Thursday January 18, 2018

Immunotherapy : Allison’s Trials

Among other honors, Jim Allison was a 2015 recipient of the prestigious Lasker Award for his achievements in medical science

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Doctors performing Operation Image Source: Wikimedia Commons
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  • If the immune system was tweaked just right, it could do a better job of killing the cancer than the usual treatments.
  • Allison tried to persuade drug makers to create a human version of the treatment that had worked in mice.
  • Immunotherapy has transformed the way doctors think about cancer treatment.

Sharon Belvin’s nightmare with cancer began in 2004, when she was just 22.

Belvin was an avid runner but said she suddenly found she couldn’t climb the stairs without “a lot of difficulty breathing.”

Eventually, after months of fruitless treatments for lung ailments like bronchitis, she was diagnosed with melanoma — a very serious skin cancer. It had already spread to her lungs, and the prognosis was grim. She had about a 50-50 chance of surviving the next six months.

“Yeah, that was the turning point of life, right there,” she says.

What Belvin didn’t know at the time was that a revolutionary treatment for melanoma had begun testing in clinical trials. An immunologist named Jim Allison, now at the University of Texas MD Anderson Cancer Center, had figured out that if the immune system was tweaked just right, it could do a better job of killing the cancer than the usual treatments. (Joe Palca worked for Allison early in both men’s careers.)

Allison’s treatment was still experimental, but if it worked, it had the potential to save Belvin’s life.

“It’s a new modality for treating cancer,” Dr. Samuel Broder, a former director of the National Cancer Institute, says now of Allison’s pioneering research. “It used to be there were three basic treatment options for cancer — surgery, radiation and chemotherapy — or some combination of those three. It’s fair to say there’s now a fourth option.”

Allison’s long search for this new kind of treatment — one that has since become a lifesaver for some cancer patients — began around a decade before Belvin got sick, when Allison was running a lab at the University of California, Berkeley.

At the time, he was what you could call a research scientist’s research scientist. He was fascinated by certain powerful cells of the immune system — T cells. A subset of white blood cells, T cells travel around the body and can “protect us against just about anything,” Allison says.

T cells do recognize cancer cells, but not in a way that can eliminate the disease.Allison had been studying T cells for years, and thought that by tinkering with one key molecule on the outside of these cells, he could enhance their response to cancer, enough to eradicate the illness.

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He and one of his grad students ran an experiment to test the tweaked T cells on cancerous tumors in mice, and the initial results astounded them. The T cells seemed to be doing just what Allison had hoped they would do — shrink the tumors and kill the cancer.

Allison repeated the experiment with more mice over his winter break. After a few tense days, the tumors again disappeared.

“These mice were cured,” Allison says.

Cancer cured?

“I’ve been doing this sort of stuff for years, and I’d never seen anything like that,” Allison says. “And I thought, ‘If we could do that in people, this is going to be amazing.’ ”

Allison tried to persuade drugmakers to create a human version of the treatment that had worked in mice. He thought they would jump at the chance to try a new approach.

But the biotech companies he met with didn’t bite. In those days, most firms were focused on drugs that would target tumors directly, and Allison was asking them to try something very different.

“This was targeting the immune system, not the cancer,” he says. “We weren’t trying to kill the cancer cells. We were letting the T cells kill the cancer cells.”

Backbone Surgery Image Source: Wikimedia Commons
Backbone Surgery Image Source: Wikimedia Commons

Thanks, but no thanks, the companies told him.

“I got very depressed,” Allison says. He was sure this was the most important work of his career, but he had to get others on board.

Eventually, a scientist attending one of Allison’s research talks was intrigued enough to contact a pal at the biotech firm Medarex. The company had recently developed technology that could make a human version of Allison’s therapy, and was willing to give it a try.

It took a decade, but eventually Allison’s big idea was ready for testing in people. A clinical trial to study the drug — now called ipilimumab, or Ippy for short — was set up at Memorial Sloan Kettering Cancer Center in New York City.

Allison decided he wanted to be part of this next chapter in the testing of immunotherapy, so he packed up his California lab and moved it to Sloan Kettering.

As it happens, Belvin was also in New York — a patient of Dr. Jedd Wolchok at Sloan Kettering. By the fall of 2004, Belvin had run through all the treatment options available to her. Nothing had worked to control the melanoma; it continued to spread dangerously throughout her body.

Belvin remembers feeling sick and depressed, and says she wasn’t even paying much attention when Wolchok walked into the exam room and suggested one last treatment.

“Sharon, we have an opportunity to participate in a clinical trial here. It’s something you should consider,” Wolchok told her.

Belvin says she signed up without hesitation. After just four injections of Ippy across three months, her cancer was nearly gone. And at Belvin’s follow-up appointment a year later, Wolchok delivered news that was hard for her to take in: “Sharon, you no longer have cancer.”

And in the next breath, Belvin recalls, “he goes, ‘Oh, the guy who invented this is upstairs. Do you want to meet him?’ ”

“Yes, of course I want to meet him!” she told her doctor.

Wolchok called Allison, who was working nearby, and told him to drop everything and come to the clinic — a part of the hospital Allison had rarely seen. Though the research scientist couldn’t imagine why Wolchok was in such a rush, he quickly figured it out as he opened the door and was greeted by Belvin with a huge hug.

