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- August 12, 1991
- Vol. 36
- No. 5
Tree of Hope—and Conflict
Cancer Patients Clamor for a Drug Made from the Pacific Yew—and Environmentalists Worry About the Death of a Valuable Resource
All that changed in the summer of 1988, when Christensen, then 35, was jolted awake with abdominal pain so intense that she began vomiting uncontrollably. Emergency-room doctors diagnosed a bowel obstruction and tried to mute her agony with painkillers. It wasn't until four months later, after four more attacks, that doctors discovered what appeared to be a cyst on her left ovary. "When I woke up after surgery," Christensen remembers, "my husband was crying. I asked, 'Was the tumor malignant?' He said yes. I said, 'God help me.' "
When Sally Christensen was diagnosed with ovarian cancer—an especially deadly illness that kills some 12,000 American women annually—the prognosis was poor. Tumor cells had attached to her abdominal wall, and six months of intense chemotherapy—which robbed her of her hair and the feeling in her legs and damaged her hearing—only temporarily slowed the cancer's growth.
In a desperate search for help, her oncologist began calling specialists around the nation. Last May, when tumors had spread to her liver and stomach, Christensen was told that she had been admitted to an experimental program at the National Cancer Institute in Bethesda, Md., to test a drug called taxol.
Taxol is derived from an unlikely source: the bark of the spindly Pacific yew tree, which grows primarily among the ancient forests of the Pacific Northwest. Its life-saving properties were discovered in the 1960s during a vast screening of plant life at NCI. In 1979 Dr. Susan Horwitz, a scientist at Albert Einstein College of Medicine in New York City, spotted taxol's remarkable ability to prevent cancer cells from dividing, and scrutiny of the substance intensified.
After four intravenous treatments with the drug, Christensen's condition improved markedly. Although tests of the drug are still incomplete, other women have also had positive results, and researchers are cautiously hopeful that taxol will prove to be a significant weapon in the anticancer arsenal. "Maybe, maybe, maybe [this is] the most active anticancer drug since cisplatin" (a drug approved in 1978), says taxol pioneer Dr. William McGuire, an associate professor at Baltimore's Johns Hopkins Oncology Center, who conducted the first trial tests of the drug for ovarian cancer in 1982. Taxol has also shown promise for breast cancer and possibly other malignancies.
Even at this early stage, however, taxol has drawn widespread attention—and not just for its potential cancer-fighting properties. At issue is the fate of the homely Pacific yew, a tree that for decades has been treated as a giant weed by the U.S. Forest Service and the logging industry. With no apparent commercial value, yews were routinely cut and burned during logging operations. To add to the confusion, no one really knows how many of the yews exist—estimates range from 1.3 million to 23 million. Given that it takes the bark from up to six 100-year-old trees to make enough taxol to treat one patient, some environmentalists fear that if the drug proves effective and becomes widely used, yew trees could become an endangered species if present destructive forestry practices continue. On a smaller scale, poaching of yew bark—so far limited to several incidents—could become a threat.
"You can't kill the goose that lays the golden egg," says County Commissioner Jerry Rust, 47, of Eugene, Oreg., who last year founded the Native Yew Conservation Council. "If you're an apple farmer, the last thing you're going to do is cut your tree down to gather your apples. This tree can save lives, but once you kill it, it can no longer produce."
Last September the Environmental Defense Fund, a public interest group based in New York City, filed a petition with the U.S. Fish & Wildlife Service asking that the yew be classified as a threatened species. The American Cancer Society filed a similar request, but the government turned them both down, asserting that yews are abundant. (In March, however, the Forest Service agreed to stop the needless burning of cut trees until the bark could be stripped for taxol production.)
The environmental issue may ultimately benefit all involved. Such heat will keep pressure on taxol's only authorized supplier, Bristol-Myers Squibb, to create a synthetic version of the drug. But the compound is so complex that a commercially available synthetic is probably 10 years away. Other forms, made from yew needles or plant tissue, are two to five years in the future.
For now, the drug is in very short supply, partly because of the difficulties in gearing up the complex processing of the bark. "It's good news that there's a potentially active new drug out there for patients who have a desperate disease," says Dr. Jay Klarnet, 39, an oncologist at the Evergreen Cancer Center in Kirkland, Wash. "But the bad news is that there's not enough for everyone to try. Bristol-Myers should be working 24 hours a day to try to get this stuff out."
Rhea Killian, 41, a bookkeeper and mother of three in Gresham, Oreg., is among the luckier victims. Diagnosed in May with ovarian cancer, she qualified for a current taxol trial in Oregon. (Qualifications differ, depending on the research goals of the trial.) "It makes me feel like a happy guinea pig," says Killian, who has had the first of six 24-hour infusions and suffered none of the nauseating side effects that often come with standard chemotherapy. "You feel blah and not yourself, but if you're not vomiting and miserable, you feel lucky. It makes you become a tree preservationist real quick."
For Carol Parr of Silver Spring, Md., getting taxol took a lot of pluck. The vice president for development at Gallaudet University, Parr, 50, was diagnosed with ovarian cancer in June 1990. When her doctor would not make inquiries on her behalf, Parr did her own homework, prevailing in spite of rejections and runarounds and ending up in the office of Dr. Maurie Markman at New York City's Memorial Sloan-Kettering Cancer Center. "I simply had to convince him that I should have a chance," says Parr, who called herself a chemo commuter while she traveled from her home to Manhattan every three weeks to be part of a study of high taxol dosages. "They dump two liters of solution directly into your abdomen and then give you painkillers," says Parr. "Of course you want to believe that it's killing 100 percent of the cancer cells, which is possible but not very probable. You feel like you're making a deal: Your body is being used for an experiment."
For Sally Christensen, the Montana lawyer, the deal seems to be paying off. Last week she made her fifth trip to NCI for an evaluation, fearing that if she did not show improvement, she would be dropped from the trial. The news was good. Tests indicated a significant decrease of a tumor indicator in her blood, and the rapid progress of the disease appeal's to have halted.
Christensen is now even more determined to speak out on the issue. While in Washington, D.C., she joined others to testify at congressional hearings on the development of taxol. The first woman to speak was Pam Onder, of Bethesda, whose breast cancer has been in remission since last January after 10 nightmare rounds of high-dose non-taxol chemotherapy. "I lost my hair. I lost my job. I lost my breast. I lost my boyfriend," she told the committee. "If taxol can be a key to not being poisoned, slashed and burned, we're on the road," she told the subcommittee. Added Christensen: "It is imperative that nothing impede the National Cancer Institute's studies. At stake is our most precious natural resource: human life."
MARILYN BALAMACI in Washington, D.C., JANE FERRELL in Missoula, SUSAN HAUSER in Portland
- Marilyn Balamaci,
- Jane Ferrell,
- Susan Hauser.
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