<b>Updating Chemotherapy Response Rates</b>

Dear Michael,

There have been cases where people with high grade tumors live a long time, and those with low grade tumors died first.

LMS survival is often a game of inches, and very unpredictable.

There is no question that some LMS is partially responsive to chemotherapy, and that the people with chemotherapy-responsive LMS have longer survival times. While chemotherapy is not a cure for LMS, it can extend survival considerably...and a cure or more effective management may be around the corner with a new drug. I think you need to have some additional information about chemotherapy.

Firstly, when the clinical trials for doxorubicin and ifosfamide were run, patients with GIST were included in the clinical trials as gastrointestinal [GI] LMS. Now GIST, currently treated with Gleevec, was often unresponsive to ANYTHING. So there was a wrongly lowered response rate [because of an inappropriate tumor being included.]

Secondly, many studies reported results as "remission" or "partial response" [greater than 50% shrinkage]. Stable disease was not always reported. The phenomenon of tumor death but no apparent shrinkage was not catalogued.

Thirdly, we all know that LMS sends tendrils out into normal tissue, beyond the periphery of the apparent tumor. It was unknown what chemo does to these tendrils... even with no apparent response. It is thought that the tendrils are badly beaten back, making pre-op chemo a way of possibly getting better clear margins.

Dacarbazine, Ifosfamide, and Doxorubicin are the classic chemo agents, and their clinical trials with LMS response rates run about 20% with all the caveats above, so the actual response rate is probably significantly higher.

Some of the newer chemotherapy agents, gemcitabine + taxotere, and temozolomide, may have response rates of about 50% for Uterine LMS...  but not a long response interval for everyone.  But for a median survival of 5 months, half of the people have a LONGER survival... possibly a year or more. Navelbine and ET-743 are other agents with some activity against LMS.
Aggressive metastasectomy, and careful and discriminating use of chemotherapy and radiation for control and neoadjuvant treatment, have extended the survival time of LMS patients with active disease. Some LMS survivors hit 20 years, but it is not unusual for people to survive 7 or 9 years with high grade tumors.

So your wife has a much better chance than you think.

Take her out to lunch today and celebrate that you are both alive and in love.

Do not prepare for the funeral right now, but rather live well and positively. GET PSYCHOLOGICAL SUPPORT. I URGE you. It made all the difference to me. Studies have shown that it increases survival time in other cancers.

Warmly,
doctordee
August 2002