‘Slow but sure’ progress to­ward less toxic tools to fight can­cer

Chemo­ther­apy and ra­di­a­tion are still the most dom­i­nant tools. But in re­cent years, a se­ries of clin­i­cal tri­als have shaken up the can­cer world, show­ing it was pos­si­ble to bet­ter treat and even cure some of the most dif­fi­cult forms of can­cer with­out re­sort

The Borneo Post - Nature and health - - Update -

JOHN Ryan is just one of the mir­a­cles to emerge from the Johns Hop­kins can­cer unit in Bal­ti­more. An immunotherapy treat­ment -- highly ef­fec­tive in a mi­nor­ity of pa­tients -- saved his life af­ter a lung can­cer di­ag­no­sis. The re­tired mil­i­tary nu­clear re­ac­tor spe­cial­ist will cel­e­brate his 74th birth­day in July, and his bat­tle with can­cer il­lus­trates the prom­ises and fail­ures of immunotherapy, a bur­geon­ing field in which the phar­ma­ceu­ti­cal in­dus­try is in­vest­ing heav­ily. Ryan has been able to at­tend the grad­u­a­tions of three of his chil­dren, and will take part in the wed­ding of one of his daugh­ters this sum­mer -- even though doc­tors ex­pected he had just 18 months to live in June 2013.

“That’s ex­cit­ing stuff to be around for,” he said. But he knows of plenty peo­ple who have not been so for­tu­nate. “In five years, I have lost a lot of dear friends.” Immunotherapy is one of two ma­jor cat­e­gories of drugs against can­cer. The best-known is chemo­ther­apy, which has been used for decades and aims to kill tu­mors but is so toxic that it also at­tacks healthy cells, lead­ing to ma­jor side ef­fects like weak­ness, pain, di­ar­rhea, nau­sea and hair and weight loss. Ryan went through all that in 2013, and his tu­mour per­sisted.

Ex­hausted by chemo and wracked with pain, Ryan was ac­cepted into a last-ditch clin­i­cal trial us­ing nivolumab (brand name Op­divo) in late 2013. The drug was de­liv­ered in­tra­venously at the hospi­tal, at first ev­ery two weeks, then once a month. His tu­mour rapidly dis­ap­peared, and 104 in­jec­tions later, the main side ef­fect has been itch­ing. Re­cently, a mys­te­ri­ous mass ap­peared in his right lung. It was treated with ra­di­a­tion.

“They shot me with chemo, it al­most killed me. And now I have been suck­ing up immunotherapy, and it’s been good. My qual­ity of life has been great,” said Ryan. Immunotherapy trains the body’s nat­u­ral de­fences -- im­mune cells, also known as T-cells -- to de­tect and kill can­cer cells, which oth­er­wise can adapt and hide. Some ex­perts are cau­tious, hav­ing been dis­ap­pointed nu­mer­ous times by other new­fan­gled ap­proaches to fight­ing can­cer.

But many con­sider immunotherapy as a turn­ing point. More than 30 immunotherapy drugs are in de­vel­op­ment, and 800 clin­i­cal tri­als are un­der­way, ac­cord­ing to Otis Braw­ley, med­i­cal di­rec­tor of the Amer­i­can Can­cer So­ci­ety. Ryan’s on­col­o­gist, Julie Brah­mer, said she now starts about a third of her lung can­cer pa­tients on immunotherapy first, not chemo. It helps that the Bal­ti­more fa­cil­ity has nu­mer­ous clin­i­cal tri­als un­der way, far more than the av­er­age US hospi­tal. Doc­tors are in­trigued by the un­usu­ally long re­mis­sions seen in a small num­ber of pa­tients like Ryan. These suc­cess sto­ries make up about 10 to 15 per cent of pa­tients, said William Nel­son, di­rec­tor of the Sid­ney Kim­mel Com­pre­hen­sive Can­cer Cen­tre at Johns Hop­kins. Nor­mal re­mis­sions typ­i­cally last a year and a half to two years.

Chemo­ther­apy and ra­di­a­tion are still the most dom­i­nant tools. But in re­cent years, a se­ries of clin­i­cal tri­als have shaken up the can­cer world, show­ing it was pos­si­ble to bet­ter treat and even cure some of the most dif­fi­cult forms of can­cer with­out re­sort­ing to the most toxic tech­niques. A spec­tac­u­lar ex­am­ple con­cerns prostate can­cer. Re­searchers have found that rec­om­men­da­tions of reg­u­lar screen­ing had the op­po­site ef­fect of what was in­tended: too many tu­mours that would never have spread were were be­ing treated in op­er­a­tions. – AFP

Chemo­ther­apy and ra­di­a­tion are still the most dom­i­nant tools But in re­cent years, a se­ries of clin­i­cal tri­als have shaken up the can­cer world. — iS­tock photo

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