Hoping against hope

Therapeutic vaccines are the new frontier for researchers of many forms of cancer, a tool to add to the long-standing arsenal of chemotherapy, radiation and surgery. Vaccines have been developed to prevent infection from most strains of the virus that causes cervical cancer. But no one has yet been able to develop a vaccine that would thwart other kinds of cancer that are not believed to be caused by viruses. Roughly 100 clinical trials for cancer vaccines are under way, including several at Hopkins for cancers of the pancreas and prostate as well as leukemia and others.

The breast cancer patients in Emens8217; trials are the 8220;almost dead,8221; as one puts it. And the odds are against this new therapy they have pinned their hopes on. Most experimental drugs never make it to market. Yet this is how new medicines are developed. And at the heart of each trial is an extraordinary bargain between researcher and patient.

Emens is careful not to promise anyone a cure. She knows this disease too well. When she was a teenager, her mother died of it. At times, her patients are optimistic; at others, despondent. They face their fears and draw on their faith. They have questions Emens can8217;t or won8217;t answer. Some mice were cured when they were injected with the same substance, but there is no way to know whether it will work in humans.

Emens started her first study in February 2004, injecting 28 women with the vaccine and with varying doses of chemotherapy meant to prime the immune system to attack. Siple is part of a second trial that began in December 2006 and still needs to enroll more women. The women receive the vaccine, a low dose of chemo and another drug8212;Herceptin8212;known to fight a certain form of aggressive breast cancer.

Being told she had breast cancer in May 2006 8220;totally threw the rug out from under my feet,8221; Siple said. She had a lumpectomy followed by six days of radiation. Reeling from a diagnosis she couldn8217;t handle, Siple refused chemotherapy.

She had always been curious about more natural remedies, not convinced that Western medicine held all the answers. So over the next six months, she paid 20,000 to a man who treated her with what she called a 8220;very strict protocol, mostly with Chinese herbs8221;. At the end of those six months, Siple again got bad news. The cancer was now in her liver.

Siple learned about the Hopkins vaccine through an early participant who appeared cancer-free. She saw the vaccine as the next best thing to alternative medicine.
For three months, Siple has been waiting to find out whether the vaccine is working. Now Emens is ready to let her patient know the score.

8220;The news isn8217;t perfect,8221; Emens begins, 8220;but it8217;s not terrible.8221; The tumours in her liver8212;there are four of them, two the size of walnuts, two the size of limes8212;have grown a bit. But there are no new ones.
Had there been more growth, Siple would be kicked off the trial, sent off to find another treatment. Instead, Emens schedules Siple to return in August, three months from now. Then they will take a new set of pictures and, if the cancer hasn8217;t spread, she can receive her fourth and final round of vaccines.

Siple is sure the last doses will kick-start her recovery. 8220;It just seemed like I reacted really quickly to the last vaccine,8221; she tells Emens. 8220;I felt like something had changed in my body.8221;
_Stephanie Desmon, LATWP