology at the Melvin and Bren Simon Cancer Center. "The fact that we can now talk about curing 60 percent of cancer is really spectacular. I wish we could do this in all diseases."
Brownsburg resident Zach Canada benefited from the treatment.
Diagnosed with testicular cancer in October 2005, Canada was relieved to hear statistics about the chance of recurrence. About 95 percent of men with testicular cancer will be cured by initial treatment. For patients like Canada, whose disease had not spread, the success rate is even higher.
"I thought, 'Sweet!' " he said.
Canada, now 35, went through three rounds of chemo, and the tumor was gone.
But almost a year to the day of his diagnosis, he felt a pain in his abdomen. The tumor had returned. Einhorn prescribed a grueling three months of chemotherapy and infusions.
"It was shocking, very shocking," Canada said. "But for me, there really wasn't another option. I'm fortunate enough to be in the backyard of one of the greatest cancer centers in the United States, so I didn't question it."
Canada spent 30 of the next 50 days in the hospital. At the end, a scan revealed it had been worth it.
The tumor was gone.
Einhorn's method involves delivering chemotherapy in doses about five times higher than the original treatment. Because these doses can cause severe side effects, including low blood counts, blood is collected from patients before chemo and frozen.
That blood contains stem cells that will develop into healthy blood cells and help with recovery. The doctors deliver these stem cells to the patient in a process similar to a blood transfusion.
Until about 10 years ago, Einhorn relied on bone-marrow transplants to collect the stem cells, but this newer technique does not require patients to undergo operations.
"The patient's blood counts recover much more rapidly, which allow us to give a second course more rapidly," he said. "So there's not so much time in between the courses of chemotherapy so the cancer can start growing. Even though there was pessimism about high-dose treatment, this is a very different model, so that was our enthusiasm for doing it."
Although others in the field treat relapsed patients with standard therapy, the IU researchers suggest this might be a better option, said Dr. David Vaughn, an associate professor of medicine at the University of Pennsylvania.
"This provides a lot of evidence that if you do that, the patients have a better response," he said. "It shows that this high-dose therapy with stem-cell transplantation can be done with a significant degree of patient safety."
However, he noted that three patients in the study experienced drug-related deaths, and three others developed leukemia.
But the fact that the majority of his patients did so well led Einhorn to the New England Journal, one of the field's premier publications, when it came time to publish.
"We still get problems from some insurance companies, saying that this is experimental, and having it with the imprimatur of the New England Journal of Medicine makes it easier for patients to get this therapy," he said. "Secondly, this is something that everybody in the world should be doing."
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