6 New Life-Saving Treatments
Cancer, stroke and hepatitis are words we once feared. Thanks to great medical breakthroughs, there are now …
In the past, some disease diagnoses used to strike fear in all of us. But these days, this is no longer always true. Today, vaccines protect us from once-deadly diseases. Antibiotics vanquish infections that used to kill tens of thousands. Cancers that
once were highly lethal are now more like chronic illnesses that people can live with for many years. We can all take heart from these amazing advances in prevention and treatment.
Hepatitis C
Around 230,500 Australians and 50,000 New Zealanders are infected with hepatitis C.
THE GOOD NEWS
Now there is a cure.
HOW IT HAPPENED
In 2013 a new class of anti-viral drugs became available.
It was the early 1990s, and 62-yearold Leigh-Anne Maxwell had no idea why, for years, she’d felt so awful; neither did her doctors. They’d tested for mononucleosis, anaemia and other obvious causes. Nothing. She was constantly exhausted. She was nauseated. She got yeast infections.
No one connected her symptoms to the emergency surgery she’d had years before. It wasn’t until she tried giving blood that she finally got a diagnosis. A new screening test confirmed she was infected with hepatitis C, and could not be a donor.
Because the virus is transmitted by blood, she knew immediately the transfusion that had saved her life during her emergency surgery had infected her with hepatitis C. For the next 25 years, she continued to suffer.
According to epidemiologist Dr Shruti Mehta, although some will clear the infection on their own, about 75–85 per cent of those infected with hepatitis C go on to develop chronic infections, “Which puts them at risk for all sorts of long-term complications associated with liver disease, primarily liver cirrhosis, liver cancer and end-stage liver disease.”
While most people with the virus can be asymptomatic for years, even decades, this was not so for LeighAnne. And the only treatment available when she was diagnosed offered just a 50 per cent success rate, but Leigh-Anne wasn’t a candidate.
Then, beginning in 2013, newer drugs became available that were “nothing short of revolutionary,” says Mehta. But they were extremely costly, and most drugs only worked against certain strains of the virus. Again, Leigh-Anne wasn’t a candidate.
Then, in January 2017, she was offered a chance to try a brand-new medication, Zepatier. “Within a week [after treatment completion] there was a profound difference,” LeighAnne says. She now has the energy to do all the things she’s been missing.
Today there are treatments for all major strains of hepatitis C, and in Australia, treatment is subsidised (in New Zealand, treatment is subsidised for some strains of the virus).
But because the disease can hide in someone’s body for years without symptoms, finding the people who need treatment is a big challenge.
Cardiovascular Disease
Cardiovascular disease is the leading cause of death in Australia (with 45,392 deaths in 2015) and New Zealand (where more than 10,000 people die every year).
THE GOOD NEWS
Eighty per cent of premature deaths from heart disease and stroke are preventable.
HOW IT HAPPENED
Lifestyle changes and better treatments have lowered mortality rates from heart disease and stroke.
Although CVD (including coronary heart disease, heart failure and stroke) is the number one cause of death globally, at least 80 per cent of premature deaths due to heart disease and stroke are preventable, says the World Health Organization (WHO).
“Since the 1970s, mortality from heart disease has decreased by 70 per cent in Australia,” says Professor Gar r y Jennings, chief medical advisor for the Australian Heart Foundation. “We believe that about half of the reduction in the number of deaths are due to better treatments, while the other half are due to lifestyle changes through education. There are also new and improved drugs to prevent clotting. We have more ways to reduce blood cholesterol, in particular, a new class called PCSK9 inhibitors.”
Until recently, stents were only used in people with heart disease who were stable. Today stents can be used during a heart attack. The technology around stents has been refined, and there are now stents that contain drugs that can prevent plaque from regrowing after surgery.
Stroke treatment, too, has made great leaps. Quick treatment is still important to survival, and to limit damage to the brain. Developments over the last few years include acute intervention, where a special catheter is used to ‘suck’ the clot blockage out of the artery as the stroke is happening, but also up to eight hours later.
Along with treatment, lifestyle changes have helped prevent countless deaths from heart disease and stroke. A large international study published in The Lancet in September 2017 found that just 150 minutes of moderate physical activity a week decreases the risk of heart disease by eight per cent. A healthy diet is also important for protecting your heart. A 2014 study found that eating a diet rich in fruit, vegetables, nuts, reduced-fat dai r y and whole grains decreased heart disease risk by 20 per cent.
