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Researchers Successfully Fight Colon Cancer Using Immunotherapy (nytimes.com)

Posted by EditorDavid on from the fighting-a-terrorist-cell dept.

Slashdot reader schwit1 quotes the New York Times: The remarkable recovery of a woman with advanced colon cancer, after treatment with cells from her own immune system, may lead to new options for thousands of other patients with colon or pancreatic cancer, researchers are reporting. (Shorter non-paywalled version of the article here). Her treatment was the first to successfully target a common cancer mutation that scientists have tried to attack for decades... so resistant to every attempt at treatment that scientists have described it as "undruggable"... The researchers analyze tumors for mutations -- genetic flaws that set the cancer cells apart from normal ones. They also study tumor-infiltrating lymphocytes, looking for immune cells that can recognize mutations and therefore attack cancerous cells but leave healthy ones alone.
The patient, a 50-year-old database programmer in Michigan, is now cancer-free, according to the article. "Researchers twice denied her request to enter the clinical trial, saying her tumors were not large enough, she said. But she refused to give up and was finally let in."

The treatment ultimately eliminated six of her seven tumors, and because it targeted a cell mutation that's common in colon cancer patients, "Researchers say they now have a blueprint that may enable them to develop cell treatments for other patients as well."

40 comments

  1. Ugh. by Anonymous Coward · · Score: 2

    My dad just died of colon cancer back in September. This news makes me both happy and sad at the same time.

    1. Re: Ugh. by Anonymous Coward · · Score: 0

      My dad too, in August. It was really horrible to watch and not be able to do anything.

    2. Re:Ugh. by Xian97 · · Score: 1

      I am sorry for your father. We just lost my neighbor and my wife's best friend last week to colon cancer. It hit us pretty hard. Everyone I had ever lost was sudden, here one minute, gone the next, from a heart attack, car accident, or such. Watching the slow, lingering, wasting away to nothing death was one of the hardest things I have ever went through. Cancer sucks, I hope this treatment proves beneficial so others do not have to go through what she did.

    3. Re:Ugh. by blackpaw · · Score: 1

      My sympathies and I feel exactly the same. My Dad died of colon cancer back in 2012.

      Side Note: Hope you're getting regular colonoscopies (?spelling). With my family history I get them every 3 years. 4 Polyps removed so far. If caught early, colon cancer is very treatable, even preventable.

  2. Designer medicine by Anonymous Coward · · Score: 0

    Exciting but will these things end up being too expensive for all but the elite once clinical trials are completed?

    1. Re:Designer medicine by amiga3D · · Score: 1

      Other than the price of research this treatment should be cheaper than traditional cancer treatment.

    2. Re:Designer medicine by tempo36 · · Score: 1

      I work in a group treating patients with this specific kind of therapy; chimeric receptor modified T-Cells. As other have said, right now the treatment is highly specialized and requires individual attention to each cell line from harvest through delivery; it cannot be automated. We can treat tens of patients right now with the resources available to us, not hundreds, not thousands, certainly not millions. That said, the therapy is not presently terribly expensive for the patient because it is experimental and is being funded largely by the pharmaceutical companies that are investing in the process. But if we did commercialize it right now, it would be terribly expensive because of the labor involved with the production and also because right now we are being very careful to monitor for side effects and adverse events. That means tons of lab tests and long hospital stays. As a side note, T-Cell therapy has a nasty habit of occasionally killing the recipient. Just because it's immune therapy and "uses your body's own cells" doesn't mean that the immune system run amok can't do incredible damage. Just ask someone who is experiencing an anaphylactic reaction how "friendly" and "safe" their immune system is at that moment.

  3. Old technology... by Anonymous Coward · · Score: 0

    I'm pretty sure techniques very similar to this have been available in France for more than a decade. So maybe the story should be that the slow U.S. regulatory process for medical procedures is a decade behind as opposed to framing it as brand new cutting-edge technology.

    1. Re:Old technology... by nbauman · · Score: 5, Informative

      I'm pretty sure techniques very similar to this have been available in France for more than a decade. So maybe the story should be that the slow U.S. regulatory process for medical procedures is a decade behind as opposed to framing it as brand new cutting-edge technology.

      Not true. I follow French medical science -- everybody in medicine does. Much of their work is excellent, but they don't hide it. They talk about it at international conferences and publish their results in major journals. Like everything else in medicine, when the French come up with a good idea, the rest of the world picks it up.

      For that matter, when a French scientist comes up with a good idea, graduate students all over the world want to study in his lab, just like French grad students want to study in other labs worldwide. So a lot of the cutting-edge work is by international teams. You can see that by searching Youtube for Dance Your PhD http://www.sciencemag.org/news...

