2016-05-17 09:00:00

Regenerative Medicine: Dr. James Allison of MD Anderson Cancer Cr on promise of new cancer therapies


(Vatican Radio)  Over the past five years or more, cancer researchers have made significant strides into finding a cure to the disease which claims 8.2 million lives a year.

Dr. James Allison is Chair of the Immunology Department and Director of Immunotherapy at the MD Anderson Cancer Centre in Houston, Texas, one of the world’s leading research institutions in the sector. Dr. Allison participated at a recent Vatican conference on Regenerative Medicine 28-30 April 2016  where he spoke to Vatican Radio’s Tracey McClure about promising new therapies in the treatment of cancer.

Researchers like Dr. Allison are excited about the potential of the body’s own immune system to combat – and beat – cancer, and are developing new and personalized therapies to make it more effective.

Listen to the interview:

Taking off the immune system brakes for a “wow” moment

JA:  "The ‘wow’ moment in my research was actually, well there were two of them, one of them was in about 1994-1995 when we worked out this negative signaling pathway, a molecule that stops T-cells, the soldiers of your immune system that protect you from bacteria and things and can also attack cancer, but we figured out there were some brakes there that people hadn’t known about before. And I had the idea that if we disabled those brakes it might allow the immune system to more effectively deal  with cancer cells and maybe eliminate them. And we had begun to apply that to animal models of cancer and it showed it could cure many different kinds of cancers in mice, which made a lot of sense because the treatment we had was treating the immune system - not the cancer cells. This finally, in about 2000, went into the clinic and worked in people as well.  And again, in several different kinds of cancer.

I think the second ‘aha!’ moment was when I met the first patient that had actually been cured by this treatment. I met her when she’d been declared free of melanoma for a year and then sort of kept up with her over the years. She’s had two children since then that have now grown up with full lives. She was about 24 years old when she was diagnosed and was basically given only a few months to live, so that was a really strong moment."

Targeting the immune system vs the cancer itself: the key to treating all cancers?

TM: How many cancers do you think will be able to be treated with these new kinds of therapies?

JA:  "Well in theory all cancers should respond because the drugs in this class, there are several now,  actually target the immune system and not the cancer, so the cancer doesn’t matter. In reality though, there are limitations. It seems to depend on two things. One is how many mutations there are; that is, how many things the immune system attacks.

In the case of cancer, it seems to mostly attack proteins that are generated by mutations, some of which are involved in the cancer process itself. Those who have a lot of those are more susceptible to kinds of cancer. There are a lot of them, they’re caused by sunlight, for example melanoma, mutations to the skin or lung cancer caused by smoking, by the carcinogens in tobacco - those seem to respond very well. But when you get down to other kinds of cancers that have lower mutations, they respond less well.

The other thing is, tumors that have a lot of T-cells in them. Tumors tend to differ somehow. We call them ‘hot’ tumors or immunogenic tumors that already have T-cells in them; they respond very well.  Those that don’t, we have to learn how to drive the T-cells in. But I think that as we study it more, we are facing a different situation than we were five years ago when the question was “would this sort of therapy work at all?”

We know treatment works, need now to make it more effective

"Now we know it does - it does work. It cures people, a fraction of people right now, but definitely there are people that are 10-15 years beyond treatment now, who are not being treated anymore - that are basically cured, if you can use that word.

Our job now is just to figure out how to make it more effective, not to show that we can do it but how to make it more effective and bring it to more patients with more different kinds of cancer. Knowing the rules now, I think that I’m optimistic that we are going to be able to move this fast."

Education, lower costs needed to make treatment accessible to more people

TM: You heard Pope Francis and vice president Joe Biden speak about the need to make these new therapies more accessible to the who need them. What kind of strategies can be put in place for organizations like yours to work towards that goal: making these therapies more accessible to people all around the world?

JA:  "I think the main challenge in making these therapies available to people around the world is one of education, one of just letting people know that there are these things that are available.  Because I think a lot of people have no idea.   They think that  cancer is a death decree and it’s not at all for many kinds of cancer now. So I think that’s the first step: to make people aware and then to disseminate the message to community doctors, and in more developed countries, to the community doctors to let them know these things are there and to encourage them to learn how to use them, to use them properly and treat people.

