Terminally ill? New treatments offer some groups of patients with metastatic cancer the prospect of recovery. This raises new uncertainties – for patients and doctors.
Jeroen den BlijkerFebruary 29, 2024, 10:00 PM
It used to be simple for us healthcare providers, says Eric Geijteman, internist-oncologist at Erasmus MC in Rotterdam. Geijteman conducts research into end-of-life care. “If the condition of someone with metastatic cancer deteriorated, we knew that the patient would die in the foreseeable future. We could then organize care accordingly.”
New therapies
Nowadays, other promising cancer treatments such as immune and targeted therapies are also available for some patients. “So not for all patients,” Geijteman underlines. “To date, only chemotherapy can be given for some forms of metastatic cancer, such as pancreatic cancer. For other forms of cancer, such as metastatic lung cancer, colon cancer and melanoma – a specific skin cancer – these promising therapies can be used under certain circumstances.”
Geijteman and several colleagues published an article about the successes of these treatments in the scientific journal The British Medical Journal. Immunotherapy stimulates the body’s own immune system to eliminate cancer cells itself. With targeted therapy, medication does that job.
Healing?
Immunotherapy, for example, can be so successful that you might even call it a cure. Although it is still too early to really conclude that, says Geijteman. “For example, there are no known long-term survival figures.”
But the signs in specific patient groups are very good. “About one hundred percent of all people with metastatic melanoma who respond successfully to immunotherapy will live in good condition for at least five more years.” Previously, this group of people lived at most six to nine months. Unfortunately, immunotherapy does not work in all patients with metastatic melanoma, but only in six out of ten patients. To date, it is unknown why this is the case and who will or will not respond well.
Startling and fast
The experiences with targeted therapy are also remarkable. Also because this treatment works so quickly. Geijteman: “Patients with metastatic cancer are regularly admitted to hospital and we, as practitioners, normally expect them to die shortly. If the therapy does work, we can get them back into good condition remarkably quickly.”
The BMJ article describes a 58-year-old patient with advanced, metastatic lung cancer. In her final phase she needs to be ventilated in intensive care. Until she is given medication through a tube – targeted therapy. After which she was able to leave the ICU seven days later in good condition.
Caveat
But patients differ, Geijteman emphasizes. “And targeted therapy can only be used in a limited group of all patients with metastatic cancer. For example, in twenty percent of lung cancer patients, with a specific abnormality in the cancer cell.” Of this group, 60 to 80 percent benefit.
Another side note: the effect of this therapy is not permanent. “Sooner or later resistance occurs, sometimes after a few months, sometimes after a year or a number of years. There is little to say about this in advance,” says Geijteman. The big advantage of targeted therapy is that the patient can recover very quickly, which in turn makes new treatment options possible. Immunotherapy, for example.
Target healthy cells
Unfortunately, these treatments also have side effects. Immunotherapy can also target healthy cells, the medical oncologist explains. “Organs that have never had problems before, and that have not previously been diagnosed with cancer, can still become damaged.” For example, thyroid or joint problems can arise from immunotherapy.
The list of reported side effects of targeted therapy is long, such as diarrhea and fatigue. In general, patients mainly experience only discomfort, says Geijteman. “But if you experience a lot of discomfort, this may also be a reason to discontinue the treatment.”
Nagging uncertainty
On balance, these new treatments cause uncertainties for the patient. Geijteman compares this to the New Year’s Eve lottery. “If I buy a ticket for this purpose, I do so with the thought: I am going to win the main prize, otherwise I wouldn’t have to start.” He also sees a similar feeling in people who are faced with the choice of whether or not to receive immune or targeted therapy. So there is great disappointment when the treatment fails.
All in all, it is about uncertainties. With immunotherapy, the question is: will this treatment work? And with targeted therapy: how long does the treatment last? “That uncertainty can be so great that in extreme cases a patient is relieved when it turns out that the therapy does not work or does not work; then at least there is certainty about the future,” says the internist-oncologist.
That is why Geijteman advocates a two-pronged policy: the doctor must radiate ‘we are going for it’ and at the same time also prepare the patient for setbacks. “If necessary, in several conversations.” According to him, supportive and palliative care has an important role to play in this. Attention should not only be paid to physical problems, Geijteman emphasizes, but also to the psychological, social and spiritual side of disease and treatment.
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Science
2024-02-29 21:00:14
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