The Efficacy of Chemotherapy for Cancer

http://www.whale.to/cancer/benjamin2.html

The Efficacy of Chemotherapy for Cancer

By Don Benjamin

In my previous article (Natural Health, December 1995/January 1996) I
focused mainly on the efficacy of surgery. In this article I try to answer
several questions related to chemotherapy:

1. What is the rationale for the use of chemotherapy?
2. What is the scientific evidence for its efficacy?
3. How much harm does it do?
4. What are the opinions of practicing oncologists about its efficacy?

1. Chemotherapy - a rationale

Chemotherapy acts differently from surgery and radiotherapy. It is designed
to kill off fast-growing cells. But it also kills many fast-growing healthy
cells. In addition it damages the immune system (see below) and is toxic.
Also unlike surgery and radiotherapy, chemotherapy is a systemic therapy (as
is hormone therapy). If cancer is a systemic disease, as claimed by most
alternative practitioners, chemotherapy is the most likely of the orthodox
therapies to be effective if only its toxicity could be reduced.

2. What is the scientific evidence for its efficacy?

Proof of efficacy of a cancer treatment such as chemotherapy requires a
randomised trial in which it has been shown that the group treated with
chemotherapy experienced a significantly increased survival when compared
with that of an untreated group. This has never been done. Unfortunately
most claims for the efficacy of chemotherapy come from trials showing
shrinkage of tumours; or from comparison of survival rates of unmatched
groups over time.

Tumour response trials assume a particular paradigm, eg the tumour is the
disease. If this paradigm is wrong and the tumour is only a symptom of a
systemic disease, the symptom can be removed, destroyed or shrunk without
affecting the course of the disease. Unless tumour shrinkage is accompanied
by evidence of increased survival the treatment cannot be claimed to be
effective. Tumour response trials rarely produce such evidence of increased
survival1. Tumour shrinkage can however reduce pain.

Comparison of unmatched groups over time can be valid if a very large
increase in survival is observed and this cannot be attributed to other
factors. For example when used to treat acute lymphocytic leukemia (ALL) in
children, chemotherapy using different types of drugs has been shown to
increase 10 year survival from less than 10% in the 1950s to about 60% in
the 1980s2. Part of this increase is only apparent because it is due to
earlier diagnosis extending the survival starting time and the increasing
incidence of less-fatal forms. However it is unlikely that more than a third
of this improvement is due to these factors. The percentage survival has
continued to increase steadily over this thirty-year period whereas
improvements in diagnostic methods and an increase in less-fatal forms are
unlikely to have developed in this way.

For other forms of leukemia the evidence is questionable. An analysis of
3-year survival rates between the 1950s and 1960s showed increased
percentage 3-year survival over this period for all forms of leukemia, yet
for all forms combined the survival remained unchanged3. Unlike the case of
ALL above, all of this increase can be attributed to the effects of earlier
diagnosis extending the survival starting time and the changing proportion
of the more fatal forms in the total cases.

A less dramatic improvement in survival has been observed for some
lymphomas1. However much of this increase can again be attributed to poor
methodology.

According to a leading epidemiologist, "for most cancers in adults, and
particularly for epithelial cancers, there has been so little progress that
it is difficult to distinguish any real improvement in survival rates from
artifacts due to improvements in diagnosis and cancer
registration4"..(survival is also slightly prolonged using tamoxifen for
breast cancer; oestrogens for prostatic cancer; cytotoxic chemotherapy for
small cell lung cancer and ovarian cancer; adjuvant therapy for resected
breast cancer and possibly colorectal cancer.)

"The efficacy of most other treatments is not established, however, and a
small proportion of patients are certainly killed by the short or long-term
effects of cytotoxic treatment4."

"There have been considerable advances in avoiding disfigurement by
radical surgery, limiting tissue damage by radiotherapy and controlling
chemotherapeutic toxicity, but for the majority of adult epithelial cancers
it is not clear whether the withdrawal of all cytotoxic therapy would
measurably alter the annual number of cancer deaths."....

"....In the many situations where it is still not known whether treatment
will prolong remission or survival, the oncologist is therefore in the
invidious position of having to weigh the cost, inconvenience and toxicity
of treatment against its unknown clinical benefit. Not surprisingly, many
clinicians respond by developing a set of firmly held but unsupported
beliefs in the merits of particular regimens. The primary treatment of
advanced non-metastatic laryngeal cancer, for example, will usually be by
surgery at certain treatment centres and by radiotherapy at others. Whether
chemotherapy is given as well and, if so, what form it will take, are also
determined more by the idiosyncrasies and outpatient arrangements of the
particular treatment centre than by objective evidence of long-term
efficacy. Similar examples could be taken from most areas of cancer
therapy4."