Right now these kinds of therapies that we work with, these immunological therapies, are actually quite expensive, so something’s got to be done to bring the cost down, to make it generally available to people. Although there are some exceptions that were discussed this morning, with vaccines for human papilloma virus for example, which could prevent a large number of cervical cancers, head and neck cancers and everything. 

And you can treat children, both boys and girls, when they’re 13 years old or so, with these vaccines which are 99% plus effective, that really eliminate or minimize the risk of those kinds of cancers and that again needs education.  But those things are ready to go and they’re not very expensive at all.  We just need to get more active in using those."

Speeding up the cure: the move from individual research to collaborative, multi-institutional teamwork

TM: is it also going to take convincing pharmaceutical companies, philanthropists that they need to do more? One of the problems with the funding that many institutions are getting today is that the [philanthropic] foundations and government bodies [that support research] want to see a specific team’s results, whereas working together and sharing information can sometimes be a problem if you have different institutions involved in the research.  There’s no way to quantify how much each individual team is achieving…

JA:  "That is a problem, because there has to be credit for people’s career development and everything.  But I think the academic world and pharmacological world are changing a bit and there is more emphasis being placed on teamwork now. Between institutions too.  I think that organizations like ‘Stand Up to Cancer’ and the new ‘Parker Institute for Cancer and Immunotherapy’ -  their whole proviso is that they’ll bring teams together at different institutions, which can really spark rapid advancement by bringing people of different specialties, different knowledge, different interests together with,  not huge teams - but 6, 12, 20 people or something like that - to work together.

And again, picking where their expertise is, and pulling the teams together rather than just having everybody doing their own little thing and having it percolate up to the literature and other people saying,  ‘I’d like to work with you on that.’ It’s moving down; it’s changing, but it’s changing quickly."

A definitive cure for cancer?

TM: When will we be able to see a definitive cure for cancer?

JA: "I don’t think there’s going to be a definitive cure for cancer.  We can already see some fraction of people with certain kinds of cancer being cured. We need to work on those and get the frequency up higher.  It’s really case by case: to try to learn [who are] those people who respond and those who don’t, and figure out what it is [that makes others] who don’t respond. So there’s not going to be one cure.   It’s going to be many, many different treatment types depending on the kind of cancer and the individual.   But I think we are making a lot of progress towards curing some cancers at least."

Misconceptions about clinical trials and the need for more patient participation

TM: there’s also been talk about getting more people involved in clinical trials?

JA:  "It’s really a shame that people go to major academic cancer centers, where the best minds are, where the new things are being tried, and only about 5% of the patients actually go onto trials.  And that’s a shame because we would gain so much more information, if more people would take these experimental treatments."

TM: Is the problem funding again?

JA:  "No, it’s not funding so much as it is I think attitudes. I think people don’t quite understand trials.  There are rumors for example, that there are placebos, so you either get the treatment or you won’t get the treatment maybe.  That’s not a problem anymore, or that doesn’t ever happen anymore. You get the standard of care versus the new drug, so it’ll never be that ‘you get nothing.’   But I think some people don’t understand that.  Again, it’s an education process… Things have changed, since 10 years ago about how they’re done."

TM: You’re here in the Vatican, what has been your impression so far of this conference, of hearing Pope Francis speak to you …and also U.S.Vice President Joe Biden?

JA:  "As far as the Vatican goes, I really, until I was coming to this meeting, had no idea that there was this Pontifical Council for Culture, I guess it’s called. I was really pleased to learn that there is interest in the Vatican in these areas of science to try to bring health issues to the front, including stem cell work, and these new cancer therapies. I am really also thrilled that Vice President Biden came here.  I think there has not been sufficient effort devoted by the US government for cancer research.  For the last decade or more, the support’s really been declining. Vice President Biden’s efforts indicate that hopefully that attitude has changed and that there will be new directive efforts towards, all the way across the spectrum from immunology to molecular therapies, to data sharing, to big data.  And  just looking at the whole thing as an integral enterprise that needs to be addressed that way, to really conquer this problem."

See also:

http://en.radiovaticana.va/news/2016/04/29/cell_conference_opens_with_focus_on_kids,_rare_disease/1226257

http://en.radiovaticana.va/news/2016/05/10/regenerative_medicine_dr_soon-shiong_on_new_cancer_vaccine/1228794

 

 








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