Closing In On Cancer

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So Step 1, the scientific panel concluded, was to change current trial design to give the new drugs more time to work. As a second step, the panel also wants to change the criteria by which a drug's success is measured. The group proposed that with the newer, better-targeted medications, success should be determined not by whether a tumor shrinks in size but by whether it can be confined, or by how long a patient can put off chemotherapy.

In the next few months, these recommendations will be compiled by the Angiogenesis Foundation, a nonprofit clearinghouse for research in the field, and forwarded to the FDA and the National Institutes of Health, which funds the bulk of cancer research.

Meanwhile, some of the latest angiogenesis studies have already incorporated lessons learned in the early trials. Initially, most blood-vessel inhibitors were tested alone as potential magic-bullet treatments, and in patients with advanced cancer. But scientists now have a better understanding of how angiogenesis inhibitors prevent growth factors from reaching blood-vessel cells. They believe that, for now, in terminally ill patients, the best you can expect of the experimental drugs is to keep tumors from spreading. So researchers have begun to evaluate them in conjunction with traditional chemotherapy, radiation and surgery. So far, the results are promising. Preliminary trials involving patients with advanced non-small-cell lung cancer and kidney cancer suggest that the combination of angiogenesis inhibitors with standard therapy improves survival rates beyond those of either treatment alone.

Ultimately, if cancer treatment shifts to include the new drugs, the definition of cancer may have to evolve. "Someday," says Folkman, "we may treat cancer as a chronic, manageable disease, very much like we treat heart disease now." Until then, the trials continue.