Similarly claims that chemotherapy have produced increased percentage 5-year
survival for other cancers, such as cancer of the large bowel1, could be
attributed to poor methodology because none of these cancers exhibited a
divergence between incidence and mortality rate curves over time5.

Ulrich Abel reviewed the evidence for the efficacy of chemotherapy for
invasive epithelial cancer6, the types of cancer for which chemotherapy is
most commonly used. He concluded that there was some evidence from
randomised trials that chemotherapy increased survival only for small-cell
lung cancer. Yet even here the gain in survival was measured in weeks or
months.

Adjuvant chemotherapy for breast cancer

It is widely claimed that adjuvant chemotherapy extends survival with
late-stage breast cancer. For example, in a letter in the Sydney Morning
Herald of 22 November 1996 Professor Allan Langlands claimed that the
results of a meta-analysis of more than 100 trials of adjuvant systemic
therapy in many thousands of women with breast cancer have confirmed a
reduced risk of death by more than 20% over the next 10 years. Presumably he
was referring to the results of 133 randomised trials involving 75,000 women
published in the Lancet in 1992.

There were 11,041 women in these trials who were randomised to long-term
polychemotherapy vs. no chemotherapy. This was the chemotherapy with the
best results. Looked at ten years after their participation in a randomised
controlled trial, these women seemed to show a 6.3% survival advantage (51.3
% vs. 45.0%). For node-negative women the advantage was just 4% (67.2% vs.
63.2%). For node-positive women it was less than 7% (46.6% vs. 39.8%). This
small difference led two researchers from Manitoba to write in the Lancet
that "no overall survival advantage has been seen so far".

Before these figures can be relied on the original trials need to be
analysed to see if they were methodologically sound. It is likely that they
contain results from many trials that have since been found to be flawed.
The history of randomised trials of adjuvant therapy for breast cancer is
dotted with examples of fraud and poor methodology.

In Italy, where the first positive survival effect was seen using the
combination chemotherapy of cyclophosphamide + metho-trexate + fluorouracil
(CMF), later analyses revealed that many patients had been excluded because
they could not complete the rather arduous treatment. So randomised
comparisons were of the healthier treated women against all controls,
rendering the trial results invalid.

In the United States randomised trials of chemotherapy were begun in earnest
in 1957 under the auspices of the National Institutes of Health (NIH). This
program eventually became the National Surgical Adjuvant Project for Breast
and Bowel Cancer (NSABP), headed by Bernard Fisher. In 1994 Fisher was
sacked from the program because he had failed to notify the National Cancer
Institute (NCI) of enrolment of inappropriate patients, a fact that had been
known for three years. Further irregularities were then discovered in data
from 12 other treatment centres. Some of the earlier NSABP trials had also
involved exclusions that would have affected results, as in the Italian
trial.

The results referred to by Professor Langlands include the results of both
the Italian and NSABP Trials.

Adjuvant treatment of breast cancer with cytotoxic drugs is one of the lynch
pins of chemotherapy and the NSABP was the key element within that program
for more than 40 years. According to Irwin D. Bross, writing in the New
England Journal of Medicine in 1994 "..the statistical quality control was
grossly inadequate in the NSABP studies. Hence, whether or not some
fraudulent cases are eliminated post hoc, any findings lack scientific
validity"7.

Ulrich Abel makes the following points about claims of efficacy in adjuvant
breast cancer therapy6:

1. Good and consistent evidence of beneficial effects of adjuvant
systemic chemotherapy on survival exists only for breast cancer, and more
specifically, for patients with at most three positive nodes;

2. So far no positive results seem to have been published for
definitely postmenopausal patients;

3. The restriction of beneficial effects to this small group appears
somewhat strange;

4. It is probable therefore that the effect is not due to the direct
cytotoxic effects on the tumour but rather to treatment-related suppression
of the ovarian function.

Chemotherapy for invasive cervical cancer

Recent claims have been made that chemotherapy helps with invasive cervical
cancer. In fact the US National Cancer Institute is claiming a breakthrough
in the treatment of late stage invasive cervical cancer according to a news
item in the Sydney Morning Herald of 24 February 1999. They claim this is
the first breakthrough in the treatment of this type of cancer in more than
40 years. (Many years ago it was being claimed that surgery was effective.
This claim has now been abandoned.) However this new evidence warrants
closer consideration because, unlike the claims made for surgery, this new
one is based on the results of randomised trials. The evidence found from 5
randomised trials is that adding chemotherapy in the form of cisplatin at
the same time as radiotherapy, following hysterectomy, increased the
percentage 3-year survival by about 10-12%.

