PARK RIDGE, Ill. — A new approach to cancer care is about reducing the short and long-term toxic side effects while still reaping the benefits of a powerful treatment regimen.
Local doctors are testing the concept of lower dose chemotherapy, in some cases even excluding the drug, in patients with breast cancer.
Less may not be more, but it may be enough for some fighting the disease.
With one more needle prick, after nearly a year, this is Lana Callahan’s last treatment.
The 43-year-old has what’s called her two positive breast cancer.
“Her two positive tumors are more aggressive,” Dr. Christie Hancock said. “They like to return. They like to come back in bad places, the brain, the liver, the lungs.”
Callahan said she is very lucky it didn’t spread to her lymph nodes.
For patients like Callahan, as well as those with triple-negative tumors, standard treatment is typically six cycles of chemotherapy with four different doses, including one, carboplatin, which is known to cause significant side effects.
“This regiment is pretty tough,” Hancock said.
Patients may experience nausea, vomiting and overall fatigue and weakness. Diarrhea is a major concern.
“One out of five patients end up in the hospital admitted for IV fluids and continued support, so it’s very toxic,” Dr. Sigrun Hallmeyer said.
And some drugs can damage bones and vital organs along the way, the heart, lungs and kidneys can all be impacted.
“I did the research and I made a decision. This was the best decision for me,” Callahan said.
Hoping to avoid the toxicity of standard treatment, Callahan opted for a clinical trial at Advocate Lutheran General Hospital in Park Ridge where medical oncologists are testing the efficacy of fewer chemotherapy cycles and fewer drugs.
More specifically, removing carboplatin from the treatment regimen.
“What I liked about this trial was it’s just a little bit less chemo, it wasn’t zero chemo,” Callahan said.
Callahan received three drugs in her chemo cocktail before and after her double mastectomy, hoping to achieve a similar outcome as patients who underwent standard treatment.
“We can feel the disease and many of those patients will have palpable tumors and I’ve seen it in my practice, very frequently where they come back for their second or their third or their fourth cycle,” Hallmeyer said. “And their breast exam has already completely normalized so that is where the question was born, well do we really need to do cycle 5, cycle 6? Do we really need all 4 drugs to get to this outcome?”
Called the Compass Trial, doctors at multiple study sites are tracking how the reduced therapy holds up.
“We still want to cure all these patients of their aggressive breast cancer, but can we get to curative outcome by using less therapy at least up front,” Hallmeyer said.
For the busy mom, the experiment meant she might be well enough to work and care for her family throughout treatment.
“It’s hard. You feel tired, you’re exhausted and your body is fighting and it’s hard. It’s hard to be a good mom during that time, but long term, I wanted to make sure I was here for them,” Callahan said.
Hancock said she was an advocate for herself and the reduced treatment was a success.
“So best case scenario, she got the four cycles of treatment and then when she went to surgery, no cancer was seen,” Hancock said.
The strategy doesn’t work for every patient. Those who still have residual cancer following surgery require a more aggressive treatment protocol.
I think trials are important. I think about my daughter, I think about other women,” Callahan said. “We want to kill the cancer, but we don’t want to damage our bodies so much that it shortens our lifespan after we’ve killed the cancer.”
The Compass trail is still open for enrollment across the country.