Isn't it time we acknowledged the potential of immunotherapy?
Immunotherapy has few side effects for cancer patients compared to chemotherapy, and research – including some into therapies involving natural products such as mistletoe – is advancing
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Coloured scanning electron micrograph (SEM) of a lung cancer cell during cell division (cytokinesis)
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The 'T cells' in our bodies are of key importance to our immune systems. They act like soldiers who search out and destroy invaders. It is these cells that immunotherapy researchers want to harness and turn into mega-soldiers that will attack and kill cancer cells, thereby using our own immune systems to counteract cancer.
Several years ago, I wrote a blog post for the Telegraph about work being done by the Australian company Prima Biomed on an immunotherapy treatment called ‘CVac’ for epithelial ovarian cancer. Dr Neil Frazer was leading the research work in the USA and explained to me the method. Immature, dendritic cells – filtered from the patient’s blood – are cultured to grow to 200-600 million, then ‘bathed with mannan-mucin-1 fusion protein’ and injected back into the patient. Here, they meet up with T cells, which the cultured dendritic cells turn into the mega-soldiers who then hunt and destroy the abnormal mucin-1 covered tumour cells (found on lung, colon and breast cancers, as well as ovarian).
My second blog post on the subject asked the question “How long before CVac is available in the UK?"
I recently realised, after reading the responses to my column on ovarian cancer in April of this year, that this question is still unanswered. I wrote to Dr Frazer to ask for an update, but the email came winging back. Has Dr Frazer moved on to other work? Information on Prima Biomed’s website, dated May 19 2015, tells of a successful outcome to the Phase II trial – “CVac shows clear trend for Overall Survival Benefit in Second Remission Ovarian Cancer in Phase II Study”. There is even a video of the ‘Manufacturing of CVac’. Maybe someone from the company would be able to answer my question, I thought – but no luck there either. There was simply no reply to my email.
All very strange and disappointing as I have followed CVac’s development with great interest, not least because I was alerted to it by the husband of a dear friend who was desperately searching for something to help his wife to – at least – prolong the time between chemotherapy treatments. However, the trials were in their infancy – and not in the UK – and she did not have time on her side.
One of the huge benefits of immunotherapy – compared with chemotherapy – is far fewer potent side-effects; indeed, there may be none at all.
Immunotherapy research in America
Professor Elizabeth Mittendorf, who is associate professor of surgical oncology at the University of Texas, says access to immunotherapy may change
The University of Colorado Hospital is conducting a clinical trial of a cancer vaccine called ONT-10, made by Oncothyreon, which stimulates the body’s own immune system to attack cells that express MUC1. This protein is found in a number of cancers, especially ovarian and breast. The trial recruited women with advanced cancers which have spread despite conventional treatment and Dr. Virginia Borges – the medical oncologist from the University’s School of Medicine – said: “In an initial Phase 1 study in all different types of cancers, we saw an excellent safety profile and also evidence of response in people who had very advanced late-stage cancers”.
The patient begins with four weeks of no drugs at all – a ‘wash out’ period – followed by four injections once a week for eight weeks. For one participant, the spine metastases were ‘annihilated’ and she was able to continue on the maintenance programme only – four injections once every six weeks. She is reported to have had no side effects.
A second study will combine ONT-10 with Varlilumab – an antibody developed by Celidex Therapeutics. Varlilumab uses a different molecular pathway to stimulate the T cells to work better and help the immune system to attack tumour cells. On this trial, there will be 15 breast cancer patients and 15 ovarian cancer cases.
At the 32nd Annual Miami Breast Cancer Conference, Professor Elizabeth Mittendorf – associate professor of surgical oncology at the University of Texas MD Anderson Cancer Centre in Houston – said: “Breast cancer specialists once assumed that the relative paucity of nearby T cells limited the potential of immunotherapy in their field, so they concentrated (very effectively) on targeted treatments. Patients with breast cancer have thus had limited access to the kinds of immunotherapies that are currently available to people with melanoma or prostate cancer. But that may change”.
Mistletoe therapy?
Could mistletoe help in the fight against cancer? [PHOTO: NIGEL CATTLIN]
Along the way, there is also the controversial suggestion of Iscador – a medication made from mistletoe. I first came across this alternative therapy in a book written by Sarah Horton. “Being Sarah” describes her breast cancer diagnosis in 2007 and how she declined most of the conventional therapies, preferring to select her own treatment plan. Part of this plan was to receive injections of Iscador from a homeopath.
White berry – not red berry – mistletoe has been used for generations and claims for its efficacy abound. It was introduced by Rudolf Steiner – the educator and practitioner of alternative medicine – in the early 20th century. However, modern, clinical trials in Europe have produced mixed and confusing results.
At Johns Hopkins University in Baltimore, Luis Diaz – Director of Translational Medicine at the Ludwig Centre for Cancer Genetics and Therapeutics at the Kimmel Cancer Centre – was requested by a patient, whose colon cancer had metastasised to her liver, to allow a specialist in complementary therapies, Peter Hinderberger of Baltimore’s Ruscombe Mansion Community Health Centre, to administer injections of mistletoe extract.
After much persuasion and a review of the available literature, Professor Diaz agreed. The patient began to feel better almost immediately. Professor Diaz said: “That’s a universal feature I’ve seen in all patients who get mistletoe. Their colour improves; they have more energy.”
Researchers at Johns Hopkins have been looking increasingly at naturally derived medicines to fight disease and Channing Paller (assistant professor of oncology at the Johns Hopkins School of Medicine) is the lead investigator for the mistletoe trials, which began in the spring of last year. Results should be known soon. Professor Paller said: “We don’t treat these natural products (e.g. the study involving the treatment of prostate cancer with pomegranate and an extract of muscadine grape skins) any differently than any other immunotherapy trial that we do.”
She followed up by saying: “Mistletoe’s primary benefit could lie in its ability to boost the immune system, as studies have revealed that it can help patients better withstand the side effects of chemotherapy.”
A word of warning – please do not self-administer any mistletoe product without first discussing it with your cancer consultant. The jury is still firmly out on the subject and your safety is paramount.
The patient – Ivelisse Page – and her husband have set up a charity called“Believe Big” to connect cancer patients with doctors who use unconventional therapies and raise funds for three-stage clinical trials.
Clearly, immunotherapy is the way forward and if Dr Neil Frazer – or anyone at Prima Biomed – is reading this, please email me [email protected]
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