Thus for women with Stage IIB, III and IVA cancer survival increased from
63% to 75%. For women with earlier invasive cancer, Stage IA2, IB and IIA,
survival increased from 77% TO 87%. It suggests that chemotherapy and
radiotherapy have a synergistic effect when used together and possibly that
chemotherapy stops cancer cells from repairing the damage caused by
radiation.

Unfortunately trials comparing these types of treatment with no treatment
have never be carried out so it is also possible that percentage survival is
increasing towards what it would be without treatment. Radiotherapy has been
found to increase deaths in many types of cancer so it is possible that the
same result could have been achieved simply by eliminating the radiotherapy.

After considering these developments there is no reason for changing my
original estimate that fewer than 6% of cancer cases would benefit from
chemotherapy.

Chemotherapy for neuroblastomas in children.

A recent case involving a court requiring chemotherapy against the parents
wishes for a child with a neuroblastoma raises the question: is chemotherapy
effective against this type of tumour? Neuroblastomas are tumours that can
occur anywhere in the sympathetic nervous system, as well as the adrenal
gland, the chest or pelvis. The response rate is said to be 59% with
cyclophosphamide and combinations involving high-dose cisplatin, vincristine
and other drugs1. For high-risk patients the survival rate is said to be 15%
"despite several therapeutic apporaches"1. This contrast between response
rate and survival rate is a good example of the invalidity of most claims
for efficacy with chemotherapy. This low percentage survival figure is
confounded by the fact that neuroblastomas sometimes regress spontaneously

3. How much harm does chemotherapy do?

There are three main areas of harm:

· Weakening the body's natural defences

· increasing mortality

· decreasing the quality of life

Weakening the immune system

Chemotherapy has been found to reduce the activity of natural killer cells
by 96%8. So if there are tumours growing elsewhere in the body and the
immune system helps to control tumour growth, then chemotherapy could make
things worse by allowing more rapid growth of other tumours present. However
there is little hard evidence from orthodox immunotherapy that the immune
system is a major controlling factor. In fact a recent editorial reporting
on an immunotherapy conference in Canberra in September 1998 suggests it
might be a major factor only in cancers of viral origin9.

On the other hand Immuno-Augmentative Therapy as practised at the IAT Clinic
in the Bahamas appears to produce between 15 and 18% 5-year survival with
late stage cancer patients10. Similarly the Issels Wholebody Therapy
produced 16.6% 5-year survival among late-stage cancer patients11. (Expected
5-year survival for late-stage cancer patients using orthodox therapies is
less than 2%.) As these two therapies are based on boosting the immune
system using natural methods, it appears that that orthodox immunotherapy
and alternative immune-boosting techniques must be completely different.

Increasing mortality

By analysing non-cancer deaths among cancer patients it is clear that
orthodox therapies often do more harm than good, a phenomenon that helps
explain certain claims of apparently effective treatments. (For example
cancer treatment can damage the heart and cause deaths from heart failure.
This means fewer deaths from cancer.) As there is little evidence that
surgery actually causes harm other than temporarily suppressing the immune
system8, it would appear that most of the harm is done by radiotherapy and
chemotherapy.

Analysis of the results of records of 1.2 million cancer cases in the US
SEER (Surveillance Evaluation & End Results) database showed that non-cancer
deaths accounted for 21% of all deaths. These deaths were in excess of the
rate expected for such patients. This excess was observed in all types of
cancer with an overall figure of 37%. The excess ranged from 9% for breast
cancer to 173% for lung cancer12. During the year following diagnosis this
excess was about 5 times higher, so it ranged from about 50% for breast
cancer to about 800% for lung cancer. The authors attributed this effect to
the damage caused by cancer treatment (presumably mainly radiotherapy and
chemotherapy).

Decreasing the quality of life

There is no shortage of evidence that chemotherapy usually causes a serious
reduction in the quality of life. The only question is whether or not the
worsening in the quality of life is justified in view of the very limited
claimed increased survival.

What are the opinions of practising oncologists about the efficacy of
chemotherapy?