Belvin says she tried not to tackle him. “It was hard to control myself,” she says. “I owe this man my life.”

Adoptive T-cell therapy Image Source- Wikimedia Commons
Adoptive T-cell therapy Image Source- Wikimedia Commons

Belvin was the first recipient of the immunotherapy that Allison had ever met. “It really meant a lot,” he says. “It reminded me what it’s all about at the end of the day.”

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That was in 2005; today, Sharon Belvin is still cancer-free.

Ippy is now sold under the brand name Yervoy by Bristol-Myers Squibb, which bought Medarex in 2009.

Meanwhile, Jim Allison has become a bit of a celebrity in the cancer research world. Among other honors, he was a 2015 recipient of the prestigious Lasker Award for his achievements in medical science.

He’s become well-known among patients, too. Now and again, Allison fields calls from patients yearning to learn from the master himself what it will take to cure their disease.

Allison can’t really answer them. Each case is different, and using a patient’s own cells to destroy tumors won’t work in every patient or in every type of cancer. Still, the approach offers promise to some people that other therapies can’t, and has transformed the way doctors think about cancer treatment.

It might be too early to say we’re going to cure cancer, Allison says, “but we’re going to cure certain types of cancers. We’ve got a shot at it now.”

-by Ajay Krishna (with inputs from NPR)
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Rene Laennec : The man who invented the stethoscopes

He invented the stethoscope but that wasn't his only major contribution or achievement in the medical field.

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Rene Laennec- The man who invented stethoscope. Wikimedia Commons
Rene Laennec- The man who invented stethoscope. Wikimedia Commons

by Ruchika Verma

  • Rene Laennec invented stethoscopes in 1816
  • He also coined many other medical terms which helped us in understanding a different kind of diseases
  • His contribution in the field of medicine are immense and will always be remembered

One thing which is most frequently associated with a doctor is a stethoscope. Be it advertisements or real life, a stethoscope is one thing which we see hanging around every doctor’s neck.

The stethoscope is an instrument which is used by doctors to hear a patient’s heartbeats and to check their breathing. This medical instrument is used to hear the resonance of sounds made by our hearts and lungs for evaluative purposes. The instrument has been an object of fascination for a long time, because of its simple design, which consists of just a resonator and two tubes.

Stethoscopes are quintessential to a doctor. Pixabay.
Stethoscopes are quintessential to a doctor. Pixabay.

But who invented the stethoscope?

René-Théophile-Hyacinthe Laennec or simply known as Rene Laennec, was a French physician who invented stethoscope in the year, 1816. He invented this medical instrument while working at the Necker Hospital in France, and used it in diagnosing various chest and lung conditions, pioneering the whole concept.

Rene-Laennec invented the Stethoscope. Wikimedia Commons
Rene-Laennec invented the Stethoscope in 1816. Wikimedia Commons

He was born on February 17, 1781, Brittany, France and died on August 13, 1826, Kerlouanec due to Tuberculosis.

Necessity for this invention

Rene Laennec invented stethoscopic or stethoscope because of his embarrassment while treating women. He didn’t like to put his ear at their chest in order to diagnose their problems, especially in the case of overweight women. He also found this method of listening to heartbeats very ineffective.

The original stethoscope was just a piece of paper rolled into a cylinder. Pixabay.
The original stethoscope was just a piece of paper rolled into a cylinder. Pixabay.

As a result, he invented an instrument which won’t require him to put his ear on his patient’s chest and will be more effective. He rolled a piece of paper into a cylinder and placed one side on the patient’s chest and the other near his ear. He found that he could hear the sounds better.

His contributions to the Medical Field 

He invented the stethoscope but that wasn’t his only major contribution or achievement in the medical field.

He famously coined the term ‘melanoma’, which is a type of cancer that typically occurs in the skin but rarely occur in the mouth or intestines. He was the one who recognised that melanotic lesions are the result of metastatic melanoma.

Laennec is also well known for his studies of peritonitis, amenorrhea and tubercle lesions. He also coined the term cirrhosis, which is a lung disease. His works played a huge role in the understanding the of this disease.

You may also like: Acharya Charaka: Indian father Of Medicine, Author of Charaka Samhita “science of Ayurveda” 

A difference in the design of Traditional and Modern Stethoscopes

The modern stethoscopes that we see today are not what Rene Laennec invented. His original design was rather simple. The doctor’s stethoscope that we see today is much more complex that Laennec’s simple design.

His original design was just a tube, which could be made of wood and copper. It could be assembled and dissembled easily as per the convenience of the physician. The new age stethoscope is a modification of his original design.

The original design of Rene Laennac's stethoscope. Wikimedia Commons
The original design of Rene Laennec’s stethoscope. Wikimedia Commons

His original stethoscope was replaced by the stethoscopes using rubber tubes by end of the 19th century.

A modern day stethoscope using rubber tubes and a resonator. Pixabay
A modern-day stethoscope using rubber tubes and a resonator. Pixabay

Achievements

The government of France honoured Rene Laennec with First Prize in Medicine and Sole Prize in Surgery in 1803.

He was also conferred with the title of the ‘Knight of the Legion of Honor’ in 1824.

His contributions in the medical fields are immense and for it, he will always be remembered.