Health: Physicians advise chemotherapy patients to ask
about treatments that may reduce suffering from side effects.

By Marilyn Chase The Wall Street Journal

Many of this country's 11 million cancer survivors have had to deal
with the side effects of chemotherapy.

Chemotherapy kills cancer cells, but also damages healthy cells in
the digestive tract, bone marrow, hair follicles and other organs.
Research is homing in on new rescue drugs for these haalthy cells all
the time. But some healthcare plans don't offer the drugs to patients
because they are so costly.

"Most patients don't know they exist," says Marti Ann Schwartz, a
Portland,Ore.based consumer advocate who survived Hodgkin's disease
after radiation therapy and a fourdrug medley called MOPP.

"Ask your oncologist, the nurse who administers chemotherapy, your
cancer counselor... everyone and anyone for hints," she says. "Nothing
is easy, but there are tips that make it less horrrendous."

Only after Schwartz was hospitalized three days for nausea did a coun
selor suggest the drug ondansetron, or Zofran, which quelled her vomiting.
Now that has been joined on the market by a similar drug, granisetron,
and more are coming.

Lisa DeAngelis of Memorial SloanKettering Cancer Center in New York
tells of a California managedcare patient who underwent chemo with
out either ondansetron for nausea, or drugs to help her bone marrow recover
from chemo.

The new anti nausea drugs are expensive, topping $100 for an intravenous
infusion, or $50 dollars for two pills. But by making tough treatment tol
erable, they can enable patients to stay the course and get a shot at a cure.
Moreover, compared with total chemo costs or, say, an emergencyroom visit
for uncontrollable nausea, their cost pales.

Patients shouldn't accept missery as unavoidable, health professionals say.
They should ask for relief and enlist their doctor in lobbing insurance com
panies, which vary on coverage.

"People are on firm ground to ask for these drugs before their chemotherapy
'" says Mark Kris of Memorial SloanKettering. He contends that standard care
should seek to prevent chemo's side effects, and he's pressing pharmaceutical
and cancer groups for more liberal treatment guidelines "to ensure optimal
therapy is given to everybody."

Kris also is testing the next generation of nausea fighters, chemicals
that
target substance P, a neurochemical involved in digestion and pain perception.
At least three drug companies are in hot pursuit of products based on this
research.

Additional new rescue agents aim to take the sting out of chemotherapy's
other toxicities.

Memorial's DeAngelis and Brigitte Widemann of the National Cancer Institute
are testing an enzyme that limits toxicity of the drug methotrexate. A staple
of the chemotherapy armory, methotrexate is used on many cancers, including
leukemia, lymphoma, bone cancer and head and neck tumors. Among its side
effects
is kidney dysfunction, which hampers excretion of the potent drug, raising
blood levels and, in turn, raising its potential to damage other organs.

The rescue enzyme, carbodypeptidaseG2, or CPDG2, detoxifies excess metho
trexate in the blood, rendering it harmless to other organs.DeAngelis is using
CPDG2 in experiments treating patients with brain tumors. At NCI, Wildemann is
using CPDG2 and another rescue drug thymidine to mute methotrexate toxicity
in several cancers.

Because they're still classed as investigational drugs, CPDG2 and thymidine
are available only to patients under a compassionateuse program. Doctors can
obtain the drugs by contacting the NCI's Cancer Therapy Evaluation Program in
Bethesda,Md., at (301)4965725.

To be sure, not all chemo side effects can be counteracted by rescue
agents.
But many can. Patients can arm themselves with information about their
particu
lar tumor types, the recommmended drugs and potential toxicity and remedies
for
it.

"Ask your physician lots of questions and ask what drugs are available to
prevent toxic effects," says Robert Witherspoon of the Fred Hutchinson Cancer
Research Center in Seattle. Do this before treatment begins, he advises. But
remember,he adds, "Oncologists have to walk a tightrope. You want to make
sure
you don't protect the cancer in trying to protect the patient."

Some rescue strategies that may seem harmless selfmedicating with
megadoses
of antioxidant vitamins, for example could undermine treatment, he warns. Ice
caps or skulll bands to limit hair loss might be OK during treatment of solid
tumors far from the head, but not for blood cell malignancies such as
leukemia or
lymphoma, where stray cells might take refuge under hairsparing devices.

"Most toxicities are short term and reversible," Memorial's DeAngelis says.
"Every now and then, some are not." The essential thing is to "understand what
potential toxicities are before they even get the drug," she adds. "Ask what
the options are, should they develop toxicity."

"Prevention is the goal of therapy," adds Memorial's Kris urging
patients to
plan their rescue strategies well before toxicity develops.

Schwartz concludes, "No one making a decision to withhold drugs has ever
gone
through chemotherapy." Thanks to treatment and the drugs that eased it she's
reveling in her renewed ability to "take felling good for granted."