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
  • 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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Smoking: Its Ill effects On Fertility and Child Birth

Smoking and tobacco use can have a serious impact on fertility and consequently the quality of life in pregnancy

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Smoking
Smoking increases miscarriage rates in women. Pixabay

BY SIDDHI JAIN

Smoking and tobacco use can have a serious impact on the fertility of both men and women, and consequently the quality of life in pregnancy. These health tips by expert can help. If a woman is a regular smoker, then it has a double effect on a woman’s fertility. Smoking can harm both the eggs and the uterus. It not only affects her egg quality, but can also have endometrial effect. Many studies too have shown that smoking can have negative effects on fertility, notes Dr Apurva Satish Amarnath, Fertility Consultant, Nova IVF Fertility.

“In women, smoking decreases in vitro fertilization (IVF) and intrauterine insemination (IUI) pregnancy rates by about half. Smoking also increases miscarriage rates. smoking also reduces the egg reserve of the woman which is not a reversible condition. For instance, if we are to compare two women with the same characteristics in terms of egg quality, quantity, BMI, AMH-level, among others, the chances are that the non-smoking woman will conceive faster than the smoking woman. If a woman quits smoking completely, then the chances of conception improve and the risk of miscarriage reduces,” Dr Apurva told IANSlife ahead of the International Anti-Tobacco Day on May 31.

From the male’s perspective, the carcinogen quality of cigarettes in general affects the motility of the sperm and excessive smoking can lead to the poor sperm count and other fertility problems. As compared to females, the condition can be reversible.

If a man completely gives up smoking the quality of his sperms can improve, resulting in his fertility improving in a span of 3-6 months after quitting completely, she said.

Smoking
Smoking and tobacco use can have a serious impact on fertility. Pixabay

Smoking during pregnancy

According to Dr Sandeep Chadha, Consultant Obstetrician and Gynecologist at Motherhood Hospital, Noida, smoking during pregnancy are dangerous for both mother and the baby.

If a mother smokes, the 4,000 harmful chemicals present in each cigarette passes directly to the baby through the mother’s bloodstreams. In such cases, the risk of stillbirth and miscarriage goes up besides an increased risk of low birth weight, baby’s heart rate, breathing problem and premature delivery, Dr Sandeep told IANSlife.

These risks to the baby multiply with the number of cigarettes smoked during pregnancy. Not only for babies, but tobacco smoking is also harmful to the mother, increasing her risk of cancers, cardiovascular disease, emphysema, and other conditions.

Passive smoking and childbirth

A study has presented that exposure to secondhand smoke was associated with lower IQs in children. For babies exposed to secondhand smoke, there is an increase in risk for developing asthma attacks, breathing problems, ear infections, impaired lung development, and coughing.

Smoking tobacco
Smoking tobacco decreases in vitro fertilization (IVF) and intrauterine insemination (IUI) pregnancy rates. Pixabay

Children exposed to secondhand smoke require more ear tube surgeries than those who are not exposed. Sudden infant death syndrome is more common in babies born to women who smoked during pregnancy as well as in babies exposed to secondhand smoke. Exposure to second-hand smoking by pregnant mothers is similar to first hand smoking.

Also Read: Patients of 80% COVID-19 Cases in India Exhibit Nil or Mild Symptoms: Health Minister

If you are planning to conceive, it’s better for the couple to kick the butt as early as possible. (IANS)

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COVID-19 Makes it Difficult to Manage Cancer Care: Oncologist

Dr Abhishek Shankar said that coronavirus has made it difficult to manage the cancer care delivery system

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pink-ribbon-cancer care
Coronavirus outbreak has made it difficult to manage cancer care. Pixabay

By Dr. Abhishek Shankar

A recent report– ‘Cancer Care Delivery Challenges Amidst Coronavirus Disease – 19 (COVID-19) Outbreak’ published in the journal of Asian Pacific Journal of Cancer Prevention has pointed out that cancer patients are more susceptible to coronavirus than individuals without cancer as they are in an immunosuppressive state because of the malignancy and anticancer treatment. Oncologists should be more attentive to detect coronavirus infection early, as any type of advanced cancer is at much higher risk for unfavorable outcomes.

Author, Dr Abhishek Shankar, assistant professor in the department of radiation oncology at Lady Hardinge Medical College said that coronavirus has made it difficult to manage the cancer care delivery system.

“As we are having a lockdown in the whole country, patients can’t travel from one place to another. About 95 percent of the cancer care services are restricted to the urban areas but we also know that 70 percent of the people live in rural areas. So, there is a lot of disparity in cancer care. For cancer patients, stress is more disturbing for the patient rather than cancer itself,” Dr Shankar told ANI.

Cancer care
Dr. Shankar added that in this situation, it is very difficult to manage these people as they are unable to come to the hospital as we are running only emergency services. Pixabay

Also Read: Having a Child with Cancer Doesn’t Impact Parents’ Separation: Researchers

He added that in this situation, it is very difficult to manage these people as they are unable to come to the hospital as we are running only emergency services.

Talking about the report, Dr Shankar said, “We have published the paper on cancer care delivery, although guidance is that you shouldn’t delay and you should continue with the treatment. But there are many challenges that are coming right now. We have also advised cancer patients about the precautions they should take. Also, patients need to verify social media messages coming in from a credible source like the Indian Council of Medical Research (ICMR) and WHO.”Furthermore, he suggests that persons suffering from cancer should get treated from nearby hospitals and try avoiding the delay.

The cancer specialist remarked that it is a dilemma for healthcare professionals as well as patients because there is an issue regarding what to follow and what not to. “To date, there is no scientific guideline regarding the management of cancer patients in the backdrop of coronavirus outbreak,” Dr Shankar informed.

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Having a Child with Cancer Doesn’t Impact Parents’ Separation: Researchers

Being parents to a cancer patient kid doesn't trigger separation, say researchers

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cancer seperation
Chldhood cancer may not trigger seperation among parents according to researchers. Pixabay

Contrary to traditional belief, researchers now say that having a child with cancer did not appear to impact parents’ risk of separation or divorce or affect future family planning.

Childhood cancer can cause feelings of fear and uncertainty among parents and burden them with many practical challenges related to caregiving and work-related obligations, according to the study published in the journal Cancer.

For the findings, the research team from the Danish Cancer Society Research Centre examined data from several registries in Denmark, linking information on parents of children diagnosed with cancer in 1982-2014 (7,066 children and 12,418 case parents) with parents of children without cancer (69,993 children and 125,014 comparison parents).

Parents were followed until 10 years after diagnosis, separation or divorce, death, emigration, or the end of 2017, whichever came first.

Overall, parents of children with cancer had a four per cent lower risk of separation and an eight per cent lower risk of divorce compared with parents of children without cancer.

Among parents of children with cancer, those who were younger had less education, and were unemployed had elevated risks for separation and divorce.

The findings showed that risks were also higher among parents of children diagnosed at a younger age.

divorce-separation
Parents of children with cancer had a four per cent lower risk of separation. Pixabay

The investigators also evaluated how the diagnosis of cancer in a child affects parents’ decisions on having another child.

Also Read: Lockdown: Here are 5 Occasions to Celebrate With Luxurious Meals at Home

They expected that parents of a child with cancer would have fewer children than parents of children without cancer and that they would postpone having another child.

This was not the case, however, as the researchers found that the childhood cancer experience did not negatively affect parents’ future family planning in Denmark.

The researchers noted that health care providers should communicate these reassuring and encouraging findings to parents, but that support should be offered if needed to improve family life in the long term. (IANS)