What Medical Oncologists Aren’t Telling You About Chemotherapy

The treatments used in modern oncology represent decades of drug development, clinical trials, retrospective and prospective studies, meta-analyses, and protocols.

Some years ago, I conducted an analysis of the response rates (measurable benefit) for all the available cancer therapies in the 1990’s. After reviewing the literature on the common tumors, I calculated an overall response rate of 36.8%. While the results have improved over the past three decades, they remain disappointing.

A report entitled “Estimation of US Patients with Cancer who may respond to Cytotoxic Chemotherapy” (Maldonado, Future Science, 2020) examined the objective response rates in solid tumors and hematological cancers from a database of 609,640 patients who received therapy under NCCN (National Comprehensive Cancer Network) guidelines.

However well-intentioned NCCN guidelines may have been in their conception, designed to provide national standards for “quality care” and best practices, they have become a straitjacket, rigidly applied by insurers to prevent physicians from using anything that falls outside of their stringent standards. Worse, they have undermined medical oncologists’ open discourse and analysis of options as everyone must now religiously adhere exclusively to NCCN guidelines.

This might be alright if these guidelines provided meaningful improvements. That is, if the majority of patients who received NCCN therapies actually benefited. Sadly, that is not the case. Indeed, in the Maldonado study the objective response rate was 48.6%.

Worse still the 48.6 % overall response rate drops precipitously when we delve into disease-specific results. For brain tumors like glioblastoma, it’s 9.2%, for prostate cancer 15.5%, for pancreatic cancer 20.4%, biliary tract cancers 26.1% and soft tissue sarcomas 24.5% to name but a few.

While certain cancers did better with acute lymphoblastic leukemia (ALL) at 96%, acute myeloid leukemia (AML) at 76.7%, osteosarcoma at 50.4%, ovarian cancer at 57.4%, these cancers have always been the most responsive of all the human malignancies.

Taken together, these results confirm that the majority of cancer patients in the US today do not respond to the NCCN guideline therapies that their physicians are virtually forced to deliver.

Failure to Advance

In most disciplines, the failure to advance the field over decades would result in scrutiny of methods and outcomes. In private industry it would be time for pink slips, but in medical oncology it results in awards and fat paychecks.

The obvious retort by the oncology community is to clamor that they are applying the most advanced “genomic” analyses to “personalize” cancer care. But the reality is somewhat different. A recent large analysis provided an objective response in only 7.04% of cancer patients who received their treatments selected by DNA analyses (Haslam, A. Annals of Oncology, 2021).

To the contrary, by applying the published performance of our Ex Vivo Analysis of Programmed Cell Death (EVA/PCD™) to the tumors described in the Maldonado NCCN study we would predict an improvement in clinical outcome for thousands of cancer patients by 2.04-fold (p <0.001), all without inventing a single new drug!

Predicted cancer responses by disease using the EVA/PCD platform to select drugs

Brain: NCCN Response = 9.2% EVA/PCD Response 2.04 X 9.2 = 18.7%

Prostate: NCCN Response = 15.5% EVA/PCD Response 2.04 X 15.5 = 31.6 %

Pancreas: NCCN Response = 20.4% EVA/PCD Response 2.04 X 20.4 = 41.6 %

More importantly, the EVA/PCD platform has been shown to improve one-year survival by 44% (p=0.02).

The question we must ask: What cancer patient, given the chance to significantly improve their response rate and one-year survival, wouldn’t want their cancer tissue tested?

The answer: A cancer patient under the care of a physician who applies NCCN guidelines and who does not alert their patients of the option to use the EVA/PCD methodology, or worse a physician who will not apply the results when they are provided to them.

Medical oncologists are not informing their patients of the availability of these technologies, yet they conduct costly genomic analyses on virtually everyone with advanced disease.

Given these dismal statistics, the question arises, what else are medical oncologists not telling you?

Robert A. Nagourney, M.D.

Medical and Laboratory Director, Nagourney Cancer Institute

Associate Clinical Professor, University of California Irvine