“The human body is well equipped to deal with cancer – we just have to help it”
Today, for many people, cancer is no longer a death sentence. Significant advances in medical research have made it possible to treat particular tumor types. However, as our knowledge increases, our perspective of cancer has become more diverse, and the picture has become more complex. We spoke with Dr. Julie N. Graff, associate professor for internal medicine at Oregon Health and Science University, about treatment options.
Cancer often has a fatal outcome, and current therapies are frequently extremely invasive.
Researchers at Bayer are investigating and developing new therapeutic options to directly target tumors, such as vaccinations, radiation therapy and immunotherapy - with considerable success.
New cancer treatments mean that the disease is no longer a death sentence for many people. In some cases, it is even possible to speak of a “cure”.
We’ll begin with the most important question: Will we ever be able to eradicate certain types of cancer?
Yes, I do think so. We can manage care so that the cancer never develops, rather than to cure it afterwards. I think vaccines are very critical for that. One positive example is cervical cancer caused by infection with human papillomavirus (HPV), which may soon be eliminated in Australia, because the country follows a resolute vaccination plan.
Do you have other examples?
In addition to vaccination against cervical cancer, we also have a treatment for hepatitis C, which is probably going to help reduce the number of hepatic carcinomas. But I agree that the HPV vaccine is even more promising because that infection leads to cervical, anal and some head and neck cancers, which probably make up a bigger proportion of the cancer numbers.
Additionally, there are some lymphomas caused by viruses. And eradicating or preventing those viral infections may prevent certain types of cancer.
Your particular focus is on prostate cancer – vaccination is not possible here. What other options exist to cure the disease? Is there any chance it can be defeated?
Prostate cancer is a more difficult case. It just appears to be a cancer of aging without a very clear cause. So, as our population gets older, it may become more prevalent. There is not a specific bacterium or virus that leads to it. Even though there is some indication that perhaps chronic inflammation may cause prostate cancer, there is not yet a “smoking gun.” I’m sure hormones contribute to development of those cancers.
So, there is no magic bullet so far, either. Do you think there ever will be?
We still have so much to learn. It’s hard for me to imagine that all cancers have a specific trigger that we could eradicate. But some cancers are relatively simple. Chronic myeloid leukemia (CML) is the best example, as there is a very specific mutation in the DNA that leads to this disease. And now there are treatments that make CML basically a chronic disease, whereas it used to be fatal.
In prostate cancer, however, many different types of mutations lead to it. When the cancer is present, it contains multiple mutations that don’t necessarily match from tumor to tumor and from patient to patient. The genetic characteristics can be more versatile. There are some attempts to fight prostate cancer with targeted therapies. But these are not very successful – the cancer cells develop resistance right away.
What other methods could work against prostate cancer?
Immune therapy is very promising. Cancers are very complex. And the body is equipped to deal with complex diseases and cancers. But the tumors find ways around the immune system. So, your body may already have identified the enemy, but the effect of the immune system is blocked. Today, certain drugs can interfere with that negative feedback – then the immune system can go ahead and target the cancer.
That’s a great way to treat cancer, because it doesn’t rely on just one mutation or just one protein. It helps your body fight the proteins that it identifies as abnormal.
Are there any disadvantages to that method?
This type of therapy is approved and being used for as many as ten cancer types. Unfortunately, not that many patients respond to it, so it doesn’t work for most patients. But when it does work, it works very, very well. The other potential issue is serious auto-immune disease, where the immune system starts targeting healthy tissue.
Can you anticipate which patients it works for, or is it just trial and error?
At this point it is mostly trial and error. But we know that tumor types with a lot of mutations are more likely to respond to this type of treatment. Now there is approval for use of these drugs with any tumor type that has one of those mutations. High mutational burden, we call it.
That’s the medicine you are working on with your patients?
Yes. I had a patient with very, very advanced prostate cancer. He received these treatments in 2015, and he still has no evidence of cancer today. So, it worked well.
We have seen some excellent responses with immunotherapy. One patient probably was cured – even if we almost never speak of “curing” cancer! He was treated ten years ago. And he still today has no evidence of cancer, nor has he undergone cancer treatment since then.
What’s the status of research in treating prostate cancer?
Right now, research is focused on looking for tumor markers – a mutation or a certain protein that we could target with medication. In prostate cancer, there are at least three strategies in phase 3 trials – immunotherapy, radiation therapy and drugs that interfere with so-called DNA repair defects. Every day the body makes mistakes in DNA multiplication. And all cells, including cancer cells, have a type of machinery that fixes these mistakes. But some cancer cells don’t have this machinery. We can use the fact that this mechanism is missing to help fight the cancer.
In summary, there are three ways we can target tumors. One is using immunotherapy. A second method is through this “machinery” thing, where you administer drugs to block the DNA repair in cancer cells that are missing mechanisms for DNA repair. And the third one is targeted radiation. That is a big interest right now. These patients are treated with radioactive molecules that will be taken up only by cancer cells. Once inside the cells, they will cause death to the cancer cells. The reason is that the tumor cells have something that is specific for the prostate cancer (so-called antigens) and you can target the tumor in this way.
What is the advantage of immunotherapy in comparison to other cancer therapies?
Other cancer therapies can shrink tumors and delay their spread, and help people live maybe a few more months. But these immunotherapies, when they work, they work really well, and the patients can practically get rid of the cancer.
We are getting these methods approved for cancers that have already spread. But they also might have some use in the primary tumor setting.
What are you working on at the moment?
One thing we are working on is to try to help immunotherapy work in more patients. One of our ideas is that immunotherapy works better in people who have certain types of bacteria in their colon. We just got funding to look at stool transplants. We will begin the study soon. We still can’t say if it’s going to work. But there is evidence that says it might work. And if it does, it will be pretty fascinating.
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