      Cancer immunology is a big field. Everybody's trying to make it work. Sometimes it works, sometimes it doesn't. Bone marrow transplants (actually blood cell transplants) are standard now for some leukemias, and fairly effective. This specific treatment has never been done before, not in France, or anywhere.

      It's also not true that the European regulatory agencies approve drugs faster than the US FDA:

      http://www.nejm.org/doi/full/1...
      The 21st Century Cures Act â" Will It Take Us Back in Time?
      Jerry Avorn and Aaron S. Kesselheim
      N Engl J Med 2015; 372:2473-2475
      June 25, 2015
      DOI: 10.1056/NEJMp1506964

      An underlying premise of the bill is the need to accelerate approval for new products, but this process is already quite efficient. A third of new drugs are currently approved on the basis of a single pivotal trial; the median size for all pivotal trials is just 760 patients. More than two thirds of new drugs are approved on the basis of studies lasting 6 months or less â" a potential problem for medications designed to be taken for a lifetime. Once the Food and Drug Administration (FDA) starts its review, it approves new medications about as quickly as any regulatory agency in the world, evaluating nearly all new drug applications within 6 to 10 months, an impressive turnaround for such complex assessments.

    2. Re:Old technology... by Anonymous Coward · · Score: 0

      Once the Food and Drug Administration (FDA) starts its review, it approves new medications about as quickly as any regulatory agency in the world, evaluating nearly all new drug applications within 6 to 10 months, an impressive turnaround for such complex assessments.

      6 to 10 months is impressive? Wow. Your expectations are very very low.

    3. Re:Old technology... by ebvwfbw · · Score: 1

      Viva la France

  4. Moral: Be a persistent ASS to save your ASS by Anonymous Coward · · Score: 0

    Nuf said in subject

    1. Re:Moral: Be a persistent ASS to save your ASS by Anonymous Coward · · Score: 0

      Well, it was a Database person amiright?

  5. Never understood some trial criteria by RogueWarrior65 · · Score: 4, Interesting

    I can't understand why clinical trials reject people who aren't in bad enough condition. What if the treatment only works before the disease gets really bad? Wouldn't you want to know this?

    1. Re:Never understood some trial criteria by rmdingler · · Score: 2
      You would also think that clinical trials would be eager for successful results, thus more interested in candidates that are not as far gone.

      We were able to get my mother into one of these after she performed suitably poorly during testing.

      The thing is, a great number of side effects and adverse reactions are uncovered during human trials, and medical researchers prefer to reserve the high risk, experimental treatments for those without other, proven medical recourse.

      --
      Happiness in intelligent people is the rarest thing I know.

      Ernest Hemingway

    2. Re:Never understood some trial criteria by Anonymous Coward · · Score: 0

      When doing a clinical trial, you are testing something that hasn't been used in humans before, and thus there is the possibility of serious, possibly lethal side-effects.

      If you accept someone whose disease isn't very bad and thus could recover on their own, or has a good chance of recovering with already-known treatments, you are running a risk that you will kill them, and you aren't helping them very much because you thought they could be cured already.

      If you accept someone whose disease didn't respond to already-known treatments, or who is too far gone for them to work, then you are sill running a risk that your experimental treatment will kill them, but since they are going to die soon anyway from the disease, this is a reasonable risk to take -- maybe you'll kill them, maybe you'll save their life.

      After the new treatment is demonstrated in some people whose disease was very advanced, and you know it isn't killing those patients and it is doing something helpful for them, then you can do another round of trials with less-bad patients to compare how well it works compared with other treatments in the more standard cases.

    3. Re:Never understood some trial criteria by Anonymous Coward · · Score: 0

      There are also lots of people that are misdiagnosed and don't actually have cancer and then gets 'miraculously' cured, since they never had cancer in the first place, but something else entirely, which cleared up. (For example 50% of people diagnosed with prostate cancer are misdiagnosed - you can just as well flip a penny - way cheaper too). Looking for patients with large obvious tumors eliminates those.

    4. Re:Never understood some trial criteria by bazorg · · Score: 2

      Sometimes the guys at Science Based Medicine blog about this subject. In general those guys object to "right to try" because:
      a) patients who are desperate enough to try *anything* are potential victims for quacks to sell stuff under the guise of "clinical trials" (the results of those trials never being published is a good clue as to whether the trial was genuine in the first place)
      b) pharmaceutical companies could use "exceptionally urgent trials" as a conduit to get products to the market earlier than normal regulation allows.

