If We Can't Kill Cancer, Can We Control It?
An anonymous reader sends this excerpt from The New Yorker:
In April, [Dr. Eytan Stein] presented his findings to a packed auditorium at the annual meeting of the American Association for Cancer Research, in San Diego. It was the first public airing of the results of AG-221; patients with progressive [acute myelogenous leukemia] had never improved so quickly and definitively. ... The breakthrough is notable in part for the unconventional manner in which the drug attacks its target. There are many kinds of cancer, but treatments have typically combated them in one way only: by attempting to destroy the cancerous cells. Surgery aims to remove the entire growth from the body; chemotherapy drugs are toxic to the cancer cells; radiation generates toxic molecules that break up the cancer cells' DNA and proteins, causing their demise. A more recent approach, immunotherapy, co-opts the body's immune system into attacking and eradicating the tumor. The Agios drug, instead of killing the leukemic cells — immature blood cells gone haywire — coaxes them into maturing into functioning blood cells. Cancerous cells traditionally have been viewed as a lost cause, fit only for destruction. The emerging research on A.M.L. suggests that at least some cancer cells might be redeemable: they still carry their original programming and can be pressed back onto a pathway to health.
Bullshit. I've seen lots of friends die of AIDS in the early 90s. Now HIV/AIDS is under control. It's now a chronical disease that people can live long productive lives with, as long as they take their drugs. When treated early, most infected people will be asymptomatic except for the (relatively mild) side effects of the drugs. I wish we could say that for most cancers.
Of course unlike cancer, HIV is communicable. And unlike Ebola, it killed many rich white men. These factors might have contributed to the success story of its treatment.
Let me give you a brief summary of TFA:
- Some cancers have IDH1, IDH2 mutations that change cellular metabolism
- This drug is the first targeting the IDH2 enzyme that has been tested in humans
- 6 out of 7 patients whose disease (leucemia) had the specific IDH2 mutations had "objective response" to the drug, ie the disease burden was reduced. Note, this does not mean cure.
Now, this is obviously good news, in the same spirit as previous targeted agents like vemurafenib, erlotinib, trastuzumab, crizotinib, especially since it concerns a new aspect of cellular functioning (metabolism). It's too early to say whether the drug will have long lasting impact, but we'll know more after phase II/III trials. It does seem promising.
For patients with AML or MDS and documented IDH2 mutation, the study (NCT01915498) is still recruiting in several centers around the US and in Paris/France (Institut Gustave-Russy). More information can be found in clinicaltrials.gov (http://www.clinicaltrials.gov/ct2/results?term=NCT01915498&Search=Search).