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Fall 1999 Volume 3, Issue 6:
Tour De France Victory
By Brian G.M. Durie, M.D.
Can it become a tour de force?
When Lance Armstrong crossed the finish line of the Tour de France wearing the yellow jersey, it was not only a winning moment for an amazing individual, but also the triumph of a cancer survivor. He illustrated what can be accomplished when there is an aggressive chemotherapy which works well and induces an excellent remission. His testicular cancer was most likely cured.

How close are we to this type of cure for myeloma? How did testicular cancer – incurable 25 years ago – become a disease which now has treatment that can be curative? How did treatment make this leap forward? The answers are in many ways hopeful for all the patients looking to the development of better treatments for their disease.

I was in the audience at ASCO in 1976 when Dr. Larry Einhorn of Indiana University presented his initial findings using a combination of drugs incorporating one newer drug, a type of platinum. This new cocktail was producing dramatic shrinkage of metastasis to lung and brain and other sites. Patients with advanced disease were suddenly going into remission. Dr. Einhorn showed slide after slide illustrating the dramatic shrinkage in lung nodules. There was amazement in the packed room as the results were presented. There was also skepticism as to whether these results would hold up, if the disease would stay in remission and produce a lasting cure. As the years passed, it became clear that this particular combination of drugs can produce dramatic benefit for testicular cancer. The initial observation turned out to be a major breakthrough.

A similar paradigm shift occurred when it was realized that leukemia in children could not be cured until cells remaining in the nervous system were treated with radiation or chemotherapy, thereby eliminating these protected cells and producing a full cure. That conceptual change in protocol at the St. Jude's Hospital in Memphis converted a treatable disease to a curable disease.

Is it possible that some drugs already available can be added to our prior cocktails to convert good remissions into longer remissions and then into a cure? What made the difference for testicular cancer was the persistence and dedication of Dr. Einhorn, the upcoming president of ASCO. Each new treatment must be carefully evaluated and considered as part of a cocktail with prior therapies to see if the addition of the new drug can make the crucial difference.

Myeloma patients, like most suffering from cancer, are awaiting development of the magic drug cocktail that cures the disease. This pressures both patients and physicians to try potentially toxic treatments in the hope of stumbling upon the magic bullet. Is the cure around the next corner or the corner after that? If you are feeling well, is it worth risking an experimental approach? Does that approach compromise your options for future treatments? There is considerable confusion in the medical and lay communities as to what is best. Ironically, one problem is the many new treatments currently available. Which one to try? And, who can give the best advice?

The prospect of toxic treatments can be frightening. But the fear of missing an opportunity for a cure can be devastating. Although I do believe a cure for myeloma and many other types of cancer is closer than ever before, it will take great courage on the part of both patients and physicians to chart the best course and achieve the best quality of life while waiting for a miracle.

Will the new breakthrough for myeloma come from some deep molecular understanding of the disease? Will it come from luck or an inspired decision in bringing together some new combination? The history of medicine suggests that, although some background knowledge is helpful, the inspired guess is the likely scenario. The example of testicular cancer will undoubtedly be followed by advances in other types of cancer. As we move towards this Tour de Force for all cancers, I hope that myeloma patients will be wearing yellow jerseys very soon.

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