      Maybe if all trials could be published properly this could be a good way to weed out the quacky ones from actual attempts to treat really sick people.

    5. Re:Never understood some trial criteria by mlyle · · Score: 1

      > I can't understand why clinical trials reject people who aren't in bad enough condition. What if the treatment only works before the disease gets really bad? Wouldn't you want to know this?

      A key reason is that there are already pretty good treatments for stage 1 or stage 2 colon cancer that significantly drop 5 year mortality. So the potential for doing more harm (by doing this instead of other treatments) or confusing the results and potentially creating harm (by offering this with existing treatments) are much greater.

      So it's a much lower bar to justify trying it on late-stage cancer patients who don't have a proven, really effective therapy available and are pretty likely to die anyways even if your treatment is somewhat dangerous.

    6. Re:Never understood some trial criteria by nbauman · · Score: 4, Informative

      In this case, they were surgically removing large tumors that were infiltrated with T cells.

      The T cells normally attack cancer cells, but they couldn't do it because the cancer cells had established a defense mechanism.

      They were trying to overcome the death mechanism and train the T cells to attack the cancer.

      For that they needed big tumors with a lot of T cells.

      At first, they did a biopsy of her tumors to see whether she had enough T cells to make the treatment work. She didn't have enough T cells. If they had tried it, even if their theory was correct, the treatment would have failed.

      Then her x-rays showed that her tumor had grown, so her doctor sent them in to the researchers. They did another biopsy, and she had a lot of T cells infiltrating the tumor -- enough to make the treatment work. That's why they accepted her in the trial.

      I'm writing this from memory. I read the paper and a few articles about it, but I'm not going to read it again.

    7. Re:Never understood some trial criteria by nbauman · · Score: 1

      Particularly in colon cancer.

      Colon cancer is curable with surgery in the early stages, but uncurable by anything after it metastasizes.

      After metastases, they're trying to extend life for another 5 or 10 years.

    8. Re:Never understood some trial criteria by nbauman · · Score: 1

      Unfortunately the 21st Century Cures Act will encourage the FDA to approve treatments based not on randomized, controlled trials, but on weaker evidence, such as observational studies, case studies, anecdotes, and testimony by patient groups financed by the drug companies.

      Here's an article that rounds up some of the other articles about it. http://www.healthnewsreview.or...

      Sometimes you read a medical case history and the doctor says, "There are no randomized, controlled trials to demonstrate effectiveness, so it is treated empirically." Because of the 21st Century Cures Act, you'll now see this more and more. We won't know what the effective treatments are.

    9. Re:Never understood some trial criteria by Anonymous Coward · · Score: 0

      I would agree to "right to try" IF:

      Trials were by law held by 3rd party companies that had no incentive (were chosen by lottery to decrease potential "come to us if you want approved" nonsense) and were paid a standardized rate (that wasn't subject to inflation if the pharma company "gets a good reviewer")

      I know full well this will never happen outside the coasts of the US Since there is too much money to be made the way things operate now. (I doubt it will ever happen there too, but at least there is the off chance) (Yes personal political opinion, deal with it)

    10. Re:Never understood some trial criteria by RogueWarrior65 · · Score: 1

      Okay, cancer is one thing but from my own perspective watching my parents deal with wet age-related macular degeneration, the ophthalmologist they see is THE top guy in the field. His practice conducts research studies all the time. In one instance, it wasn't a case of whether or not they might get a placebo. They were guaranteed to get at least the current method of treatment but they could be getting the new drug. They said, "Oh, you don't qualify because your vision is too good." Well, it will likely get worse no matter what so why not take the chance. Personally, I think he should cheat on the eye test.

    11. Re:Never understood some trial criteria by mlyle · · Score: 1

      If the new drug is very possibly much worse than the current treatment, it's still a bit of an ethical conundrum.

    12. Re:Never understood some trial criteria by Anonymous Coward · · Score: 0

      The FDA has "fast path" trails for some cases, probably the ones you are complaining about. If you are stage 4 of an incurable cancer (like I was) they can put on trials for new drugs that normally would be years from phase 2 or phase 3 trials. The thinking is the cancer is going to kill you in 6 months, how much worse could a bad drug do to you at that point.

      When you are stage 1 or 2 cancer, there is still a decent chance of curing it and a drug that has a significant chance of killing you on its own is really not a good idea.

      In my case, despite being stage 4, I wasn't bad enough off for those advanced phase 2 or 3 trials, but was going to be there in a month or two at the rate I was going.

      So its just a quicker path the FDA approves for guaranteed mortality cases that the drug can't make things worse. I would think this treatment in the story is probably over 5 years out from being common, even if they can repeat it right away with perfect results.