Back in 2013, Mark Oakley, father of two young children from Preston, Victoria, was in good shape. Aged 39, he had a reasonably healthy diet, walked six kilometres every day, had never smoked, and was a light social drinker. His family had a history of high blood pressure, but he’d been on medication for 18 months to control it, and his doctor was monitoring him on a regular basis. All that changed suddenly one afternoon.
“I can’t explain it, but my whole body felt odd,” he recalls. “I felt totally different, but I couldn’t pinpoint what was wrong.” Most imagine that a heart attack would be painful, but Mark felt no pain, no tingling – only a slight discomfort in his collarbone. He visited his GP immediately, where he was given an ECG. His doctor was puzzled by the reading, so called an ambulance. The paramedics carried out their own ECG, transmitting the results live to the nearby hospital. They confirmed that Mark was having a heart attack, but concerned that he had no pain, they decided to rush him to nearby Austin Hospital. “When they put me in the ambulance, I knew it was real,” he says.
From the moment he was brought out of the ambulance, to be greeted by the anaesthetist, to the moment he emerged from surgery – with a stent inserted into his main coronary artery – just 26 minutes had passed. It turns out his main coronary artery was completely blocked. Two weeks later he went back for a stent to be inserted into another main artery, which had been 75 per cent blocked. It took eight months for him to make a full recovery.
Mark is on a rigorous course of medications, and he’s now more conscious of salt and fat in his diet. “I always read the labels for salt and fat content,” he explains, with a laugh. “Plus, I’m even more conscious of the importance of a healthy lifestyle.”
Cancer
138,321 new cases of cancer will be diagnosed in Australia in 2018, with around 22,000 new cases expected in New Zealand.
THE GOOD NEWS
Even with advanced cancers, people are enjoying longer survival times.
HOW IT HAPPENED
New immunotherapy drugs.
The most promising news in cancer treatment today is immunotherapy, which encourages the body’s immune system to rally its own forces against disease. The newest advance in this field is CAR T- cell therapy (CAR stands for chimeric antigen receptor). In the lab, a person’s own T-cells (a type of white blood cell) are re-engineered into cancer-fighting machines.
The f i rst such therapy was approved in the United States in
August 2017 to fight acute lymphoblastic leukemia in children and young adults. In a clinical trial, 83 per cent of those receiving CAR T-cell therapy experienced remission within three months. It’s also being used to treat certain non-Hodgkins lymphoma patients.
Several other immunotherapy drugs are current ly being used against cancer, sometimes with dramatic results. But most immunotherapies only work for a smal l percentage of people. Usually, a biopsy of the tumour is required to find out who’s a good candidate for which therapy. But now, a new blood test, called a liquid biopsy, is being studied to determine whether, by looking for DNA markers in an individual’s blood, they can quickly and easily determine which immunotherapy will help which patients.
Liquid biopsies might also be the future of early detection of cancer, according to an August 2017 paper in Science Translational Medicine, which reported their use to detect genetic changes linked to early-stage colorectal, breast, lung and ovarian cancer, and may help detect cancer recurrence.
One very different type of immunotherapy is a vaccine for lung cancer called CIMAvax. It has significantly increased survival times in patients in Cuba, where it was developed, and is now being tested in clinical trials in the US. What makes CIMAvax unique is that unlike most immunotherapies, which are only effective against very specif ic cancer sub- types, CIMAvax suppresses a ‘growth factor’ called EGF in the patient’s body, and numerous different types of cancers require EGF in order to proliferate. “The possibility is that this vaccine would be useful in a large number of cancers,” says Dr Kelvin Lee, professor and chair of the immunology department at Roswell Park Cancer Center. Among those are breast, prostate, pancreatic, colon, and head and neck cancers.
Bowel Cancer
Bowel cancer is the third most common cancer in Australia and second highest cause of cancer death in New Zealand.
THE GOOD NEWS
Many more people are surviving today.
HOW IT HAPPENED
More widespread and accurate screening allows doctors to catch it early.
