Researchers have published the results of the first clinical trial in Africa of a treatment for non-Hodgkin's lymphoma, a major cancer in people with AIDS. The new treatment promises to be safer and less arduous than current anti-cancer therapies.
The problem with many kinds of cancer treatments is that they often can be as bad as the disease. Chemotherapy can increase the risk of anemia, fatigue, infection and excessive bleeding. In developing countries, this presents some big problems, says oncologist Scott Remick at West Virginia University.
"The health care system is going to be very challenged by taking care of people that get very very sick from chemotherapy," he says. "And often times patients can't get to health care facilities in a timely manner, so by the time they present, they're very, very sick."
Even if chemo patients can get to a hospital, there often aren't enough blood products, antibiotics or other drugs to treat them. Studies in Africa show many people die from the treatment alone, Dr. Remick says.
"You see treatment mortality rates in the order of 20 to 66 percent. And that clearly is unacceptable," he added.
According to Dr. Remick, in the United States today, treatment mortality is about 1 or 2 percent. So he and his colleagues tried an approach he had helped develop in the 1990s, in the early days of the AIDS epidemic. By avoiding certain drugs and lowering the dose of others, they could make the treatment less toxic.
Forty-nine patients in Kenya and Uganda received this low-dose regimen. Three died from it. In this small study, that's a 6 percent mortality rate, which is much better than the 20 to 66 percent reported in other studies. Survival rates were about one year on average, which is comparable to rates in the West before the era of effective antiretroviral therapy, or ARVs. Patients receiving ARVs did better than those who didn't. Overall, a third of the patients lived for five years. Dr. Remick says it's an important step forward in Africa.
And there's another advantage to this back-to-the-future approach, he notes. "The drugs in the regimen are all very affordable. They're old cancer drugs. They're also drugs that are readily available in Africa. They are on most World Health Organization drug formularies, so there's another practical or pragmatic reason to use this regimen."
Treating and caring for patients receiving this therapy is still expensive and labor-intensive, Dr. Remick acknowledges, but it's much more practical than standard therapy.