    13. Re:Never understood some trial criteria by mlyle · · Score: 2

      > Colon cancer is curable with surgery in the early stages, but uncurable by anything after it metastasizes.

      Just a curious aside-- the survival / staging thing is probably somewhat misleading.

      Some fraction of cancers are probably incapable of establishing themselves in other tissue; and aggressively-growing cancers tend to get diagnosed later in phase of disease progression. So in other words, there's a selection bias where the inherently nastier cancers show up with a worse staging.

      A lot of attempts to detect cancer earlier / screen more frequently have spotted earlier stage cancers but have not delivered nearly the survival benefit you'd expect from the staging changes.

      (This effect is clearly present in colon cancer but there's still really big benefits from colonoscopy--- this effect has shown up to a greater degree in mammography, prostate cancer screening, etc)

    14. Re:Never understood some trial criteria by nbauman · · Score: 1

      You're basically right. I picked colon cancer because that is the one major cancer in which screening really can result in a cure.

      The way I learned it, the cancers appear in the inner layer of the colon, and they progress to the outer layers and finally the surrounding tissue. Doctors can screen for them with colonoscopy, and the initial cancer can be removed, sometimes directly during the colonoscopy, and sometimes in a separate operation which might remove more of the colon. Once it spreads outside the colon, though, it can't be cured by surgery any more, and there are no drugs that can cure colon cancer.

      I think I've seen long-term studies which showed that people who have the cancer surgically removed in the early stages ultimately live a normal life span, whereas people with the same early stage cancer who don't have it removed go on to develop later stage cancer and die of it within 5-10 years. I admit I can't quickly pull up a citation right now.

      Christie Aschwanden had a good story about this in FiveThirtyEight, although it's one of those stories that makes you work for the reward at the end.

      http://fivethirtyeight.com/fea...
      The Case Against Early Cancer Detection
      By Christie Aschwanden
      FiveThirtyEight
      Nov 24, 2014

      Papillary tumors are like turtles -- they move very slowly and never pose an escape risk. They don't need screening, because they will never cause trouble. Then there are rabbits, which are eager to hop away to other parts of the body, but can be confined if they're found and fenced. These are the cancers that can be helped by early detection and treatment. Birds, on the other hand, are so flighty and quick that they can't be confined. Screening makes no difference for bird cancers, because they're so aggressive that they can't be detected before they've begun their deadly course.

      No cancer screening has ever eliminated the majority of cancer deaths. Instead, the best screening can do is reign in the rabbits. Birds remain unstoppable, and they're the ones responsible for most cancer deaths

    15. Re:Never understood some trial criteria by Applehu+Akbar · · Score: 2

      Except that (a) right-to-try laws don't apply to quack medications. They just give terminal patients early access to compounds that are already in the FDA pipeline and which have passed Stage I toxicity. As for point (b) I suppose so, and more power to pharma on this point. We need to take a little more risk if we want to bring new cures to market faster.

      It's called the Evidence Based Medicine movement, but what it really promotes is taking MDs out of the loop in medical decision making and replacing their input with standardized decisions from bureaucrats. It's the medical equivalent of the precautionary principle, and if adopted will assure that our healthcare falls even farther behind Europe and Asia.

    16. Re:Never understood some trial criteria by tempo36 · · Score: 1

      As others have said, part of the reason is that it's considered abusive to risk the life of a patient on an experiment when there are tested therapies that give them a good chance. There are other reasons though too. In the case of T-Cell therapy, sometimes they need sufficient tumor mass to perform the T-Cell harvest. Also if the disease is small, it can be hard to determine meaningful endpoints (i.e. big tumor gets tiny = significant result whereas tiny tumor gets a bit tinier = fuzzy interpretation of the PET scan). As we learn more about T-Cells, we will start considering them as more first line therapy for less aggressive disease. This is the case, for example, with ipilimumab and nivolumab which were initially experimental and used as salvage but are now moving towards first line therapy in metastatic melanoma. At the other end of the spectrum you don't want patients that are too sick, because if they're all on death's door you don't know if the treatment failed or if they were just too far along and too sick vis-a-vis end organ damage for anything, even an effective treatment, to save them. Analogy being if a man is in a horrible car wreck and he goes to surgery for an experimental procedure to fix his spine and he dies of blood loss from all his other injuries, what do you say about the success of the spine surgery? Did it work? Would it have worked? Who knows...every major organ had been turned to jelly in the wreck so fixing the spine was sort of irrelevant.