The following are extracts from the Home Page of the Burzynski Research
Institute on the World Wide Web13:

".In an article entitled "Chemotherapy: Snake-Oil Remedy?" that appeared in
the Los Angeles Times of 1/9/87, Dr. Martin F. Shapiro explained that while
"some oncologists inform their patients of the lack of evidence that
treatments work...others may well be misled by scientific papers that
express unwarranted optimism about chemotherapy. Still others respond to an
economic incentive. Physicians can earn much more money running active
chemotherapy practices than they can providing solace and relief.. to dying
patients and their families."

"Dr. Shapiro is hardly alone. Alan C. Nixon, PhD, Past President of the
American Chemical Society wrote that 'As a chemist trained to interpret
data, it is incomprehensible to me that physicians can ignore the clear
evidence that chemotherapy does much, much more harm than good'."

In 1986, McGill Cancer Center scientists sent a questionnaire to 118 doctors
who treated non-small-cell lung cancer. More than 3/4 of them recruited
patients and carried out trials of toxic drugs for lung cancer. They were
asked to imagine that they themselves had cancer, and were asked which of
six current trials they themselves would choose. 64 of the 79 respondents
would not consent to be in a trial containing cisplatin, a common
chemotherapy drug. Fifty eight found all the trials unacceptable. Their
reason? The ineffectiveness of chemotherapy and its unacceptable degree of
toxicity14. "

The more familiar these doctors were with the treatment the less likely they
were to accept it for themselves.

Similar findings came from two other studies published in 198715,16.

A study of how expert physicians would wish to be treated for genito-urinary
cancer found a similar situation in 198817.

In relation to the treatment of 252 advanced breast cancer patients one
author observed that the "risk" of being treated by cytotoxic therapy was
three times as high in the terminal stage as in the remainder of the
patients18. As Abel points out, this does not point to the use of a therapy
that is particularly geared to patients' wellbeing6.

In March 1989 German biostatistician Dr Ulrich Abel himself investigated
physicians' choices in cancer treatment. He received 150 replies to a
questionnaire sent to oncologists and research units around the word, trying
to gauge these doctors' feelings about the use of chemotherapy in advanced
carcinoma. He reported that "the personal views of many oncologists seem to
be in striking contrast to communications intended for the public"1,6.

4. And some other opinions:

".The failure of chemotherapy to control cancer has become apparent even
to the oncology establishment. Scientific American featured a recent cover
story entitled: "The War on Cancer -- It's Being Lost." In it, eminent
epidemiologist John C. Bailar III, MD, PhD, Chairman of the Department of
Epidemiology and Biostatistics at McGill University cited the relentless
increase in cancer deaths in the face of growing use of toxic chemotherapy".
He concluded that scientists must look in new directions if they are ever to
make progress against this unremitting killer. "13

In a 1997 reassessment of the situation Bailar's view had not changed19.

John Cairns, professor of microbiology at Harvard University, published a
devastating 1985 critique in Scientific American. "Aside from certain rare
cancers, it is not possible to detect any sudden changes in the death rates
for any of the major cancers that could be credited to chemotherapy. Whether
any of the common cancers can be cured by chemotherapy has yet to be
established.13

Why so much use of chemotherapy if it does so little good? Well for one
thing, drug companies provide huge economic incentives. In 1990, $3.53
billion was spent on chemotherapy. By 1994 that figure had more than doubled
to $7.51 billion. This relentless increase in chemo use was accompanied by a
relentless increase in cancer deaths.13

Oncologist Albert Braverman MD wrote in 1991 that "no disseminated neoplasm
(cancer) incurable in 1975 is curable today...Many medical oncologists
recommend chemotherapy for virtually any tumor, with a hopefulness
undiscouraged by almost invariable failure."13

The main problem with chemotherapy is that the general public is generally
unaware that in most cases chemotherapy does more harm than good; most
doctors knowledgeable in the area know this and will admit it in private.
When an oncologist is asked what he or she can do for a patient's cancer it
is hard to say - Chemotherapy is unlikely to help you!

