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Journalism of Courage
A team of researchers from the National Cancer Institute reported yesterday that they have successfully treated two cancer patients using gene therapy, the introduction of genes into the human body for medical purposes.
Two men, both with the rapidly growing skin cancer, were given immune system cells taken from their own blood and engineered to attack their tumors. They are alive, with no evidence of cancer, 18 months later. Fifteen other patients who got the same treatment died.
The report, published online by the journal Science, is the latest result of a three-decade effort by surgeon Steven A Rosenberg to find ways to manipulate the human immune system to fight cancer.
Four years ago, Rosenberg and his colleagues treated a group of melanoma patients with naturally occurring anti-cancer cells extracted from their tumors, and some of those patients also have had long-term disappearance of their cancers. The new report, however, is believed to be the first time genetically engineered immune system cells 8211; specifically, T lymphocytes 8211; have produced the same effect.
Neither Rosenberg nor others would describe the two patients as cured. At least five years would need to pass before such a declaration would be considered. And cancer sometimes returns even after that much time has elapsed.
Gene therapy was once viewed as the great hope for treating, or even curing, a long list of dread diseases. But tests of the concept since the late 1980s have been overwhelmingly disappointing.
8220;I do consider this a proof of the principle that it can work,8221; Rosenberg said yesterday. 8220;I have every expectation that we can get it to work better.8221;
Response by others in the field was positive but not effusive.
8220;I think it is an important landmark to see some cancer patients respond to a gene therapy 8211; finally,8221; said Patrick Hwu, a physician and gene-therapy researcher at the University of Texas M.D. Anderson Cancer Center, in Houston, who was not involved in the new study. 8220;I think that clearly all of us want to do better than two out of 17.8221;
Michael T. Lotze, a professor of surgery and bioengineering at the University of Pittsburgh, said, 8220;the work is heroic. The question is, does it advance the field in a major way?8221;
While the good results in two patients are encouraging, 8220;in terms of response rates, the overwhelming data is that T cells, even in high numbers, are inadequate to mediate sufficient anti-tumor effects,8221; Lotze said.
The paper published yesterday provided few details of previous treatment the men had received. Rosenberg also did not analyze any of the reintroduced lymphocytes to see if, in fact, they had the ability to kill cancer cells. Because of that, it is difficult to say with certainty that the engineered cells were responsible for the tumors8217; disappearance. However, Lotze, the Pittsburgh expert, said 8220;it is unlikely8221; that it was the result of other treatments.
Rosenberg said he and his colleagues have engineered lymphocytes to recognize tumor markers, or antigens, found in about half of all cancers, including breast, colon and lung cancers. He said many of the modified cells have a much better ability to bind to tumor cells than the anti-melanoma cells he used in the study reported yesterday, which was conducted two years ago.
The research team recently applied to the Food and Drug Administration to try the new cells in about a hundred patients. The FDA is expected to respond to the request by the middle of this month.
Other researchers are working on similar strategies. Hwu, of M.D. Anderson, is engineering lymphocytes that have receptors for substances called chemokines that some tumors put out. This will help the lymphocytes home in on the cancer.
8220;We need to figure out how to get the T cells to migrate into the tumor more efficiently,8221; he said. 8220;If the T cells are able to recognize the cancer but are circulating in the bloodstream, then they are not on the battlefield where they need to be.8221;
THE IDEA
8226; Autologous lymphocytes 8211; a person8217;s own white blood cells 8211; have previously been used to treat metastatic melanoma. In a process called adoptive cell transfer, lymphocytes are first removed from patients with advanced melanoma
8226; The most aggressive tumor-killing cells are isolated, multiplied in the lab, and then reintroduced to patients who have been depleted of all remaining lymphocytes. While reasonably successful, this method can only be used for melanoma patients and only for those who already have a population of specialized lymphocytes that recognize tumors as abnormal cells.
ROSENBERG8217;S TREATMENT
8226; Rosenberg and his colleagues took lymphocytes from blood and inserted into them genes for a receptor capable of 8220;recognizing8221; a protein on melanoma cells called MART-1. This would allow the lymphocyte to attach to a tumor cell and kill it.
8226; The engineered lymphocytes were infused into 17 patients with advanced metastatic melanoma, who were divided into three groups.
8226; The patients, all of whom had previously undergone surgery and immune-based treatments, were given chemotherapy to temporarily wipe out their immune systems.
8226; The engineered cells were then re-injected, with the hope that they would proliferate as the immune system recovered. The patients also received interleukin-2, which is a cytokine, or immune-system hormone.
8226; The first group consisted of three patients who showed no delay in the progression of their disease. But of the 17, two showed remarkable progress.
8226; One, a 52-year-old man, had melanoma in his neck, armpit and liver. It disappeared every place but one spot in the liver; surgeons removed that area.
8226; The other man, age 30, had cancer in his lungs and just outside them in the middle of the chest. His cancer disappeared, also.
8211;David Brown
