Has Carl June Found a Key to Fighting Cancer?

http://www.phillymag.com/articles/carl-june-key-fighting-cancer/

by gmatty • 13 years ago

186 77 13 years ago

swombat• 13 years ago

I really hope this is not another one of those false cures. It's time we made some real big-news progress against this horrible collection of ailments we call cancer.

For those who don't want to read through the lengthy human interest story wrapping the news here, from a quick read I gathered they're basically modifying T-Cells:

In their natural state, T cells usually aren’t able to kill tumor cells, partly because they can’t latch on strongly enough. But June was fascinated by scientific papers showing it was possible to change this. A few researchers—first an Israeli named Zelig Eshhar in the ’80s, then other investigators around the world—had discovered that you could force a T cell to stick to a tumor cell and kill it. To pull this off, you built an “engineered T cell”—a T cell never before seen in nature. You altered the T cell’s genetic blueprint by injecting a new gene into the cell. The new gene would tell it to build a new molecular limb. The limb, called a “chimeric antigen receptor,” would sit partly inside the cell and partly outside, and it could send signals either in or out. One signal it could send was: kill. Another was: replicate.
June loved this approach. So elegant. Put the immune system on steroids. What if you could train the body to fight cancer on its own? What if, instead of replacing a patient’s immune system (as in a bone-marrow transplant) or pumping him full of poison (chemo), you could just borrow some cells, tweak them, and infuse them back into the patient? In theory, the engineered cells would stay alive in the blood, replenishing themselves, killing any tumors that recurred. It occurred to June that one infusion could last a lifetime.

It seems this research has been going on for 10+ years. How many people have died because of the glacial regulatory pace of cancer research?

grey-area• 13 years ago

I really hope this is not another one of those false cures.

It seems this research has been going on for 10+ years. How many people have died because of the glacial regulatory pace of cancer research?

One of these statements explains the other - verifying research is safe with trials takes time, it's not something that should be rushed.

nazgulnarsil• 13 years ago

Blanket statements like this aren't true. With a lethal ailment, a risk analysis must be done on how many you are killing with each delay.

nl• 13 years ago

There are cases where early results from a trial were so promising that both sides (of a double-blind trial) were put on the treatment.

eg:

A new prostate cancer drug trial has been so successful doctors have decided to stop it early. Medics at London's Royal Marsden Hospital were testing a powerful alpha radiation drug on 461 people while another group of the same number were being treated with a dummy drug. Patients taking the new drug experienced less pain, side effects and lived longer. Researchers were so astounded with the results they decided to stop the trial and started treating all 922 patients taking part in the study because they said it would be unethical not to.

http://www.dailymail.co.uk/health/article-2041301/Prostate-c...

dave_sullivan• 13 years ago

There's a book I can't recommend highly enough called "the emperor of maladies" and it's a history of cancer up to ~2008. It's pretty depressing in a lot of ways (both the disease itself and the history of the fight against it), but it's one of the most fascinating books I've read in years.

The kind of trade offs re: safety vs "getting things done" comes up quite a bit. The key optimism I pulled out of it was that cancer research is progressing exponentially, but this is harder to see because the general public only sees through the lens of "cured/not cured". But I think most cancer researchers would say "progress is being made, and faster than ever before with increasing velocity". Then again, the cure was around the corner in the 70s.

But yeah, cancer is bad news and a disease many of us will be forced to face in our lifetimes...

Mvandenbergh2• 13 years ago

Probably not all that many. They were able to move into the clinic pretty quickly once they had gotten the research to that state.

jostmey• 13 years ago

Why has it taken 10 years? Because this stuff is really hard. Is there red tape in science? Sure. But even if all the red tape were removed, science would still move incrementally forward at a slow and steady pace.

Most areas of research are simply not mature enough to move forward at the exponential pace that computer technology leaped forward into our society. What is required? More hard work!

WalterSear• 13 years ago

Money, and the lack of political will to procure it is the problem.

brador• 13 years ago

This is an interesting precursor to curing cancer. What will happen to the leukaemia industrial complex? The charities? the specialists? the drugs? Will they all just close shop and go home?

aspensmonster2• 13 years ago

Move on to another disease that has yet to be cured or feasibly treated?

sliverstorm• 13 years ago

Such as one of the uncountable numbers of other types of cancers?

x0x0• 13 years ago

I think you shouldn't allow yourself to become too cynical, even when you see bad examples like the komen foundation. I have no doubt the vast vast majority of doctors and charity employees that treat or support leukemia patients would be delighted (in particular, I'd bet many volunteers have been personally affected) to declare victory and either retrain for different diseases or find another hobby.

edit: for an example rather than a hypothetical, see polio

edit2: also, if this works, an enormous chunk of doctors, medical researchers, and scientists are going to drop whatever they're doing and frantically attempt to apply this technique to every cancer one can think of

gargoiler00• 13 years ago

Also what about the sudden population explosion? What if the survivors need after care for the rest of their lives, or expensive drugs?

Mvandenbergh2• 13 years ago

What sudden population explosion? I'm fairly sure that leukemia isn't playing a huge role in demographics.

anovikov2• 13 years ago

Leukemia doesn't affect many enough people in reproductive age to cause a population explosion. Basically, no medical advance can cause population explosion in the rich world: there are very few people dying from disease in reproductive ages there. Making people who would otherwise die at 55 live through 95 does not make a population explosion because they won't have any kids anyways.

chris_wot• 13 years ago

Gladly, I would think!

codezero• 13 years ago

I'm baffled by the HN title of this article. There is no place in the article that claims a 100% success rate for curing leukemia.

The title is: "Has Carl June Found a Key to Fighting Cancer?"

Fighting cancer and curing it are hugely different. Yes, this is a human interest story that outlines the success of a particular patient using a particular method, it's great, but it seems disingenuous to use the title that is here.

tluyben2• 13 years ago

9 out of 12 is also not 100%

westicle• 13 years ago

60% of the time, it works every time.

derleth• 13 years ago

I'm baffled by the HN title of this article. There is no place in the article that claims a 100% success rate for curing leukemia.
The title is: "Has Carl June Found a Key to Fighting Cancer?"

And here we see the other side of not being able to change (editorialize) titles. I can see both sides of the argument, but I think this example forms a good reason to disallow giving articles different titles.

reustle• 13 years ago

Isn't that what downvoting is for?

gmatty• 13 years ago

Sorry about that. I can see how its unclear in the way it reads. I shortened a more descriptive title and lost the meaning. I was originally referring to how dramatic the treatment has been for those it has been effective in. I have updated the title.

gngeal• 13 years ago

Fighting cancer and curing it are hugely different.

Does it actually matter? It's not like you can clean your body completely of pathogenic viruses and bacteria either.

3327• 13 years ago

Misleading headline...

aspensmonster2• 13 years ago

This certainly seems like a very interesting and double-edged sword of a treatment. The engineered T-cells nuke the tumors, which is a good thing. But if I'm reading this right, the large amount of cytokine that gets released from such a rapid destruction also wreaks havoc on your kidneys and could itself be fatal. It sounds like an all-or-nothing treatment that you either sweat out or succumb to. Apparently there's a drug (tocilizumab) that essentially acts as an undo button by taming the engineered T-cells and avoiding such fatalities, but then you're back to square one. It looks like the Penn team has partnered with Novartis to study the engineered T-cells and (I'm guessing) develop a method to tailor the engineered T-cell growth rate to a magnitude the kidneys can manage.

nostrademons• 13 years ago

Cytokine storms are fairly well-understood complications of various infectious diseases like Spanish Flu, SARS, and Hantavirus. There's no perfect cure for them, but there are a number of treatments that seem to help, and research into that benefits a number of other deadly ailments other than this cancer treatment. This is not a phenomena unique to this treatment.

http://en.wikipedia.org/wiki/Cytokine_storm

VLM4• 13 years ago

One answer that immediately struck me was generally in medicine if something is on a decline, waiting for it to get worse is not a wise choice. On the other hand at research time, administering something that might simply kill someone or confuse them into not taking a known existing "good" treatment path because they're experimenting has some ethical issues (unless you're into patent medicine, fads, faith healing, homeopathy, crystal healing, that type of thing).

So in the long run, rather than sitting around waiting for the tumors to weigh 7 pounds because every other current treatment failed as per the article examples, this might be an early treatment option. Certainly "processing" 7 pounds of dead tumor is going to be hard on your biochemistry. But years or months earlier in the progress of the disease, a couple grams of dead tissue, maybe even less, eh, no big deal.

Gangrene of a leg, today, well that's gonna be a tough one. Minor infection of a toenail six months earlier, eh, no problemo.

The interesting part of the human interest puff piece is they ran several trials and of course only the successes get any commentary. Curious what happened with the failures, ranging from no effect to maybe the treatment killed them. Although the journalist thinks what happened to the most successful patient will define the future of this treatment, in the real world, what happened to those folks where it didn't work is likely to define the future. Compared to the amount of ink spilled about baseball, not much was mentioned, which sounds like good news...

ams6110• 13 years ago

Wondering why dialysis couldn't be employed to take the load off the kidneys during the worst of it. Or does dialysis not remove the cytokine?

VLM4• 13 years ago

I googled around looking at the opposite direction, are t-cells small enough to get flushed out by dialysis? Could not get a straight answer. There must be a lot of money to be made in dialysis; there are a lot of "popular science" type articles about it. My guess is we'd have to try a level of indirection, red blood cells aren't lost, so relative size of t-cells vs red blood cells would probably answer that.

The other idea I have is MDs are not overly dumb, so if its possible for natural or artificial kidneys to filter the bad stuff to the outside while keeping the good stuff inside, they would probably just absolutely flood the patient with IV fluid. The original article was very detailed about the experience; this didn't make the article, so I don't think they were doing it.

anonymous2• 13 years ago

If this treatment proves 100% successful against a given kind of cancer, and the procedure is developed to the mass-production stage, I would imagine we'd start getting cancer. Then you'd only get the tiny initial tumors nuked and correspondingly not suffer cytokine storms when large amounts of cancer tissue dies at once.

angersock• 13 years ago

So, somewhat darkly, when I saw this article a moment ago, it had a claimed 100% success rate. Now it's a 75% success rate.