REFERENCES

1.. Moss, RW. Questioning Chemotherapy. Equinox Press, New York 1995.
2.. Lilleyman, JS. Childhood leukemia, The facts. OUP, Oxford, 1994.
3.. Enstrom, JE & Austin, DF. Interpreting cancer survival rates. Science
1977; 195: 847-851.
4.. Peto, J & Easton, D. Cancer treatment trials - past failures, current
progress and future prospects. Cancer Surv 1989; 8: 513-533.
5.. Benjamin, DJ. The efficacy of surgical treatment of cancer. Medical
Hypotheses 1993; 40 (2): 129-138.
6.. Abel, U. Chemotherapy of advanced epithelial cancer: a critical
review. Biomedicine & Pharmacotherapy 1992; 46: 439-452.
7.. Bross, ID. NEJM 1994; 331: 809.
8.. Beitsch, P et al. Natural immunity in breast cancer patients during
neoadjuvant chemotherapy and after surgery. Surgical Oncology 1994; 3 (4):
211-219.
9.. Goodnow, CC. Editorial. MJA 1998; 169: 570.
10.. Walters, R. Options, The Alternative Cancer Therapy Book, Avery
Publishing, New York, 1993.
11.. Issels, J. Immunotherapy in Progressive Metastatic Cancer - A
Fifteen-Year Follow-up. Clinical Trials Journal, August 1970: 357-365 with
editorial on pp 355-356.
12.. Brown, Barry W et al. Non-cancer deaths in White Adult Cancer
Patients. JNCI 1993; 85 (12): 979-987.
13.. Chemotherapy Report, Do we need a new approach to cancer? Burzynski
Research Institute Home Page, http://www.cancermed.com/chemo.htm.
14.. McKillop, WJ, et al. The use of expert surrogates to evaluate
clinical trials in non-small cell lung cancer. Br J Cancer 1986; 54:
661-667.
15.. Hansen, HH. Advanced non-small-cell lung cancer: To treat or not to
treat? J Clin Oncol 1987; 5: 1711-12.
16.. Anonym. Ein gnadenloses Zuviel an Therapie. Teil I. Zweifel an den
chemischen Waffen. Der Spiegel, 1987; 26, 128-47.
17.. Moore, MJ, Tannock, IF. How expert physicians would wish to be
treated if they developed genito-urinary cancer. Abstract No. 455. Proc.
Amer. Soc. Clin. Oncol. 1988; 7: 118.
18.. Holli, K, Hakama, M. Treatment of the terminal stages of breast
cancer. BMJ. (Jan 7) 1989); 298(6665):13-14.
19.. Bailar JC & Gornik HL. Cancer Undefeated. NEJM 1997; 336 (22):
1569-1574.
http://www.ciss.org.au/documents/chemo2.html

On Fri, 9 Oct 2009 10:12:15 +0100, "john" wrote:

http://www.whale.to/cancer/benjamin2.html

The Efficacy of Chemotherapy for Cancer

By Don Benjamin

In my previous article (Natural Health, December 1995/January 1996) I

That is old crap.
--
"Hurenweiberenkelkinder * Gott verstößt die Kindeskinder
hasst der Herrgott auch nicht minder. * von Huren(5.Buch Mose,Kap.23)
Dies gilt auch für Ammoniter *
und die miesen Moabiter." * http://www.reimbibel.de

On Fri, 9 Oct 2009 10:12:15 +0100, "john" wrote:

Proof of efficacy of a cancer treatment such as chemotherapy requires a
randomised trial in which it has been shown that the group treated with
chemotherapy experienced a significantly increased survival when compared
with that of an untreated group. This has never been done.

Of course it has, and the results showed both much longer survival and
better quality of life for those treated with chemotherapy compared
with those treated with a "naturopathic" treatment.

"Peter Parry" wrote in message
...
On Fri, 9 Oct 2009 10:12:15 +0100, "john" wrote:

Proof of efficacy of a cancer treatment such as chemotherapy requires a
randomised trial in which it has been shown that the group treated with
chemotherapy experienced a significantly increased survival when compared
with that of an untreated group. This has never been done.

Of course it has, and the results showed both much longer survival and
better quality of life for those treated with chemotherapy compared
with those treated with a "naturopathic" treatment.


http://www.whale.to/cancer/chemo.html

http://www.whale.to/cancer/benjamin.html

On Fri, 09 Oct 2009 20:27:16 +0100, in misc.health.alternative, Peter
Parry wrote:

On Fri, 9 Oct 2009 10:12:15 +0100, "john" wrote:

Proof of efficacy of a cancer treatment such as chemotherapy requires a
randomised trial in which it has been shown that the group treated with
chemotherapy experienced a significantly increased survival when compared
with that of an untreated group. This has never been done.

Of course it has, and the results showed both much longer survival and
better quality of life for those treated with chemotherapy compared
with those treated with a "naturopathic" treatment.

What was the recent news about the latest study on Pancreatic
cancers?

This old report looks like it can be no longer considered true at
all, if it was ever considered true at all.

John lives in a dark world of beliefs and superstition, not science.


--
Bob Officer
Posting the truth
http://www.skeptics.com.au