U. joins in groundbreaking cancer study

Four Philadelphia medical institutions, including the University's Medical Center, have joined together to study a new treatment for curing breast cancer. The institutions, which have dubbed themselves the Philadelphia Bone Marrow Transplant Group, are examining whether high-dosage chemotherapy combined with bone marrow transplants will help women with metastatic breast cancer more effectively than traditional methods that include low dosage chemotherapy, radiation therapy and hormonal therapy. Breast cancer afflicts one in nine women during their lifetimes and researchers say approximately 175,000 women will be diagnosed with the disease in 1991. In addition, about 45,000 women will die from the disease this year. Metastatic breast cancer is breast cancer that has spread to other organs of the body. Normally, women with this advanced state of breast cancer have a very low survival rate. "Currently, the various treatments are good at sustaining lives of women with breast cancer, but if you should develop metastatic disease, ultimately you will die," said Medical School Assistant Professor Edward Stadtmauer, one of the researchers taking part in the study. In the past, high doses of chemotherapy have been successful in destroying deadly tumors, but the radiation has also destroys bone marrow. Marrow creates blood cells and is essential to human life. The new treatment begins by removing bone marrow from the patient, freezing it and storing it before high-dosage chemotherapy treatment is administered. The bone marrow transplant is called "autologous" because the patient receives his own bone marrow and not bone marrow from a donor. The marrow is returned to the patient after the chemotherapty to grow and replace damaged or destroyed marrow. The whole procedure is expensive and lasts 30 to 35 days, during which the patient remains in the hospital. But the treatment is only administered once, making it much shorter than standard chemotherapy treatments, which are given to outpatients over a two year period. The new treatment using high-dosage chemotherapy and bone marrow transplants is the first new breast cancer treatment introduced in 10 years. Researchers said the study will examine if the new treatment is more effective than current procedures. Patients who respond well to normal chemotherapy will be randomly separated into two groups -- one group will continue receiving standard low-dosage chemotherapy and the other group will receive the new treatment. Candidates for the study must be women under the age of 60 and in good health besides having cancer. The study will by conducted at Hahnemann University Hospital, Temple University Hospital and at HUP. In small-scale studies, women with the disease have responded positively to the new treatment frequently. About 20 percent of the patients have had "long-term cures" of the disease, and researchers said they did not know if anyone afflicted with metastatic breast cancer treated with conventional therapy has ever been cured. A "long-term cure" means the patient will live two to five years after the therapy. Additional objectives in the study include comparing costs of the two treatments and comparing the quality of life of the patients during and after the treatment. In the past, treatment with high-dosage chemotherapy and bone marrow transplants has been successful in curing leukemia and lymphoma, cancer of the lymphoid tissues. Approximately 50 percent of the patients who have received this treatment are now cured. Researchers do no feel the succes rate for breast cancer will be as high. Breast cancer is a "solid cancer" while leukemia and lymphoma are not. "I do not think we will see a response of 50 percent," Stadtmauer said. "This study will show if the 20 percent long-term cure rates are true." According to Stadtmauer, this is the first study in the nation to compare traditional therapy with the new treatment. Founded last spring, the Philadelphia Bone Marrow Treatment Group has brought together four major institutions -- Hahnemann University, Temple University, Fox Chase Cancer Center and the University. "The four major institutions have bonded together rather than competed with each other and will probably be a prototype for future research groups," Stadtmauer said. "Together, we have the number of patients needed to prove whether or not statistically, the new treatment is successful." He also said the group will continue to do research after this study is completed. In addition, the study is unique because U.S. Healthcare, one of the largest health-care insurance companies in the nation, is underwriting the cost of administering the study and has agreed to pay for the treatment for their customers who voluntarily choose to enter the study. "This marks the first time that a health maintenance organization has officially provided coverage on an exception basis in order to support experimental therapy in a randomized clinical trial," U.S. Healthcare Senior Medical Director Hyman Kahn said in a recent news release.

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