The Prognosis for Elizabeth Edwards

Wha

t kind of odds does Elizabeth Edwards face now that her cancer has spread from breast to bone? Oddly enough, doctors find it nearly impossible to say. They can state with some confidence that a woman with this kind of stage 4 disease, who has never been treated for cancer, faces approximately a 1 in 4 chance of being alive five years after treatment. But the odds are different — and lower — for someone who has already been treated and in whom the cancer is recurring. That's because the tumor cells that have continued to grow are resistant to whatever drug treatment has already been used.

"This is not a virgin cancer," explains Dr. Christy Russell, co-director of the Norris breast center at the University of Southern California. "These are cancer cells that survived the fight with chemotherapy." Doctors commonly say that the average survival for breast cancer that recurs and spreads after treatment is two to three years, but "there's a huge lack of statistics in this circumstance," says Russell, who chairs the breast cancer advisory committee for the American Cancer Society. For a patient like Edwards, who is 57, the response to renewed treatment will depend on the specific and unknown genetic makeup of her cancer cells. Says Russell: "It's a total crapshoot."

The treatment options, however, are clear. Edwards' doctors will choose from a menu of drugs that she's not yet taken. Luckily, says Russell, "We have a ton of drugs that work for breast cancer. There are eight or nine — more than for any other kind of cancer."

Edwards' original cancer was diagnosed in the fall of 2004. The specifics of her treatment were not made public, but doctors say it's likely that, in addition to surgery and radiation, she's already received three of the most commonly used drugs — Adriamycin, Cytoxan and either Taxol or Taxotere. This potent regimen knocks out tumor cells and causes the familiar side effects of nausea and hair loss. If her original tumor was estrogen-sensitive — meaning growing in response to the hormone — then she is almost certainly taking an estrogen-blocking drug such as Tamoxifen.

Since those therapies failed to control her cancer, Edwards now faces treatment with other medications. If she's on hormone therapy, says Russell, the first step would be switching her to another kind; there are four or five options. If her tumor isn't sensitive to estrogen, she'd go straight to chemotherapy, but probably with a well-tolerated oral drug like Xeloda. These kinds of treatments are taken as pills and have relatively few side effects. Continuing to campaign while taking them doesn't seem unreasonable.

The Edwardses have acknowledged that Elizabeth's cancer is not curable. The best that can be hoped for is to shrink whatever tumors are present and try to prevent more from cropping up. Most patients do respond to drugs for a while, and then relapse. The standard care is to stay on a drug as long as it's working and switch when it stops — nearly all drugs eventually stop working — until doctors run out of drugs to try.

Patients whose cancer moves into the bone tend to survive longer than those with metastases in the liver or lung. Russell says that she has a few patients who have survived 10 years with bone involvement, but this is extremely rare. The fact that Elizabeth Edwards relapsed just a little over two years after initial treatment is a bad sign, suggesting that her cancer is very aggressive. On the plus side, though, is that Edwards' disease is "low volume", according to her oncologist, Lisa Carey of Chapel Hill, N.C., meaning little tumor is present. Also favorable, says Russell, is that "she's apparently in excellent health and she's having no symptoms."