Cancer, immunity and survival

Who said the immune system was useless in cancer medicine? Is a biologically elegant, one drug answer to cancer possible?

For years we have known some people have experienced medically unexpected, remarkable recoveries from difficult cancers. How these recoveries have occurred has received very little mainstream attention.

More than this, one popular notion, that a reactivated immune system may be behind these recoveries, was for many years denied as being even remotely possible by leading immunologists and oncologists. They claimed that the immune system did not have the capacity to identify cancer cells, and therefore could not, or would not attack them. I suspect there would be very little of that vehement denial these days as immunological principles, research and therapies have become better explored and implemented.

Also, recent ground- breaking new research points at a remarkable new possibility. A one drug answer to cancer. Well at least the theory sounds good, and here is how it would work.

Basically cancer is triggered by specific genetic damage. All healthy cells have what are called oncogenes and when these particular genes are damaged, and the cells that contain them reproduce, instead of producing another healthy cell, they produce a cancer cell.

Now if you think about it, cancer cells are pretty useless. They are primitive in their nature, they have no purpose or function, they grow out of control and would be of little consequence except for the fact they tend to get in the way and as such have the potential to be fatal.

What cancer cells do have going for them is their ability to convince the body’s defence system that they are not to be attacked.  Essentially, cancer cells have the ability to camouflage themselves from our immune systems. Without this protection, they would be identified as the problem they are and destroyed quickly and effectively.

This destruction would be very similar to what happens when we are faced with a bacterial infection. When foreign bacteria enter our bodies, the immune system recognizes the potential threat, is activated, destroys the bacteria and returns us to good health.

If the immune system and other components of the body’s defence system could detect and recognize cancer, it could and would act swiftly. So having a strong immune system is the starting point, but then getting past the camouflage is the vital issue.

Exciting new research published in January this year in the Proceedings of the National Academy of Science has demonstrated that a single drug can shrink or cure human breast, ovary, colon, bladder, brain, liver, and prostate tumours that have been transplanted into mice. The treatment, an antibody that blocks the cancer cells’ ability to conceal themselves, enables the immune system to destroy the cancer cells.

How is this possible? Ten years ago it was discovered that leukemia cells produce higher levels of a protein called CD47 than do healthy cells. CD47 is also displayed on healthy blood cells where its function is to block the immune system from destroying them. The breakthrough has been the discovery that all the cancers tested so far use CD47 to camouflage themselves from the immune system. The research indicates that the amount of CD47 a tumour made could predict the survival odds of a patient, while blocking it could lead to an immune system inspired recovery.

In mice, blocking CD47 with an antibody cured some lymphomas and leukaemias by stimulating the immune system to recognize the cancer cells as invaders. But the new research suggests that the CD47-blocking antibody may have a far wider impact than just blood cancers.

To determine whether blocking CD47 was beneficial, the scientists exposed cancer cells to macrophages, a type of immune cell, and anti-CD47 molecules in artificial tissue culture mediums. Without the drug, the macrophages ignored the cancerous cells; with it the macrophages engulfed and destroyed cancer cells from all tumour types.

Next, the team transplanted human tumours into the feet of mice, where they can be easily monitored. When they treated these mice with anti-CD47, the tumours shrank and did not spread to the rest of the body. In mice given human bladder cancer cancer, 10 of 10 untreated mice had cancer that spread to their lymph nodes. Only one of 10 mice treated with anti-CD47 had a lymph node with signs of cancer. Moreover, colon cancers transplanted into the mice shrank to less than one-third of their original size, on average. And in five mice with breast cancer tumours, anti-CD47 eliminated all signs of the cancer cells, and the animals remained cancer-free 4 months after the treatment stopped.

Although macrophages also attacked blood cells expressing CD47 when mice were given the antibody, the researchers found that the decrease in blood cells was short-lived; the animals turned up production of new blood cells to replace those they lost from the treatment.