Australia and New Zealand have some of the highest rates of bowel cancer in the world, but over the last ten years, earlier detection has resulted in a 20 per cent fall in the overall mortality rate.
The most common screening tool in Australia is the faecal occult blood test (FOBT), which detects the presence of blood in the stool. Advances over the last few years have produced a more accurate version of the faecal test: the faecal immunochemical test (FIT). A positive result may require a follow-up colonoscopy, which can both locate and remove growths in the colon or rectum.
“In a perfect world, we’d all have colonoscopies to screen for bowel cancer,” says Dr Graham Newstead, director of Bowel Cancer Australia. “But it’s expensive, invasive and resource- dependent.” The faecal occult blood test, he says, is an accurate screening tool – and the next best thing – for the general population.
Forty per cent of males and 30 per cent of females will develop a polyp in their bowel – most of which will not develop into cancer. “But in the cases that become cancerous, by the time you have significant symptoms, the polyp will have grown through the bowel, and possibly into the lymph nodes or liver.” The best prevention is early detection, with screening every two years between ages 50–74. “Screening can save lives when followed up by timely diagnostic colonoscopy, by detecting bowel cancer at its early stages when 90 per cent of cases can be successfully treated,” says Newstead.
Breast Cancer
In 2018, an estimated 18,235 new cases of breast cancer will be diagnosed in Australia, and around 3000 in New Zealand.
THE GOOD NEWS
Many breast cancers are so slow-growing that may not need treatment. For those needing treatment, survival times are greatly improved.
HOW IT HAPPENED
Genetic testing now allows doctors to pinpoint which treatment will work best for which cancer, making long-term survival possible.
The incidence of breast cancer in Australia and New Zealand is, at first glance, alarmingly high. About one in eight women will get the disease. But a breast cancer diagnosis no longer needs to be a death sentence. Amazingly, a good portion of breast cancers don’t need treatment. Most small tumours (under two centimetres), found only by mammogram, will never grow large enough to lead to symptoms or death, according to a 2016 study in The New England Journal of Medicine. Even when a breast cancer is an aggressive type, it has become a very treatable, survivable disease. “We’re finding breast cancers earlier and earlier, when they’re much smaller and haven’t spread elsewhere in
the body,” says medical oncologist Dr David Shiba. “Cancers that have spread to the lymph nodes, liver, lung, bone or brain are becoming few and far between.” A good deal of credit goes to the discovery that one treatment doesn’t fit all. Using the right treatment for an individual’s cancer subtype saves lives and prolongs survival times for many women.
Newer drugs have turned even static disease into a chronic illness that patients can live with for years.
Living Transplants
Too few people donate organs to keep up with the need.
THE GOOD NEWS
From 2015 to 2016, living donations (kidney and liver) in Australia and New Zealand increased by nine per cent.
HOW IT HAPPENED
More people understand that most of us can live with just one kidney; live donations of livers are even lower risk.
Daniel Germanos of North Rocks, New South Wales, was just 17 years old when he was diagnosed with kidney disease back in 2014. He embarked on a regime of medications, including steroids, but his condition deteriorated rapidly.
It was obvious to all concerned that dialysis was Daniel’s next step. But Daniel and his parents were confronted by a stark truth: to have any chance of living a normal life, Daniel would have to undergo a kidney transplant. There was just one problem: the waiting list for a donor kidney was between five to ten years.
“We knew we couldn’t let him wait that long so we started looking into live donations in the hope one of us would be a suitable match,” says Rita Germanos. Daniel’s father was ruled unsuitable, and Rita was ruled out due to being too overweight.
So Rita began a regime of training and weight loss. “Not many mothers get to test their unconditional love like this,” she says. Over 12 months, Rita lost 32 kg until Daniels’ doctors finally gave her the go-ahead. In December 2017, Rita and Daniel underwent surgery, which was a success.
Daniel urges people to join the organ donation register [ www. donatelife. gov. au or www. donor. co.nz]. “Everyone should be on it because there are so many people that need one,” he says.
We now have new, better treatments for some of our most dreaded conditions. We’ve discovered that it might be possible to prevent some of these illnesses. Even those diseases still lacking an effective remedy have begun to reveal their secrets. What was once a death sentence is today often treatable, even curable. And tomorrow? With ongoing research, each year brings better news.