TARGETED IMMUNOTHERAPY: Still work to do.

Enjoying life in Split Mountain Gorge

 

Dick Ingwall is my oldest Research Assistant (in point of service, and probably other ways as well).  He has pounced upon an important article in the New York Times of May 8^th.  In addition to being my most prolific source of ideas, Ingwall is my best-remunerated RA: only last year I arranged for him to be inundated by shipments of squash; to save himself he took actions that earned him the title of Most Honored Donor of 2013 by the Cape Cod Food Bank.  Thanks again, Dick: without you I’d have to subscribe to the Times myself.  Let me know if you need more squash.

It seems to me that the two most exciting lines of research in the field of cancer therapy are immunotherapy and targeted therapy.  The first involves teaching the immune system to recognize cancer cells as enemies, and then attack them.  The second requires much genotyping in order to design a molecule that will interfere with the chain of biological events that causes proteins coded for by mutated genes to work mischief.  It appears now that a combination of the two is getting some scrutiny.  This surmise is based on work done at the National Cancer Institute laboratories by Dr. Stephen Rosenberg and his team.  What they have done is to develop immune cells specifically aimed at the tumor itself.  They do this by sequencing the genome of the tumor, then identifying specific types of immune cells that are attacking the deleterious mutations.  Next they extract some of these immune cells, grow billions of them in the lab, and inject them back into the cancer victim, -  and watch what happens.  So far they have done this with only a single patient, a particularly courageous woman from Billings, Montana.  Her tumors have “melted away”, and she is enjoying life many months after she had been expected to die.  Let’s hope the cure is really permanent; a heck of a lot more work will be needed to verify if this treatment really works.  It is targeted on solid tumors; epithelial ovarian cancer is one such.

There are aspects of this article that I don’t understand.  I am going to quote from it:

“By then, the team had sequenced the genome of her cancer, and done extensive studies on her immune system. And it had found what researchers had long hoped for: a mutation in the cancer that was unique to it and not found in normal cells, and a type of T cell that would attack the mutation.”

I don’t know how you “attack a mutation”.  Does the immune cell actually destroy the mutated gene?  Or does it just stifle the protein that the gene produces?  I guess I don’t need to know: if it works, it works, and that’s all I really care about.  (But I’m curious.) 

If it (this kind of therapy) really does work, it is bound to be very expensive.  Thus, a related question: how do we (society) pay for it?  If this had been available when Linda was alive we would have paid for it out of pocket if necessary, that goes without saying.  However, that option is not available to most people, even in rich countries.  Another business model is required.  Maybe economists are  useful, after all.

This is a particularly important article: why don’t you read it?

http://www.nytimes.com/2014/05/09/health/doctors-use-patients-immune-cells-to-shrink-cancer-tumors.html?ref=health

Happy Mothers’ Day!