The cancers that can be treated without chemo
A new breed of drugs and strides in research offer hope to Irish people who are diagnosed with the many different types of leukaemia and lymphoma
PAUL Keane has a hazy recollection of the day of he was diagnosed with blood cancer. Lying in isolation in the intensive care unit at St James’ Hospital, his body was struggling to fight the blood infection which had taken hold and was, so far, not responding to antibiotics.
‘My memory of that time is fuzzy because I was so sick with septicaemia but I know my wife Lorraine got a phone call to say that it wasn’t looking good for me,’ he recalls. ‘It was touch and go.’
This was just eight days after the father of three began suffering flulike symptoms at home in Carlow in February last year.
‘I remember when it started, I was feeling relatively fine all day, however, by evening I began to feel sick,’ he says. ‘I woke the next day with a pain in my left leg that got worse, so I went to my GP. I had to use a wheelchair because I couldn’t walk.’
But as Paul continued to deteriorate, he was taken to St James’ Hospital in Dublin where two days later doctors diagnosed him with Chronic Lymphocytic Leukaemia (CLL), a form of blood cancer.
Paul is just one of 2,000 people who are diagnosed with a type of blood cancer every year. September is Blood Cancer Awareness Month and specialists are keen to help the public understand that chemotherapy might not be the only option available to patients when they are diagnosed.
PROFESSOR Peter O’Gorman, Director of Pathology and Consultant Haematologist at the Mater Misericordiae University Hospital (MMUH), says chemotherapy may soon become a thing of the past when it comes to blood cancers.
‘The old fashioned treatments are toxic chemotherapy, or drugs that target dividing cells, and the most rapidly dividing cells in someone with cancer are usually the cancer cells so they tend to be more susceptible,’ he says.
‘But you also have rapidly dividing cells in your hair follicles and the lining of your mouth and gut and these tend to be targeted by toxic chemotherapy.’
The new generation of drugs are biological agents which Professor O’Gorman says have a more selective effect on the leukaemia or lymphoma.
‘These sometimes directly target the cancer or the support network of cells or blood vessels. It’s an approach based on a better understanding of the disease and it has a much better side-effect profile.
‘Chemotherapy now has become obsolete in some areas. In multiple myeloma treatment for instance, there is very little chemo used at all in the early stages of the treatment. The induction treatment to induce a remission is the medication.
‘There are also stem cell transplant where high dose chemotherapy is used to consolidate the induction of a remission in younger patients under 65. In some areas they still use some chemotherapy but it definitely has a reduced role.
‘There are international studies between Europe and America that are comparing an approach without any chemotherapy at all.
‘The questions are being asked: do we really need these very toxic drugs? There is a preference for no chemo where possible.’
Professor O’Gorman says the survival rate for multiple myeloma has doubled in the last five years.
‘That is directly because of new treatments,’ he insists. ‘With other types like CLL, now there are four biological agents that can achieve long-term, indefinite control.
‘With chronic myeloid leukaemia 90%-plus of patients achieve longterm control and remain on oral medication, and co-exist with their condition which is kept to a very low level by the drugs.’
The consultant specialises in multiple myeloma and is currently embarking on a new trial in conjunction with doctors in the US.
‘We have just had a trial funded which we will run jointly with the Dana-Farber Cancer Institute in Boston which is the leading world centre in that type of blood cancer,’ he explains. ‘I will lead the Irish group, studying newly-diagnosed multiple myeloma patients.
With our previous trial we had an overall response rate of 93% which is very impressive and we want to improve on that and get 100% overall response rate, and get longer remissions. Three of the drugs have been used before and the fourth is a monoclonal antibody which is new. We are hoping it will open in the first quarter of January 2019.’
For Paul Keane, the new drugs are a lifeline as chemotherapy didn’t work for him and the 43year-old urges people to see their GP if they feel worried.
“I was getting respiratory infections maybe four times a year,’ he says. ‘My doctor thought that a post-nasal drip caused by a deviated septum might be causing my chest infections as my chest wasn’t able to properly clear itself because of my asthma.
‘I even had surgery to fix this and got grommets in my ears. When they told me I had CLL, I couldn’t process it. It was about two weeks until I could even say it out loud.’
Because chemotherapy did not work for Paul, the next step was a new targeted drug therapy to block a specific protein, and stop the cancer from spreading.
‘This drug totally turned things around for me,’ he says. ‘Overall, I spent seven weeks in hospital, I had to learn to walk again and I lost a lot of weight, but I was moving slowly towards recovery and that was the most important thing.’ Paul feels that his positive mindset is what helps him to deal with his CLL day to day.
‘The treatment options are getting better every day,’ he says. ‘The drug I’m on is only three years old and I already have a second drug I can take if this one stops working.
‘Of course things are different to the way they were before, it becomes a balancing act between your desire to plan while also enjoying right now.
‘But living with cancer becomes your new normal and to be honest, I feel better today than I have in years because of my medication.
‘I know it won’t cure my cancer but I can manage it for the rest of my life. I’m back at work, and I can live really well.’
Visit cancer.ie/bloodcancer for more information