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BLOG: June 2009

Efficacy and safety of the
conventional treatment for Hodgkin's: behind the hype

Daniel's case - True chances - Late effects - Mortality
Real picture - Hodgkin's kids - Alternatives

Let's summarize our findings.

Is Hodgkin's lymphoma in children as highly "curable" with the conventional chemo and radiation treatment as the headlines in various medical and media publications would make you think? After going through a small but relevant portion of evidence, it turned out not to be the whole truth.

And, mind you, what's been left out doesn't exactly support proclaiming official treatments for Hodgkin's a cure.

What makes it to the headlines is usually the success rate with early-stage, low- to mid-risk childhood Hodgkin's patients within 5 years, occasionally 10-years from commencing the treatment. That probably seems to be a nice thing to put in the headline, or write about.

So, what should we make of a headline such as "Doctors report high survival rates for Hodgkin's disease", with 98% 5-year symptom-free survival rate for Hodgkin's patients on conventional treatment with most favorable prognosis, and at least 85% for those with worse outlook cited in the text? Adding that it's been already surpassed by the more effective and safer chemo/radiation modalities?

Sounds as if conventional medicine has gotten for us

a real cure for Hodgkin's,

doesn't it?

But when you take a closer look of this particular study (Chemotherapy plus Involved-Field Radiation in Early-Stage Hodgkin’s Disease, Fermé et al. 2007), you find out it was, as its title says, limited to early, easier to treat stage Hodgkin's (I and II), but that nevertheless used rather intensive treatment of MOPP-ABV chemo plus 36-44 Gy involved field radiation. If the study had advanced Hodgkin's disease (III and IV) cases included, the low percentage would be, as usual, somewhere around 70%. Not good enough for the headlines.

Remember, also, that "symptom-free" relates to the specific symptoms of Hodgkin's; it doesn't account for other symptoms of compromised health and feeling of wellbeing caused by the harsh, toxic treatment.

This news is, actually, no news. It is known for quite some time that intense chemo/radiation treatment can result in higher overall and "symptom-free" survival rates in Hodgkin's patients in the first 5 to 10 years. The earlier, more favorable stage the higher rate, sometimes approaching 100%. The drawback is that its

higher toxicity takes higher toll in elevated morbidity
and mortality rates after this period.

And, as the long-term mortality plots show, this toll is too high, not in a small part due to those practicing the treatment being lured into favoring more intensive protocols by their higher early "success rate".

For instance, the National Cancer Institute web site cites the study that had established 3.2 times higher risk of developing breast cancer (period not specified) for women treated with 4 Gy of radiation and 8-fold increase for those exposed to 40 Gy (Travis et al, Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease, 2003). But the study was for women diagnosed at the age of 30 or younger.

What NCI page doesn't mention is that the risk increases significantly for females younger than 20 - as mentioned, as much as 56 times for women treated at 16 years of age or younger, within averaged 17-year period from the treatment (Late Effects Study Group).

In fact, trials claiming near 100% survival rate within first 5 years, or so, from the treatment, have been around for the past 2-3 decades. The shiny facade of conventional medicine that these every-once-in-a-while studies proudly display is that its highly toxic chemotherapy/radiation treatments can be very effective in killing Hodgkin's malignancy. What gives much less of a reason to be proud of and is, for that reason, either left out or usually mentioned only in more or less general terms, is that cardiac, pulmonary, liver, and overall cellular toxicity of such treatments is

taking heavy toll on Hodgkin's patient population down the road.

Especially the children. What was unfolding for the past few decades in this field - and still continues as we speak - is a long, slow process in which the conventional medicine attempts to reduce this toll by modifying these toxic treatments so that their suspected most damaging "ingredients" are minimized or, if possible, replaced by other toxins that haven't gotten a "bad jacket" yet.

So the last 2-3 decades have been spent in chasing that particular combination of toxic chemical and radiation that would maximize remission rate for different stages of Hodgkin's, while at the same time minimizing relapse rate and long-term treatment-related morbidity and mortality.

The list of what they have learned so far is rather long. Excessive toxicity is, so far, associated with:

indiscriminate extended field radiation, intense involved (limited) field radiation, both linked to vastly increased risk of developing secondary solid tumors, sterility, cognitive impairment, cardiac disease, pulmonary fibrosis, spinal deformities, skin cancer, etc.
anthracyclines (heart disease, bone marrow suppression - leukemia)
- alkylating agents (hypogonadism, sterility, leukemia, bladder disorders/cancer, bone cancer, pulmonary fibrosis, kidney damage, cataract)
vincristine (neuropathy)
methotrexate (seizures, cognitive impairment, bone marrow suppression, liver cirrhosis)
6-mercaptopurine (liver cirrhosis, neuropathy)
- bleomycin (pulmonary fibrosis)
epipodyphyllotoxin (leukemia, secondary malignancy)
prednisone and other corticosteroids (osteopenia, osteoporosis, osteonecrosis, cataract)
combinations like chest radiation and bleomycin, chest radiation and anthracyclines, chest radiation and alkylating agents, chest radiation and abdominal or pelvic irradiation,
topoisomerase 2 inhibitors (bone marrow suppression, acute myeloid leukemia, myelodysplastic syndrome)

and so on.

