Author and New York Times reporter Gina Kolata wrote an important but sobering article similar in tone and concept to an extensive article in Newsweek last year, essentially saying that despite a declared “War on Cancer” that is approaching four decades long, our progress has been painfully slow. These sources stand out against a broader media tone that paints a misleadingly rosy picture of our progress, highlighting all too many early leads as an imminent breakthrough. These puff pieces are the stories that get you to tune in at 11, or buy newspapers (well, until they go the way of the 8-track tape). But they do a real disservice when they delude the public into thinking there are easy answers for cancer, especially metastatic cancer.

This isn’t to say that we aren’t making progress, because we are, but it’s “evolutionary and not revolutionary”.  Dr. Pennell recently wrote about an article that documents meaningful improvements, and I most definitely agreed. But the oncology community can’t bask in the glory of major victories here. We’re chipping away at the prison wall.

One other issue that the NY Times article highlights is that throwing money at research hasn’t translated into the return on investment we’d have hoped for. While we can probably all agree that continuing to channel efforts into cancer research is important, I’ll make the point as someone from an inside view of oncology practice, we could achieve far better results for cancer patients here and now if everyone received the best treatments we already have.

For me, it’s humbling to know that cancer research is simply a much sexier concept than cancer education. But the painful secret is this: Our five year survival rate in lung cancer has improved by only 5% since the US waged a “War on Cancer”, despite spending well over 100 billion dollars on cancer research in that time, and we could do better than that just by having people receive the best treatment available today. But that doesn’t happen.

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This doesn’t directly relate to lung cancer, but in a prior post I described a trial of the vitamin D analog calcitriol (Asentar) with taxotere for treating advanced NSCLC. Although it has been very unclear whether there might be any future for this agent in lung cancer, I and many others were pretty impressed by the results of a randomized phase II trial for metastatic prostate cancer, called ASCENT, with 250 patients who were randomized to taxotere and prednisone with or without calcitriol. This study actually showed an improvement in overall survival in the recipients of calcitriol with chemo, but it wasn’t a huge trial. A larger phase III randomized study with the same design (called ASCENT-2, cleverly enough) has been ongoing in prostate cancer. Presumably, if this one came out as well, it would look good for it to be approved by FDA.

While we don’t have any real results yet, we know from a press release that the trial was stopped early due to an unexpected excess of deaths on the arm that received calcitriol with chemo. This led the Data Safety Monitoring Board to close the trial. This doesn’t have any immediate implications for lung cancer, except that now I’d really doubt we’ll see the concept I described in my post followed with a larger study in lung cancer. And it’s another example of how an early small trial can look really promising, but the new treatment not only be of no significant benefit but also potentially be harmful. I haven’t been recommending high dose vitamin D for my patients, but it’s a cautionary point that there might be detrimental effects from high doses of certain vitamins (potentially from the interaction with chemo but wouldn’t occur without concurrent chemo). I don’t have any more details, but I’ll let you know if we learn more.