"" Ralph Moss—Cancer Consultant: REVISED BLOG--HYPERTHERMIA EXTENDS SURVIVAL

Sunday, February 18, 2018

REVISED BLOG--HYPERTHERMIA EXTENDS SURVIVAL




Photo: Prof. Rolf Issels, MD, Munich, Germany

NOTE: This is a revised version of my blog/newsletter from earlier today. I have made several changes. First, the publishing journal is JAMA Oncology (not Lancet Oncology). Second, I have clarified the nature of the survival advantage by quoting the article's authors. Third, I have removed the previous photo, since it did not represent the type of hyperthermia used in this experiment.

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On February 15, JAMA Oncology published a phase III randomized controlled trial (RCT) on the use of regional hyperthermia (heat therapy) with chemotherapy for soft tissue sarcomas. As this landmark paper points out, "Patients with soft tissue sarcoma are at risk for local recurrence and distant metastases despite optimal local treatment." Preoperative chemotherapy improves the outcome somewhat. But the authors' theory was that adding targeted heat therapy might improve the outcome even more.

A clinical trial to test this hypothesis began in 1998 and it has taken two full decades to finally prove that heat therapy improves both progression-free (PFS) and survival (OS). Thus, out of 341 patients treated, a total of 220 experienced disease relapse, and 188 died. But the addition of regional hyperthermia improved progression-free survival (PFS) by 35 percent. The true bottom line for patients and their loved ones is whether they live longer. The really exciting news is that survival was also prolonged vs. preoperative chemo alone. Here is how the authors phrase it:

"Patients randomized to chemotherapy plus hyperthermia had prolonged survival rates compared with those randomized to neoadjuvant chemotherapy alone...with 5-year survival of 62.7%...vs 51.3%..., respectively, and 10-year survival of 52.6%...vs 42.7%."

That could results in a great many lives saved through a relatively safe and simple procedure.

Writing in JAMA Oncology, the 21 authors concluded:
"Among patients with localized high-risk soft tissue sarcoma the addition of regional hyperthermia to neoadjuvant chemotherapy resulted in increased survival, as well as local progression-free survival. For patients who are candidates for neoadjuvant treatment, adding regional hyperthermia may be warranted."
The study was headed by Prof. Rolf Issels, MD, of University Hospital Medical Center, Großhadern, Munich. Although a mainly European multi-national effort, there were American participants at the University of Maryland Medical Center.  Nonetheless, the study has a global significance that goes far beyond its applicability to relatively rare sarcomas. 

Hyperthermia has been scorned as "alternative medicine" for decades. Mainly through the work of scientists in Rotterdam, Holland, it was eventually acknowledged as a way to help delay progression of the disease. But there remained skepticism that it actually extended human survival. Now through this meticulous multi-national study, it has now been conclusively proven to do so in a type of cancer that is notoriously difficult to treat.

JAMA Oncology is ranked #8 among the top 217 oncology journals in the world. But will this study really change anything? Skepticism towards hyperthermia still runs very deep. This is compounded by the fact that this treatment is not a mass-produced drug, but relies on a natural treatment, heat. It  requires the purchase and maintenance of expensive equipment and, more importantly, the training of highly skilled technical personnel to administer the treatment. Few hospitals have proven willing to make such an investment. Perhaps this study will change all that.

When these results were first announced at a medical conference in Hawaii in November,  it garnered a mere two articles in obscure medical publications. And, so far, this JAMA Oncology publication has not been picked up by any news service or online journal. Perhaps discussions at the forthcoming Society of Thermal Medicine (STM) meeting in Tucson, Arizona (May 7-10) will generate more well-deserved attention for this important finding.

To be clear, hyperthermia is not a stand-alone "cure," but an adjuvant treatment that must be added to other approaches. It lacks the sexiness of purported "magic bullets," of the type that appeal to Wall Street investors. But it fits in very well with the holistic approach that is favored by many private clinics in the non-English speaking world, especially in the German-language zone. This study should be a powerful stimulus to the further employment of such treatments.

To read an abstract of the JAMA Oncology paper in question: