I am convinced that future generations will look back on the way we treat cancer patients with the same horror and judgement we use when considering how the sick used to be bled to remove bad blood. Our first president was bled four times and had his feet blistered to treat a throat infection. In hindsight, his treatment seems barbarous and inhumane, but it was the best care available at the time. I think the same should be said for how we currently treat those facing cancer.
Standard treatment for cancer that is localized and found early is surgery. This is the best-case scenario for a cancer patient. A surgeon will use a knife to cut open the body, remove as much tissue as necessary, sew things up, and hope they caught it all. Leaving behind even a single cancerous cell could render the whole surgery futile, so it is better to err on the side of cutting out too much rather than too little.
Another common option is to blast the tumor with radiation. Generally speaking, radiation is known to cause mutations and increase the odds of developing cancer, so questions about the wisdom of this treatment are understandable. But cancerous cells are less able to fix DNA damage than healthy cells. The goal of radiation, therefore, is to kill more cancer cells than healthy cells while accepting that many cells will be damaged.
The most dreaded modern “treatment” for cancer is chemotherapy. The term applies to a diverse array of medications with different effects, but many of these treatments work by killing or inhibiting any rapidly dividing cell. This explains common chemo side effects like weakness (from death of blood cells), diarrhea (from death of intestinal cells), and loss of hair (from death of hair follicle cells). For all intents and purposes, chemo is just poison taken at a dose that is more likely to kill the tumor cells than the patient.
And this is how we care for the seriously ill. We cut them, blast them with radiation, and feed them poisonous medications, but it is the best care we have available at this time. But, please Lord, not for long. A new paper just published in the journal Nature offers hope that a new kind of treatment could soon be possible. Not just a treatment, but a cure.
Our bodies have a set of cells who’s job it is to find dangerous, cancerous, cells before they get out of hand. These guardians, called T cells, regularly search throughout our bodies, interrogating our cells, and terminating any that could pose a threat. Cancer as discussed with an oncologist comes from those cells that have somehow escaped our T cells. One of the authors of the new study, in a news article also published in Nature, says, “It is probably the most complicated therapy ever attempted in the clinic… We’re trying to make an army out of a patient’s own T cells.”
The strategy they used started with harvesting T cells from actual cancer patients. These are the very cells that were responsible for clearing the cancer and had failed at task. Next the researchers predicted what missing information the T cells were lacking that could help them find the cancer. This task alone was a remarkable feat. Each patient’s tumor is unique so the clues or tells the cancer might reveal to arouse the suspicions of a T cell are different for every person. They selected three clues for each patient and then taught those clues to the harvested T cells. The researchers used CRISPR to edit the genomes of the patient’s T cells. They taught the T cells to recognize the markers the own patient’s tumors might carry. Then these newly edited T cells (called CAR T cells) were multiplied and infused back into the cancer patients.
The good news is that, by and large, the CAR T cells were able to find the tumors. In many patients the immune system began to recognize the cancers that had previously been missed.
The more sobering news comes from the limits of the study. This was a small Phase 1 clinical trial. Only 16 people were involved. The treatment didn’t always work. Some patients seemed to have side effects. Maybe most depressingly, this process was SLOW, taking as much as a year or more. While they waited these patients endured the litany of standard so called “treatments” that are currently the best we have available.
But this trial offers something so precious to the millions facing cancer: hope.
Hope for a better treatment someday. Hope for not just a treatment, but a cure.
If CAR T cells can be trained to focus the immune system on a tumor it would likely do so relentlessly. The human immune system is among the most complicated systems known to science, but it is fiercely efficient at removing even the smallest microscopic troublemaker when it knows where to look. It will continue to fight until every last cell of concern is removed.
When faced with the dangerous and the unknown, we often react with gut instincts based on fear. I think those instincts have shaped the whole of cancer treatment. Get it out of me, kill it, blast it! But by the grace of God, we have already been given a system that protects us every day from cells gone wrong. T cells. I find there is wisdom in paying attention to how God built the world to work. This new study offers hope that by harnessing our God given systems we will greatly improve the best care available.
Excellent article and a timely reminder! Thanks for sharing these advances in care.
CAR T therapy is not new or novel. It was FDA approved in 2018. The study you reference only uses 16 patients and discusses the use of CAR T in solid tumor cancer. CAR T is not FDA approved for solid tumor cancers, but is approved in hematological tumors. Also, studies that have meaningful clinical relevance have on the order of at least hundreds of patient subjects. This is essentially a pilot study looking at the novel application of an established therapy.
Which is why it is something we look forward to in hope. Anticipate. Long for. The new article was a nice phase 1 trial using a new and promising set of techniques. The combination of techniques they use here have the potential to offer an important advance in personalized medicine.