Spectacular Hope

Nearly half of the women who undergo radical surgery for breast cancer that has spread to other parts of the body die within the next five years. Now the odds may soon shift sharply in favor of these cancer victims. Last week Italian doctors reported a new postoperative program of drug treatment that could increase the chances of survival from breast cancer as much as fivefold.

The pioneering therapy was developed by researchers at Milan's Istituto Nazionale Tumori, the Italian equivalent of the U.S. National Cancer Institute (which supported the study). Led by Dr. Gianni Bonadonna, who studied at Manhattan's Memorial Sloan-Kettering Cancer Center in the 1960s, the Milan team picked three drugs--cyclo-phosphamide, methotrexate and 5-fluorouracil (CMF). All were known to interfere with the growth of cells, especially of fast-multiplying cancer cells. But they proved to be more active than when used alone.

When the drugs were administered to 207 women who had undergone radical mastectomies and had cancerous cells in one or more lymph nodes, the results were, in the words of an editorial that accompanied the report in the New England Journal of Medicine, "nothing short of spectacular." Twenty-seven months later, only 5.3% of the women showed signs of cancer. By contrast, the recurrence rate in a control group of 179 women who did not receive the same treatment was 24%. The researchers concluded, on the basis of their findings, that the drugs had not merely suppressed the incipient cancers but apparently destroyed them.

Severe Side Effects. The CMF therapy lasted a year, during which the women alternately received doses of the drugs for two weeks, then went without them for two weeks to enable them to recover from the severe side effects. Besides nausea, vomiting, loss of hair and the cessation of menstruation, the drugs cause a decline in production of white blood cells, which are part of the body's defenses against infection. As the tests continued, however, most of these effects subsided and many of the women were , able to go back to work.

In the editorial, Dr. James F. Holland, head of the cancer center at New York's Mount Sinai Hospital, hailed the tests as a "work of monumental importance" that could save hundreds of thousands of lives in the coming decade. Americans, he added, "now can admire more in Milan than La Scala."

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