By Jamie Reno
Farrah Fawcett’s oncologist, Dr. Lawrence Piro, has spent the past few days at the hospital bedside of his most famous patient. The actress died of anal cancer on Thursday morning at 62. But Piro, who seemed deeply saddened by Fawcett’s death, remains committed to saving cancer patients’ lives. In addition to being the go-to doctor for many Hollywood A-listers with various types of cancer, Piro is a respected lymphoma researcher and clinician who is “very hopeful” that a relatively obscure lymphoma drug he administers in his Los Angeles clinic will be approved by the Food and Drug Administration as a first-line treatment within days, and that this decision by the regulatory agency could save and extend thousands of lives.
Piro, who runs the only independent community clinic in the nation that administers the lymphoma drug Zevalin, expects the treatment to be approved as soon as next week for “first-line consolidation treatment.” This means Zevalin can, for the first time, be used as an initial treatment when a patient is diagnosed with lymphoma, in “consolidation” with chemotherapy. To date, lymphoma patients have been able to take the drug only after failing other treatments.
Zevalin, manufactured by Spectrum Pharmaceuticals, is one of two radio-immunotherapies for the treatment of non-Hodgkin’s lymphoma. (The other, Bexxar, is manufactured by GlaxoSmithKline and is not yet indicated for first-line treatment.) Radio-immunotherapy, also known as RIT, is an antibody with a radioactive attachment. Administered intravenously, it’s designed to home in on the cancer cells while generally sparing healthy cells. The latest studies from the American Society of Hematology show that RIT gives patients substantially longer remissions (about four and a half years, compared with about three for chemo patients) and fewer side effects than chemotherapy and/or the lymphoma medication Rituxan, which are the current standards of treatment for non-Hodgkin’s lymphoma. But as NEWSWEEK reported last year, few cancer patients know about RIT, and few oncologists tell their patients about it.
Piro wants to change that. He suggests that granting first-line status to this drug could change the paradigm for treatment of lymphoma, the fifth-most-common cancer in the United States. If the approval happens, Piro plans to initiate a nationwide information campaign to increase awareness of RIT among patients and doctors and increase acceptance of the treatment among his fellow oncologists. “Unfortunately,” Piro tells NEWSWEEK, “there is no such treatment for anal cancer, which is what Farrah [was] fighting.”
In an exclusive interview with NEWSWEEK’s Jamie Reno, himself a 12-year survivor of stage IV non-Hodgkin’s lymphoma, Piro discussed his work with radio-immunotherapy and his plans to spread the word about this little-known treatment, as well as his thoughts on the three-year cancer battle waged by Fawcett. Excerpts:
Can you first please share a few thoughts about Farrah, who died this morning?
I was up all night last night. It’s been a long and difficult day. Farrah was an amazing and special person who went through her entire illness and her last days the same way she went through her life: fearlessly. She’s a role model for all of us. If you remember at the end of her documentary, she put out the message, "What are you fighting for?" That will be her legacy: for us to face life’s challenges, to face our fears. She was an incredible fighter.
What did you think of her controversial decision to go to Germany to have some experimental treatments during her cancer battle?
Actually, the treatment she received in Germany was in concert with the treatment she received here. There is a bit of a misnomer about what she did in Germany. Most of the techniques she got there are available here. It was complementary, and I fully supported her decision to do it.
I’m sure it is very hard for a physician to lose a patient. But you remain committed to saving lives, and currently you’re championing a relatively obscure cancer treatment called radio-immunotherapy. How successful has this treatment been with your patients?
Because of the current guidelines, most of the experience I’ve had with Zevalin is with patients that have failed other treatment, and even so, it has been very, very effective in my patients who’ve failed chemotherapy and in some cases Rituxan. In patients who would otherwise have brief remissions with chemo, we’ve seen some very long remissions with Zevalin. It’s also exciting that the side-effects profile is relatively low and really limited to lower blood counts; patients generally tolerate this treatment well.
The studies say that RIT has the best results, in terms of duration of remissions, among all lymphoma cancer treatments. So why do so few patients take these treatments?
I have never seen a situation like this, where you have an approved treatment with so much promise and efficacy that is not used very much. There is a series of fears or beliefs that are not well founded, but are well established in the minds of many physicians. One is that the radiation will damage bone marrow and not allow you to have other, subsequent treatment. But that does not seem to be the case; patients still have full availability to other treatments. Another issue is that medical oncologists that generally prescribe [treatments for] lymphoma don’t administer it because it’s a nuclear treatment, and nuclear doctors [i.e., those specializing in nuclear medicine] administer it but don’t follow patients after treatment. It’s unusual to send patients to another doctor and then have them come back to you to monitor the blood counts, etc. That format is foreign to many physicians.
Some doctors are telling their patients that with RIT there is a greater risk of secondary cancers than with chemotherapy. Is this true?
No, it is not true. The data suggests there is in fact no greater risk with RIT than there is with any other lymphoma treatment. But there is a degree of risk of secondary malignancies with all cancer treatments.
Many doctors are not licensed to administer this medicine because it has a radioactive component. So when they tell a patient about it, they risk losing that patient if he or she chooses to be treated with RIT. Is it true that some doctors aren’t telling their patients about these treatments because if they do they will lose their patients?
My experience is that many patients are not finding out about these treatments as an option for them, but it’s not because their doctors don’t want what’s best for their patients. It’s just that many doctors don’t have the mindset that radio-immunotherapy should even be considered. I just want to get the word out. This is not the best treatment for everyone, but your doctor should be your partner, your doctor should help you figure out what treatment is right for you and give you the full set of options. Radio-immunotherapy is a very effective treatment for non-Hodgkin’s lymphoma that needs to be discussed.
By Jamie Reno