Cancer researcher Tyler Jacks of the Massachusetts Institute of Technology in Cambridge says that although the new study is promising, more research is needed to see whether the results hold true in humans. "The microenvironment of a real tumour is quite a bit more complicated than the microenvironment of a transplanted tumour," he notes, "and it's possible that a real tumour has additional immune suppressing effects."

Another important question, Jacks says, is how CD47 antibodies would complement existing treatments. "In what ways might they work together and in what ways might they be antagonistic?" Using anti-CD47 in addition to chemotherapy, for example, could be counterproductive if the stress from chemotherapy causes normal cells to produce more CD47 than usual.

The research team has received a $20 million grant from the California Institute for Regenerative Medicine to move the findings from mouse studies to human safety tests.

So that is something of the science and the potential for a new drug. In the media we hear of so many potential new cancer breakthroughs that eventually come to nothing. This one sounds very exciting to me.

But even more exciting, what if some of the remarkable survivors had found a way to mess up their CD47? What if their meditation or imagery disrupted it? What if something they ate or drank did the job. How good would it be if people who are living much longer than expected had their CD47 levels checked?

And what if these survivors were triggering other biologically elegant mechanisms to turn the tables on their cancers? What if they were producing angiostatins that prevented cancers from developing a blood supply and so starved them to death? What if their meditation somehow switched their faulty oncogenes off? What if… ???

Surely people who stand out, people with cancer who do live much longer than expected warrant investigation. It amazes me how many people I have helped who became long-term survivors and went back to their doctors feeling quite elated, only to be told they must have been misdiagnosed. I was one of them. This response seems to me to be intellectual laziness of the highest order, but it is probably worse. It probably reflects a negligence and lack of commitment to true scientific enquiry that is both scarey and dangerous. Scarey because true science advances when unexpected phenomena are investigated, and dangerous because if the survivors’ experiences could be reproduced, less people would die of the disease.

Clearly what is needed is a dedicated research body that looks into the phenomena of long-term cancer survivors. At the same time, such a body could give attention to the outcomes of lifestyle based programs as these programs are associated with so many remarkable recoveries. All we need is a few million dollars to get it going!

To link to the research paper, click here.

NEWS

1. Chemotherapy appears safe for pregnant women’s babies.

Pregnant women and their doctors can be reassured that chemotherapy does not appear to have long term effects on children prenatally exposed to the treatment, according to research published in the Lancet Oncology.

Dutch and Belgian researchers looked at 68 pregnancies subjected to over 230 cycles of chemotherapy, assessing the children at birth and at regular intervals up to the age of 18. They tested for neurological, cognitive, auditory and cardiac functioning as well as school performance, sporting activities and general health.

 “We show that children who were prenatally exposed to chemotherapy do as well as other children,” the authors concluded.

The study could reassure pregnant women and their physicians the benefits of maternal treatment did not seem to be outweighed by any long-term consequences for the exposed fetus.

Prevalence was expected to rise in developed countries as women give birth later, but prognosis was in general not affected by pregnancy, and with the exception of haema- tological cancer, termination was unlikely to improve prognosis either.

The full paper: The Lancet Oncology 2012; doi: 10.1016/S1470-2045(11)70363-1

2. Website update

My personal website, iangawler.com is currently being upgraded, so some of the old features are not yet visible. In the next few weeks, the Information section will have advice for people with cancer and MS, as well as research findings and Frequently Asked Questions. Please pardon any inconvenience, but the new website looks much better, will have more information and will be easy to navigate and use.

RESOURCES

BOOK

Surviving Cancer by Paul Kraus – stories of long–term survivors who attended Gawler Foundation programs – very inspiring and informative.

CD

The Gawler Cancer Program by Ian Gawler – in which I explain how cancer develops, including looking at how the oncogenes can be damaged and what happens after that, then how the body can be helped to reverse the process.

PROGRAMS

The Gawler Foundation