Integrated Cancer Therapeutics

Getting from here to there:

Where is "here"? 

Today, the standard of regimen in most hospitals treating cancer patients with solid tumors is to surgically remove as much of the tumor as possible, and subsequently, treat the patients with one or more chemotherapies and/or radiation, perhaps coupled with a biologic, such as Avastin, which helps shrink the blood supply to the tumor. 

There's really not any one part of this treatment regimen that is all good, except that right now, sometimes it works to rid the patient of the cancer, and often it may prolong the life of the patient, sometimes by only a few months. The surgery is highly invasive, often removing healthy tissue along with the tumor(s). The chemo often has severe off-target effects that are highly debilitating - nausea, vomiting, destruction of healthy cells, loss of hair, and sometimes destruction of the immune system. The same pretty much goes for radiation, and Avastin, depending on the application, can have its own set of complications and off-target effects.

And then there is the long anxious wait to see if the cancer returns.

Where is "there"? 

An integration of new and traditional therapies is evolving. Multimillion dollar proton beam radiation machines enable highly targeted "boiling" of the tumor cells in prostate cancer, minimizing the collateral damage to nearby healthy cells without any surgery required. However, even in cases where this technology can be used, there is still the need to follow up with chemo or radiation to make sure that residual cancer cells are destroyed. 

There is a new form of radiation that targets only the cancer, by helping guide the radiation use MRI to minimize collateral damage to healthy tissue. See: <http://www.medicalnewstoday.com/articles/150774.php>.

Also, MRI focussed ultrasound has many of the same benefits.

See: http://www.tmcnet.com/usubmit/2009/05/24/4194253.htm

Potentially, more effective methods of boosting the immune system can bypass the need for chemo altogether, or it can be used as a supplement to chemo to "mop up" the residual cancer cells following traditional cancer therapies. Often patients are deemed cancer free, only to have their cancer return. Companies today, such as MabVax (see: www.mabvax.com) are working with vaccine technologies developed over the last two decades at Memorial Sloan Kettering Cancer Center in NY to boost the antibodies in the patient following traditional therapies in order to help prevent the cancer from recurring. MabVax's vaccines are still in clinical trials, but if progress continues, it could offer an inexpensive method of helping prevent the cancer from returning by boosting antibodies against the particular form of cancer.

The idea of cancer vaccines have been around for decades, and indeed, the vaccine for human papilloma virus (HPV) has been is the market in nearly 90 countries. However, for other cancers, producing effective prophylactic vaccines has been more difficult, as enough of the right antibodies have failed to be produced. For more information on MabVax, see:

www.mabvax.com

In the first edition of this blog, the T-cell expansion work of Dr. Carl June and his team at the University of Pennsylvania has demonstrated strong anecdotal immune response in fighting cancer, and where possible, they find improved results by making a personalized vaccine from the patient's own cancer. This approach is being replicated by numerous major cancer centers around the US. Right now, there is no web site for the company that has been established around Dr. June's T-cell expansion, as the company is still in stealth mode. However, Dr. June and his team already has clearance for 18 FDA clinical trials and has treated 400 cancer patients with variations of this approach. There is enough anecdotal evidence to show that this therapeutic holds great promise. See the first blog at this site for more detail.

Today, there is no therapeutic vaccine for cancer that will work alone. Where we may be headed with solid mass tumors is an integrated set of cancer therapies to:

1.  Use a proton beam or MRI guided radiation, or

2.  Surgically remove as much of the cancer as possible, and then

3.  Use cancer specific T-cell expansion to mop up the remaining cancer cell, along with a personalized vaccine made from the patient's own cancer, and then 

4.  Later take a vaccine to boost cancer specific antibodies to help prevent the cancer from returning. 

5.  If  the cancer does return, it should be detected early enough so that all that may be needed is another T-cell expansion. 

For hematological cancers (cancers of the blood) T-cell expansion and follow up vaccines show promising relief from chemo, bone marrow transplants (with their risk of graft versus host disease) and radiation.

Scientists are developing methods to detect cancer earlier.  With that, perhaps only T-cell expansion and vaccines will be necessary - a totally non-invasive and effective approach to cancer therapeutics. Should we get to this point, the harmful side effects of chemo and radiation may become a thing of the past. There may still be some cancers that prove more difficult for these new modes of therapeutics, such as glioblastoma (a cancer of the brain). The good news is there are developments in the works to tackle these difficult cancers using novel approaches. More on that in a future blog.

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