Health News Review

A journalism professor sent this story to us and we thought it was interesting enough to comment on. It follows the pattern of local TV health news stories that are usually far too brief and incomplete.

I asked Harold DeMonaco, MS, one of our story reviewers for HealthNewsReview.org, to assess what he saw in the story. Here is what he wrote:

————————————————-

Melanoma is a nasty disease and has proven itself to be resistant to just about every treatment available if found late in its course.  Because of its relative rarity (as compared to colon or lung cancer), cooperative trials involving many medical centers have been established in an effort to rapidly find new treatment options.  My interest in the story was piqued by the notion that the treatment is only available at one center in Arizona.

Interleukin-2 was approved by the Food and Drug Administration in 1998 for the treatment of advanced melanoma.  The FDA-approved regimen involves the intravenous injection of high doses of interleukin-2. Patients are routinely hospitalized during treatment with injections occurring every eight hours for up to 14 doses. The cycles are separated by a nine-day rest period, during which the patient can go home.  The results early clinical trials on the use of interleukin-2 alone were not that impressive.  In a study of 270 patients, 16% experienced tumor shrinkage with 6% of patients disease free up to three years later. The impact of interleukin-2 as a single agent on long term survival is still unresolved.  It is a rigorous regimen to say the least with lots of toxicity.

A regimen that could be given on a outpatient basis would be a huge step forward, especially if it showed better results and had fewer side effects.

Based on our standard criteria, this story fails miserably.  We are told very little about the regimen used, whether interleukin-2 is used in combination with other drugs and what the side effects are.  Dr. Quan has been a leader in this research effort and he and his colleagues have been the sole source of published information on this regimen.  Importantly, the views of other oncologists would have provided some balance to his comments.  A single patient anecdote, regardless of how compelling it is, does not replace a large dataset looking at the experience of multiple patients.  Dr. Quan notes a complete remission rate of 5% with his regimen.  I would point out that the seminal trial involved in the drug’s approval demonstrated a 6% complete remission rate.

The story fails to point out that the regimen is in fact investigational and is listed at Clinicaltrials.gov.  The study is indeed a single center study.  This oversight seems rather important.  According to its formal listing the trial was ongoing at Loma Linda University Medical Center in California, Dr. Quan’s previous affiliation.   Immunotherapies historically have been very expensive so some information about cost and insurance coverage would have been welcomed.

Dr. Quan’s study is said to limit enrollment to 35 subjects.  While it is possible to increase that number, many patients with the disease may not have the opportunity to participate.  That’s why it is so important to provide additional information about available trials.  There are 24 other melanoma trials listed in ClinicalTrials.gov.

Patients facing life threatening illness need information about treatment options.  Unfortunately, this story came across more like an advertisement for Cancer Treatment Centers of America and/or Arizona. It remains to be seen if Dr. Quan’s investigational regimen will live up to the headline of this story.

Comments

Martin Ashdown posted on August 30, 2012 at 7:32 pm

As a clinical cancer resercher this is a very interesting story with lots of potential and something we will hear more off in the very near future. The critique by Harold Demonaco is profoundly inadequate. Interleukin 2 (IL2) has a long history of clinical experience going back to 1992 when the FDA first approved it to treat late stage kidney cancer….still being used today. Back then it was thought to stimulate the immune response but would only work randomly in about 7% of patients….but no one which patients would respond and why. The immunology has moved on / advanced and now we appreciate how and why IL2 works. These recent insights have created a renewed interest in IL2 and how to use it more accurately for greater benefit….an agent known to cure cancer patients. Well done Dr Quan for persisting….keep going…..and Harold …do your research more diligently or go an do a contemporary immunology course. We discuss these historical and contemporary aspects of IL2 in a recent journal publication freely accessible, see link US National Library of Medicine; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3421468/pdf/cmar-4-215.pdf
Best
Martin Ashdown
Faculty of Medicine
University of Melbourne

    Harold DeMonaco posted on August 31, 2012 at 6:28 am

    I thank Dr. Ashdown for his comments and for forwarding me the link to his article. But both miss the point. My comments were not directed at the adequacy of Interleukin-2 or Dr. Quan’s research. They were directed at a very bad piece of reporting. I don’t think it takes a deep understanding of the vagaries of the clinical response to interleukin-2 or immunology to recognize inadequate and misleading reporting. Dr. Ashdown’s comments suggest both are required. With all due respect (and without taking an advanced course in immunology), I disagree.

      Martin Ashdown posted on August 31, 2012 at 8:42 am

      That’s ok Harold, we see this sort of reporting from Big pharma all the time,….but in this case don’t shoot the messenger…this is different. What they are reporting is truly remarkable. If I can offer some advice, this IL2 story is worth pursuing, its a remarkable drug with a long clinical history, more so as IL2 ‘s mode of action is now becoming apparent of why it works about 7% of the time….in two very different cancers. As a journalist / scientist you should go to this years SITC October conference in Washington. It is our view that the clinical experience with IL2 will provide very shortly a universal guidance for the successful treatment of most cancers…in that sense we maintain IL2 will prove to be a medical translational “Rosetta Stone” and ultimately lead to a dramatic reduction in mortality, morbidity and cost of cancer treatment….something you guys in the US need, particularly in light of the absence of a government funded universal healthcare scheme. Also, immunology is fundamentally simple, the AK Abbas & AH Lichtman text book is really good for beginners…I refer to it all the time
      best
      martin

    Gary Schwitzer posted on August 31, 2012 at 8:27 am

    Dr. Ashdown,

    I, too, thank you for your note. This may be your first visit to our site, so let me emphasize that we review the quality of health care journalism. The use of interleukin-2 is, indeed, “a very interesting story with lots of potential.” But this specific news story – which is clearly what we were addressing (How could this be missed given our headline and opening line and comments throughout?) was inadequate by the criteria we use to evaluate news stories.

      Martin Ashdown posted on August 31, 2012 at 9:10 am

      thanks Gary,….yep first time here,……but at least you guys followed the story,…well done….keep it up, but… dig deeper for the nugget….this one won’t evaporate like all the other cancer stories you journalist must be sick and tired of covering
      best
      martin

Mike M. posted on September 2, 2012 at 1:46 am

This article thoroughly describes the beef I have with local broadcast news in general: http://www.tinadupuy.com/column/your-local-broadcast-news-is-making-us-stupid/

Pat Elliott posted on September 4, 2012 at 3:03 pm

As a health journalist, and two-time cancer survivor who lives in the market that aired this story, I applaud you for sharing this example of misleading reporting. The same organization spoke to cancer patients recently at a “Cancer Survivor Day” event, and their marketing representative implied we were risking our lives if we were treated at any other facility. Those of us living with life-threatening medical conditions do indeed need information on treatment options – truthful information. Fortunately today we are able to go online and find it from many credible resources.