‘Blind Spots’ and ‘Halos’ in Adult Solid Tumor Chemotherapy

NEW YORK—Ezra Greenspan, MD, has been at the helm of the Chemotherapy Foundation since its founding in 1968. At its 17th annual symposium, in what he termed an “op-ed” piece, Dr. Greenspan, clinical professor of medicine, Mt. Sinai School of Medicine, highlighted what he considers the “blind spots and halos” in adult solid tumor chemotherapy.”

The biggest blind spot, in his opinion, relates to the immunologic status of the cancer patient. In the face of “substantial evidence that a good immunologic status has been tied to a better prognosis,” Dr. Greenspan believes an assessment of immunologic status should be part of the initial clinical workup of every cancer patient and an essential tool in treatment planning.

At a time when research and development in tumor cell vaccines herald the dawn of a new treatment era and chemo-prevention is taking its place alongside chemotherapy, “it would be worthwhile to perform immunological staging . . . before or during the early phases of treatment,” he said.

Such staging would be particularly appropriate for ovarian and breast cancer patients, Dr. Greenspan said, adding that “responses, and particularly the duration of response, could be predicted with improved vital immunological factors.”

Immunologic staging performed before and after primary surgery would further help answer the question of whether a patient with a large but regressed tumor can ever be restored to normal immune competence.

A Daunting Task

Dr. Greenspan acknowledged that immunologic staging is a daunting task, with the details of obtaining data and establishing a staging system yet to be developed.

He also warned against being lulled by the “halo of success” surrounding patients who show an initial complete clinical response to standard treatment protocols.

He urged consideration of cyclical maintenance therapy or reinduction therapy, especially in the presence of positive tumor markers. He said that the use of tumor markers as an indication for “reinduction chemotherapy before obvious clinical relapse could be a welcome new major development.”