New strides are being made in treating certain common types of cancer. It’s not simply a matter of new drugs. Researchers are coming up with more and better ways to target treatments, to determine which patients are likely to receive the most benefit from what approach, and to tailor the treatment program accordingly. That means as soon as the disease—in particular, chronic lymphocytic leukemia, the most common type of leukemia, which can by controlled but not eliminated by chemotherapy—is discovered in a patient, doctors can figure out the treatment most likely to work for that patient, rather than running through the available ones arbitrarily until finding something that works.
In particular, different treatments work differently in patients of different ages. Normally, the patient’s age is given very little weight when it comes to determining a treatment protocol for CLL. However, a recent study at The Ohio State University found that patients over 70 and under 70 had different treatment outcomes for some regimens. In particular, a drug called chlorambucil, sold as Leukeran, helped the older patients live longest, even though it is less effective in younger patients.
By contrast, in patients under 70, a drug called fludarabine, sold as Fludara, was found to lead to longer lifespans after diagnosis and longer periods of dormancy, during which the disease did not progress. This may have lead to misleading results in clinical trials. Most participants in those trials have been in their early 60s and responded to Fludara. Meanwhile, most CLL patients are over 65, and many over 70, and that drug is less effective for them.
However, there is a suggestion that all patients, regardless of age, can benefit from fludarabine used in combination with another drug called rituximab. That’s why the researchers suggest that future drug trials with older adults ought to start with rituximab and similar drugs, rather than fludarabine. The study also showed that another drug, alemtuzumab, administered after chemotherapy to perform a sort of “sweeping-up” function and get rid of remaining cancer cells, is largely ineffective in this type of leukemia, and confers no significant benefit on patients of any age.