The early chemo modality standard MOPP, leaving nearly all male patients sterile (also leaving most female patients with ovarian failure - early menopause) and causing excessive incidence of leukemia (among other diseases), has been improved upon by the ABVD modality, more forgiving fertility- and leukemia-wise, but with elevated cardiac and pulmonary toxicity.

The problem is that significant reduction in treatment's toxicity also reduces its efficacy against Hodgkin's, to the extent that some trials in that direction had to be discontinued.

 The simple, obvious truth is that this type of treatment has to be sufficiently toxic in order to kill cancer cells. And that

there is no way to protect rest of the body from its toxicity. 

Just take a look at the mechanism of action of some common chemotherapeutic agents:

alkylating agents (some of which are used as chemical weapons, and handled wearing personal protective gear) - damaging DNA by adding to it alkyl group, which causes denaturation of DNA molecules, formation of adducts (damaging stable molecular bonds/cross-linking) and overall alteration of the DNA structure; alkylated DNA becomes dysfunctional, degrading cellular viability, or causing cellular death; it can, of course, also produce mutated, possibly malignant cells

BLEOMICIN - splitting DNA strands

PLANT ALKALOIDS - mitosis (cellular division) disruption

EPIPODYPHYLLOTOXIN (VP-16) - interfering with cell cycle progression

ANTIMETABOLITES (methotrexate, 6-mercaptopurine) - inhibition of nucleotide synthesis

ASPARAGINASE - inhibition of protein synthesis

Although, in general, chemotherapy agents should be hurting cancer cells more, the treatment has no mechanism to efficiently prevent damage to normal cells by their toxicity.

In short, conventional medicine got stuck with a highly toxic treatments for cancer in general and Hodgkin's lymphoma in particular, which it desperately attempts to repackage and resell it as a "cure". Why? Because it is a multibillion dollar business, and it is their "tardemark".

Common sense tells us that this repackaging is not likely to bring significant changes. Since the combined radiation/chemo modality treatment that begun with the MOPP+radiation back in mid 1960s, and advanced to still the "gold standard" ABVD+radiation in 1975, most of the reduction in treatment toxicity has been achieved by reducing the radiation exposure. But there is nowhere to go from where it is now. So called mixed modality treatments that juggle different toxic ingredient, as long as they are effective in poisoning the Hodgkin's, are

bound to be as toxic long-term as the standard modalities.

Such treatment can never become a cure. Even the word "success" can be applied only conditionally, when measured against the "no treatment" option. No other treatment option has been given a fair chance to compete. If 2 out of 3 of your children patients are likely to die within the next three decades, and nearly all will suffer from chronic diseases, your treatment is NOT successful. It is NOT a cure.

Hinting that this may be due to the long-term consequences of unnamed factors related to the Hodgkin's disease pathology does not sound very convincing. Toxicity does.

Toxins can be safely used against cancer only if they can be for the most part channeled to the cancerous cells, the way that, for instance, the ingenious Dr. Whelan's Photodynamic Therapy does. Or the way that the alternative, natural cancer-cell-killers like laetrile or cesium do. The other venue to explore is, of course, what is it in the body that leads to Hodgkin's disease, and address its causes directly.

All this brings us back to the original question: Does the government has the right to force children to undergo conventional Hodgkin's treatment against their own and their parents' will? Should your oncologist be allowed to take you to the court because you want to try non-invasive treatment first?

Our little research shows that the toxic, invasive conventional treatment is efficient in eliminating Hodgkin's and keeping most of the patients reasonably well in 5 to 10 years after treatment - but does not guarantee survival nor wellbeing.

The more we go beyond this period, the greater chance of suffering chronic diseases and dying, as a result of the long-term damage inflicted by treatment's toxicity. Majority of children patients is bound to suffer from one or more chronic diseases, including those life-threatening. Their chances of being dead 20 years or more after being treated are

better than to be alive.

For Daniel Hauser, that would be only 33 years of age.

And he is not alone. According to the National Cancer Institute, some 850-900 children and adolescents below 20 years of age are diagnosed with Hodgkin's every year. Expectedly, Daniel's drama is not the first one, nor the last. Let's look at some of those stories that have caught public attention.