Gettysburg Medical News
The Clinical View
by P.E. Hoffsten, M.D.

NEW TREATMENT FOR CANCER

 The story starts simple enough;  an individual developed typical right lower quadrant discomfort characteristic of appendicitis.  He was taken to the hospital where the diagnosis was appropriately made and his appendix was removed.  Unfortunately, it was found to be a very unusual type of cancer of the colon called mucinous cyst adenocarcinoma.  It appeared perhaps to have gone through the wall of the appendix and seeded into the peritoneal cavity.  The area was cleansed and surrounding tissue removed as could be done.

     Approximately a year or two later, evidence of tumor recurrence was present.  Diagnostic procedures were carried out and confirmed that the colon tumor had recurred and now was diffusely present throughout the entire abdomen.  Chemotherapy was contemplated but had little impact.  The abdomen became quite distended because the tumor secreted large amounts of mucous in the same way that the lining of the bowel and the lining of the mouth does.  Soon the abdomen was quite uncomfortably distended and fluid was removed several times.  Each time it was removed, the fluid recurred and repeated removals did not seem to be an answer.

     It was at this point that a very skilled surgeon was consulted and removed a large amount of tumor from the abdomen.  Several months later, a second operation was done removing even more tumor.  Chemotherapy was instilled into the abdomen at that time but still, sometime later there was evidence of recurrent tumor. The question was raised of how to deal with the problem at this point.

     Last week, the column dealt with a word called apoptosis.  It was pointed out that this word means programed cell death.  It is the mechanism whereby cells that are no longer necessary or useful for the body are eliminated to make room for new cells and repairs.  It appears that many types of cancers don’t necessarily grow so fast but instead have lost the instructions for how to exit when it is time.  They no longer have normal apoptosis.

     As was mentioned last week, there is an unusual familial disease called familial polyposis.  In this condition, polyps grow in the colon and turn into cancers at an unusually rapid rate.  It was discovered accidentally that people with this condition who took aspirin-like products had a slower progression of their condition.

     To make a long story short, it was subsequently discovered that patients with familial polyposis and many of those with cancer of the colon have an increased concentration of something called Cox-2.  It appears that this naturally occurring chemical is somehow associated with a decreased rate of apoptosis.  The remarkable finding was that a recently released drug called celecoxib (Celebrex) inhibited Cox-2.  When this new drug was added to cultures of cancer cells that normally would grow uncontrollably, the cancer cells seemed to die through natural apoptosis.  What an amazing idea that certain cancers have a defective instruction manual that does not lead to normal apoptosis.  It appears that this defect results from an excess of the chemical called Cox-2.  It appears that Celecoxib inhibits this enzyme and thereby re-establishes normal apoptosis and therefore the cancer does not grow as it normally would.

    To return to the story of the individual above, the surgeon discussed options.  He had several suggestions for chemotherapy.  The one suggestion he made that seemed new and different compared to the normal chemotherapy was to start Celecoxib at 800 mg per day.  With this, the tumor markers for this gentleman’s cancer have either decreased or remained relatively stable.  Note this is in the absence of classical chemotherapy which often has many side effects. Other chemotherapy may be necessary in the future.  But for the time being, it appears that a relatively simple anti-arthritis medicine is having a very beneficial effect in treating this gentleman’s cancer of the colon.

    This concept of treatment is new.  As mentioned before, classical treatments for cancer have been those that stop rapid growth of the tumor.  But in fact, rapid growth is probably not nearly as important as inappropriately slowed cell exit.  This type of treatment is in it’s infancy but continued research and new drugs hold wonderful promise for the future.