  6. New definition of Cancer Free by Anonymous Coward · · Score: 0

    So only 1 tumor remains and it's not been very long. So hardly cancer free. That is statement is reserved after a further 10 years.

  7. Same reason late term cancer meds are so popular by rsilvergun · · Score: 1

    with Big Pharma. It doesn't matter if they work or have terrible side effects because you're going to die soon anyway. Also you'll pay just about anything for a shot at life. Those things combined make them highly profitable. On the flip side some very promising treatment options for kids with Leukemia have to funded in Europe because keeping kids alive for the next 50 years of their lives can't measure up.

    --
    Hi! I make Firefox Plug-ins. Check 'em out @ https://addons.mozilla.org/en-US/firefox/addon/youtube-mp3-podcaster/
  8. To make sure the treatment is what works healing by Anonymous Coward · · Score: 0

    Some stage 1 or even stage 2 cancer can spontaneously go into remission, (or with a little chemio help) mostly because the immune system get into gear and target the cell. Since they are going for an immuno therapy, they want to make sure it isn't the case. So late stage cancer where it is clear the immune system don't have it in check is a way to do it.

  9. Saddly, yes: elite-only for now. by DrYak · · Score: 3, Informative

    Saddly,
    that's currently what it seems.

    (for the TL;DR version of people who don't want to plow through dozens of PubMed articles:
    - basically these "cure any cancer" methods consist of growing specially designed immune cell that are specific for the cancer and only will attack it while leaving the body intact.
    - Achieving it requires a whole university complex of genomics, proteomics, culture-cell growing and selection, etc. and is in the range of million-worth per cure.
    - In addition the the cost and the facilities it doesn't even *scale* beyond a few experimental patients - even if 50 billionaires decided to throw the money, the could only be cured one at a time)

    But the general proof of concept works.

    And perhaps one day, after a few "Oxford Minion" and "CRISPR/Cas9"-like revolutions down the line, new technology might get developed that brings this out of the "designer medicine for the most outrageously wealthy elite" domain and bring it within reach of normal people.

    (Well maybe "normal people who live in countries featuring a decent public health system". Sorry for you USA... maybe you could try to flee to one of those evil-communist countries like Canada or most of Europe ?)

    --
    "Sufficiently advanced satire is indistinguishable from reality." - [Tips: 1DrYakQDKCQ6y52z6QbnkxHXAocMZJE61o ]
    1. Re:Saddly, yes: elite-only for now. by ChrisMaple · · Score: 1

      Remember, the ultimate reference of wealth is human effort. If an individual cancer cure gives the patient 10 extra years of life but costs 40 man-years of labor, there's a net loss involved for humanity. Under a capitalist system, that tradeoff may be made voluntarily. Under socialized medicine, those treated will be those with political pull and those believed to have most to offer the state. Choose wisely.

      It only took a few years for DNA sequencing to go from being a multimillion dollar undertaking to being so routine that ornithologists use it to distinguish separate species from subspecies. I can see that individual cancer cures will require specialized breweries to make the proper cells, but a large part of that ought to be capable of automation some day.

      --
      Contribute to civilization: ari.aynrand.org/donate
  10. Currently doesn't scale by DrYak · · Score: 2

    This class of treatment is usually about growing some special-purpose "designer" white cells that are able to kill the cancer while leaving the almost similar looking rest of the body intact.

    Growing such designer cells requires tremendous lab resources.

    We still need some revolutions similar to how Oxford Minion and CRISPR/Cas9 brought their capabilities to the masses.

    --
    "Sufficiently advanced satire is indistinguishable from reality." - [Tips: 1DrYakQDKCQ6y52z6QbnkxHXAocMZJE61o ]
  11. Fantastic by Anonymous Coward · · Score: 0

    As someone who has seen his own mother fight pancreatic cancer, this is fantastic news.

    Colon and pancreatic cancer are relatively rare diseases. Very deadly - typically carry terrible prognosis.
    You won't see NFL stadiums filled with awareness messages.

    At any rate, this made my day brighter.

  12. Typical solution by Anonymous Coward · · Score: 0

    Do you know what the 'typical solution' to pancreatic (and bile duct) cancer is?

    The Whipple Procedure. Assuming its even located in an operable location, entire parts of the pancreas, bile duct, liver, gallbladder, stomach, are removed.
    It takes somewhere in the neighborhood of eight to ten hours, since that entire area is literally buried under multiple layers of complex veins and nerves.
    After which patients are given given the option to blast the area with radiation therapy.

    If that sounds barbaric to you, its because the procedure is largely unchanged since the 1930's.

    God, I'm thankful someone is making progress towards additional treatments. You don't want to see a loved one go through this.