Someday Cancer Patients May Hear: ‘For Relief, Take …’
Network - Spring 2009
By Sandi Stromberg
As a cancer survivor, you might ask, “What do an antibiotic, an antidepressant, a spice and a wakefulness-promoting agent have to offer me?”
“Perhaps relief,” is the answer.
According to researchers at MD Anderson, some combination of four tried-and-true agents may work as interventions for treatment-related symptoms and side effects for patients with lung or head and neck cancers — especially if they are plagued by fatigue, pain, sleep disturbance, lack of appetite or drowsiness.
“Through a grant from the National Cancer Institute, we have the opportunity to test these agents in combination,” says Charles Cleeland, Ph.D., chair of the Department of Symptom Research at
MD Anderson and principal investigator. “One of the problems with symptom research to date has been the lack of a strong evidence base. Now we have the funding to get good clinical trial information about a very accessible approach to symptoms.”
A constellation of symptoms
The clinical trials will continue the work Cleeland and his team began several years ago with clinical investigators when they defined the specific symptoms patients with lung or head and neck cancers experience in response to treatment.
“These patients start off with very few or no symptoms at diagnosis,” Cleeland says. “Then, from chemotherapy and radiation they develop a constellation of symptoms that we’ve learned are associated with aggressive cancer therapy. These can cause significant distress and are poorly controlled despite standard supportive care.
“One of the novel things about this study is the use of agents that are usually meant for another purpose to treat these severe symptoms. We’ll analyze study results frequently and assign new patients to only the most successful treatments — a departure from classic randomized clinical trials.”
The four intervention agents are:
- Curcumin, the main ingredient in the yellow spice turmeric
- Minocycline (Minocin®), an antibiotic
- Modafinil (Provigil®) , a wakefulness-promoting agent originally developed to treat narcolepsy
- Bupropion (Wellbutrin®, Zyban®), an antidepressant
An interactive voice response system tracks the impact these interventions have over a period of time. A computer calls patients who use their telephone keypad to self-report the severity of their symptoms on a scale of 0-10, 0 being “not present” and 10 being “as bad as you can imagine.”
By charting responses, Cleeland and his group can know that treatment is successful if overall severity of symptoms is reduced.
Getting to the root of the matter
Growing scientific evidence suggests that symptoms occur in clusters and that common biologic mechanisms, such as inflammatory cytokines (signaling proteins), may cause or contribute to these clusters.
Cleeland’s group hopes that by investigating various combinations of these agents with broad anti-inflammatory properties and low toxicity, they will be able to reduce the most severe symptoms caused by treatments: fatigue, pain, sleep disturbance, lack of appetite and drowsiness (in lung cancer patients) or difficulty swallowing (in head and neck cancer patients).
“It used to be that the side effects of therapies were so horrible you sort of closed your eyes and treated,” Cleeland says. “Now doctors at MD Anderson have a sense that symptoms can be treated, and as our co-investigators, they want to help patients in a way that leaves them with less symptom burden.”