If two is good four is better; isn’t that the mentality of the orthodox medical profession? Two aspirins don’t work; well, take four! It’s nonsense, of course.
Especially in respect of chemotherapy, which is highly toxic. Taking one drug is bad enough, taking two is pretty horrible, but there can be virtually no logical foundation for giving a patient three or four chemo drugs simultaneously.
Of course the shaky theory is that by tackling a tumour using different chemical mechanisms, we can get a better result. But that ignores the adding together of the toxic aspect of the treatment. It defies all reason that if one toxin comes close to killing the patient, three or four toxic substances are going to be no more deleterious.
Yet this approach is exactly what’s been happening in a recent trial conducted in Holland; adding a fourth anti-cancer drug to a three-medication treatment actually makes things worse for people with advanced colorectal cancer.
The average survival time for people in the trial who got the four-drug combination was 9.4 months, compared with 10.7 months for those given the three-medication regimen. Also, adverse drug reactions were more frequent in those given the four drugs.
The study of 755 people whose colorectal cancers had spread to other parts of the body was done because not only animal studies but two smaller human trials had found benefits from adding the antibody cetuximab (Erbitux) to a standard three-drug regimen of bevacizumab (Avastin), oxaliplatin (Eloxatin) and capecitabine (Xeloda).
Each drug works in a different way. Capecitabine and oxaliplatin kill cancer cells directly, whereas bevacizumab inhibits vascular endothelial growth factor, a natural molecule that promotes cell division. Cetuximab inhibits the activity of another molecule, epidermal growth factor.
Dr. Robert J. Mayer, a professor of medicine at Harvard Medical School and vice chairman for academic affairs at the Dana-Farber Cancer Institute, has the best comment: "Living cells are complex machines. The simple notion is that, like driving a car, you can turn the key and start running seven or eight steps under the hood, and that the same thing happens in a cell, that doesn’t fully appreciate all those steps that might be occurring." (he wrote the accompanying editorial).
But for me, the main take-away of this article is the appalling average survival time for patients taking three and four chemotherapy agents. You’d think they would have the gumption to realize it just isn’t working. 10-month survival, on average, is definitely not a positive result in my book; it cannot possibly justify the patient’s suffering as a result of the toxic treatment.
Besides, few cancers would kill the patient that swiftly if simply left alone for that period of time. Many, I would argue, would recover.
SOURCE: Feb. 5, 2009, New England Journal of Medicine