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Clearing the haze of chemo

A drug to boost cancer patients' memory is one of several research advances.

June 11, 2007|Thomas H. Maugh II

By the time Brenda Oathout had finished chemotherapy for her breast cancer, the Caledonia, N.Y., woman noticed a distinct change in her ability to think.

"Everything was a struggle. I couldn't remember things," she said. "Forgetfulness is not a strong enough word. My thought process was clouded. The more you struggle to think and remember, the more fatigued you become. By 3 o'clock, I was exhausted, overwhelmed with life."

Oathout, a 56-year-old financial advisor, was suffering from a condition known as chemo brain, a side effect associated with many forms of cancer chemotherapy, but particularly with treatment for breast cancer.

Many oncologists do not believe it is a real condition, but three papers published last December provided a strong scientific foundation to the idea. They showed that chemotherapy drugs can kill brain cells and that the brains of women who are receiving them undergo significant changes.

Oathout's life changed when she was invited to enroll in a new clinical trial at New York's University of Rochester Medical Center studying the effects of modafinil, a drug already being used to treat the sleeping disorder called narcolepsy.

"The very first day I took it, I noticed the difference," she said. Now, "I can be me again -- mother, grandmother, wife, good employee. All the things that I used to be that I had lost for a while."

Results of this trial were among several promising advances reported last week at a Chicago meeting of the American Society for Clinical Oncology.

Among the others: news of the first drug shown to increase survival in liver cancer, data showing that irradiation of the head can reduce spread of one type of lung cancer to the brain, and findings that many breast cancer patients can do well with fewer radiation treatments.

For Oathout, the benefits of modafinil were so great that she now pays $742.48 a month out of her own pocket for the drug because her insurance company will not.

Oathout was one of 68 breast cancer victims who enrolled in a study by Sadhna Kohli of Rochester's James P. Wilmot Cancer Center on the effects of modafinil, which is sold by Cephalon Inc. under the trade name Provigil. Although the study was small, it demonstrated great potential for using the drug to treat this disabling aftereffect of cancer therapy.

In Kohli's study, all the women received modafinil for four weeks, then half received it for another four weeks and half received a placebo. All were given standardized tests to assess their powers of concentration and memory.

After four weeks, the women had faster recall of things they had seen and could recognize words and pictures more accurately. At the end of eight weeks, among the women who continued to receive the drug, their attention deficits had improved and their memory was even better, Kohli said.

Sunita Patel, a neuropsychologist at City of Hope National Medical Center, said that even a small improvement in mental functioning can have a dramatic effect on how women getting chemo feel and how they perform on the functions of everyday life. Of the study, she said, "I'm a little cautious because there is so little data yet, but this is definitely good news."

The study was sponsored by Cephalon and the National Institutes of Health.

Scientists at the meeting also reported on a new therapy for liver cancer, a particularly pernicious disease that has defied most attempts to treat it. Since 1970, experts said, there have been more than 100 clinical trials of potential treatments for the disease with no successes.

Furthermore, the incidence of the disease is increasing dramatically because of the spread of hepatitis, which is one of the primary causes of liver cancer. In the United States, about 19,000 people contract liver cancer each year, with 17,000 dying. Those numbers have doubled over the last 20 years, primarily because of increases in hepatitis C.

Worldwide, liver cancer kills 622,000 people annually, making it the third leading cause of cancer deaths.

The new drug is called sorafenib, marketed under the brand name Nexavar by Onyx Pharmaceuticals Inc. of Emeryville and the German pharmaceutical company Bayer Corp. A new study reported at the Chicago oncology meeting shows that patients who receive it live 44% longer than those who do not.

Nexavar is truly "a breakthrough," said Dr. Yun Yen, head oncologist in the liver program at City of Hope. "It sets a new standard for liver cancer. From now on, all comparisons of new drugs will have to be made to Nexavar."

Already approved by the Food and Drug Administration for the treatment of kidney cancer, sorafenib has a two-fold mode of action: It blocks signals that cause the cancer cells to proliferate, and it prevents the formation of blood vessels that provide nutrients to the tumor.

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