Did a quarter of the patients just die?

mrb• 13 years ago

The title was edited to reflect the actual success rate (9 out of 12 patients).

dalek_cannes• 13 years ago

The article's more about the patients than the science.

I got bored with it so I went and found this, from Carl June himself:

http://www.youtube.com/watch?feature=player_detailpage&v=1sA...

reubensutton• 13 years ago

Would a reduction of 70%, like it cites for one of the failures of the treatment, cause the patient's condition to improve a bit, or would it be effectively the same?

lutusp7• 13 years ago

Human trials having 75% success rating for curing leukemia

Please do not use the word "cure" when talking about cancer. The article's submitter invented this headline -- the article doesn't support it in any way. In fact, it says this: "Scientists don’t talk about “curing” cancer. A cure is the hope so great, so seemingly out of reach, that it must never be invoked. They’ve built a wall around the word."

And well they might.

adaml_6232• 13 years ago

Not using the word cure is superstitious claptrap.

If I get cancer I want a cure. If anybody in my family gets cancer I want them cured.

This wariness of using the word cure is just because of the idiots in this world. People who can't understand percentages and possibilities. People who believe that anecdotes prove a point.

HN doesn't have to conform to that silliness.

lutusp7• 13 years ago

Not using the word cure is superstitious claptrap.

Not using the word cure is the rational response to the fact that there is no cure for cancer -- there is only remission.

If I get cancer I want a cure. If anybody in my family gets cancer I want them cured.

You just changed the subject. Wanting a cure, and having a cure, are obviously different topics.

This wariness of using the word cure is just because of the idiots in this world.

So scientists, and medical ethicists, are idiots. Good for you -- I prefer it when a person reveals his ignorance without beating around the bush.

People who believe that anecdotes prove a point.

It is you who are relying on anecdotes. Scientists evaluate evidence, and the evidence says there is no cure. Anyone who claims otherwise is deluding himself.

vidarh• 13 years ago

And this is exactly why they don't use the word cure: None of our current approaches to fighting cancer are particularly good as cures. They remove enough of the cancerous cells that with luck the cancer won't regrow.

But unlike a lot of diseases where we can usually pretty much guarantee that we wiped it out, we can usually do no such thing with cancer.

A cure has a vastly stronger expectation.

The day remission is something that happens in so few cases it's a rounding error, we can start talking about it being a cure.

jetru• 13 years ago

Stories like these not only show that cancer research edges us ever so slightly towards solving one of the world's biggest problems, but also shows to us the ever upward curve of human innovation. The path to an engineered humanity may seem unspiritual and mechanized to some, but to me it expositions one of the true beauties of our existence - that is, we are our own antibodies. Stories like these inspire and nurture the best in us. Keep at it Carl June - you are a true hacker.

polskibus• 13 years ago

Fantastic story, good to hear about people who decide to tackle the hardest problems. One step closer to understanding and defeating cancer.

thucydides• 13 years ago

The real headline here: "Has Carl June Found a Key to Fighting Cancer?" If a headline asks a question, the answer is virtually always "no" or "not yet," but the paper wanted to run a story anyway.

http://en.wikipedia.org/wiki/Betteridge's_law_of_headlines

anonymous2• 13 years ago

Actually, I was presently surprised that the answer was not the resounding "no" I expected, but instead a "kind of (for a layman's definition of cure, for a certain kind of cancer)".

ckayatek• 13 years ago

Micromet was developing a set of bi-functional antibodies that pretty much accomplished this same thing. That is directing the immune system to tumors. One side of the antibody would bind the tumor, while the other bound the T-cells. They were bought out by Merck a year or two ago and I believe the therapies are in clinical trials. You can read about the antibodies here: http://cancerres.aacrjournals.org/content/69/12/4941.full.pd...

The added benefit here is that the antibodies can be produced en masse and delivered as a drug rather than reprogramming the person's T-cells.

krschultz• 13 years ago

I would highly recommend "The Emperor of All Maladies" for anyone seeking a more solid understanding of cancer. I really didn't know much about cancer and treatments until reading this book, and now I feel like I at least have a general understanding. I read it after a family friend succumbed to cancer and I realized that I knew very little about the entire disease.

My take away at the end of the book was that for all of the "war on cancer" hyperbole going back to the 50s, up until the mid-90s, we just didn't know enough about cancer to really be fighting it. I feel a lot more optimistic about the next 50 years of cancer research than the previous 50.

http://www.amazon.com/Emperor-All-Maladies-Biography-Cancer/... (non-affliate link)

anovikov2• 13 years ago

I wonder what happened to those 3 unlucky guys for who it didn't work. Were they just too physically weakened+had too much tumors to survive the resulting cytokine storm, leaving the doctors with a grim choice between letting patient die of cancer by suppressing T-cells too much, or from cytokine storm by not suppressing them enough? Or there was simply no result from these T-cells, like they failed to multiply to work, or failed to work after multiplying?

Has Carl June Found a Key to Fighting Cancer?

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