Battling Cancer by Infusion

Any number of chemicals will kill cancer cells, but the vast majority destroy normal cells just as readily and are therefore worthless. One of the most ingenious ways to get around this has been devised by Dr. Robert D. Sullivan of Manhattan's VA Hospital and Memorial Sloan-Kettering Cancer Center. The problem is that it may take days of continuous treatment to knock out all the rapidly reproducing cancer cells. In that time, the drug will kill so many normal cells that the patient's life may be threatened. Why not, asked Dr. Sullivan, give the drug continuously by arterial drip, but switch off its damaging effects every few hours by injecting an antidote?

Last week the novel method was under hopeful study in both the U.S. and faraway Africa. The drug Dr. Sullivan and his colleagues chose was Methotrexate, because it has a handy, harmless and effective antagonist in folinic acid, also known as CF, for citrovorum factor. At Memorial and other hospitals, they have tried the combination on a score of patients with cancer confined to the head, where a high concentration of the drug could be infused through a single artery in the neck. In many cases the cancers shrank rapidly, and one man is disease-free after two courses of treatment, 18 and ten months ago. Yet all the team's U.S. patients had already been treated by surgery or radiation, which confused the picture. The doctors wanted to find cancer victims who had had no other treatment and for whom none was possible. The place, suggested the African Research Foundation, * was in and around Kenya, where cancer of the head, cervix and liver is common and medical care is scarce.

By Plane & by Foot. Early this year, the Manhattan doctors started treating 24 Africans from remote parts of Kenya, Uganda and Tanganyika. Most of the patients traveled to Nairobi and Kampala, some by hospital plane, others by ambulance or on shanks' mare, barefoot. They represented more than a dozen tribes; some spoke languages so obscure that a series of three interpreters was needed. More than half the patients had cancer of some kind in the head, but seven had cancer of the cervix, one of the greatest killers of African women.

Assisted by local surgeons, the doctors treated sinus cancer by cutting into the external carotid artery, inserting a thin polyethylene tube, and stitching it in place. They hooked this up to an infusion bottle and a pump, which delivered a quart of saline solution every 24 hours. So potent is the drug that this volume contained only one six-hundredth of an ounce of Methotrexate. Every six hours, a nurse gave an intramuscular injection of CF. For women with cervical cancer, polyethylene tubes are set in arteries on both sides of the lower abdomen.

Encouraging Results. The confining treatment lasted an average of five to seven days, and the patients took it stoically. If mouth ulcers or other unfavorable side effects appeared in three or four days, treatment was interrupted, but then repeated, until in some cases the patients spent as long as 15 days on round-the-clock infusion.

One of the most encouraging cases was a Jaluo woman of 35 whose cervix had been replaced by a fast-growing cancer mass. In four courses of treatment, totaling 15 days, the cancer shrank progressively. Within a month it disappeared. Now, more than four months after treatment, she is well, and apparently has no cancer remaining. To be on the safe side, the surgeons planted the outer ends of the polyethylene tubes under her skin so that they can easily resume treatment if it becomes necessary.

Last week, with more patients under treatment by Kenya Surgeons Michael Wood and John K. Duff, and Kampala Surgeon Richard Trussell, U.S.-African doctors were trying to find what other forms of cancer would yield to the promising new technique.

* Its honorary but active and hard-working chairman: the Aga Khan.

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