Immunotherapy against cancer: "The development is rapid"
Peter Jacob had already had several chemotherapies, but the cancer did not go away. Two years ago, the now 70-year-old from near Schweinfurt in Lower Franconia was diagnosed with multiple myeloma, an aggressive form of bone marrow cancer. The subsequent therapies brought nothing in the long term. "Today I feel healthy and have hardly any limitations in the quality of life," said Jacob at a press conference at the University and University Hospital Würzburg. Jacob was treated in mid-December with the so-called CAR-T cell therapy.
According to the Würzburg researchers, Jacob is the first successfully treated patient with this type of cancer in Germany. In a patient treated at the same time, the therapy did not work so well.
In CAR-T cell therapy, the patient is bled and a portion of the white blood cells, the T cells, are genetically engineered to recognize and destroy cancer cells. Thereafter, the patient gets the cells re-administered.
The therapy has been researched for some time, but was first approved in Europe in August 2018. It is also being investigated and partially applied in other cities, such as Cologne, Heidelberg, Munich, Frankfurt and Regensburg. The number of ongoing studies is increasing. "The development is currently rapid," says Michael Hudecek, head of the CAR-T-cell program in Würzburg.
According to Hudecek, about 100 patients have already been treated in Germany, just over 20 in Würzburg alone, of which more than half are successful. How many patients have exactly received the therapy in Germany, according to the German Cancer Research Center (DKFZ) in Heidelberg difficult to say.
So far, the therapy is mainly used in various forms of blood and lymph node cancer. It has not been well transmitted to solid tumors such as breast, colon and skin cancer. In addition, the side effects of the therapy are not fully understood. A well-known side effect are fever episodes. Peter Jacob had her too. "They gave themselves quickly," says Jacob. The fever episodes are at the same time signs that the therapy strikes.
In the course of treatment, it can also lead to neurotoxic reactions, such as inflammation in the brain or to so-called cytokine towers, a kind of flooding of the body with certain messengers. There were also deaths. "It is not a simple therapy and strong side effects are possible," says Stefan Eichmüller from the German Cancer Research Center (DKFZ) in Heidelberg. "But she is the most effective we have right now."
At present, the therapy is only given to patients in Germany as therapy patients. In the US and China, CAR-T-cell therapy has been used for some time. "It is very important that we do not lose the connection here," said the Würzburg oncologist Hermann Einsele on Thursday.
The world's most famous CAR T cell patient is the girl Emily Whitehead from the USA. She was the first person to be treated with the new immunotherapy in 2012. Today Emily is a teenager and, according to the Emily Whitehead Foundation, cancer free since the end of treatment. In 2017, she was ranked by the scientific journal "Nature" among the ten people who played a crucial role in science.
Whether Peter Jacob really healed, has yet to show. Cancer can basically come back. But it is a particular advantage of T-cell therapy that the "drugs" remain in the body: the once activated CAR-T cells should then possibly fight the following cancer cells.
New therapies in the fight against cancer
Secondary tumors, as medical specialists call them, can be found in certain types of tumors over 80 percent in the vertebral body. They continue to spread in the bone, cause severe back pain and, in the worst case, lead to paraplegia. Prof. Dr. med. Andreas A. Kurth, medical director and orthopedic oncologist at the Hospital Ratingen, explains what changes cancer causes in the body, shows diagnostic procedures and describes treatment approaches.
Each of the over 200 cancers triggers different warning signs. Examples of the most common types such as breast, prostate and colorectal cancers include breast lumps, testes thickening and stool blood. But changes in the skin, loss of appetite, persistent cough, chronic fatigue, dysphagia and pain of unknown origin indicate possible cancer. Secondary tumors in the spine may cause pain, numbness or paralysis due to the nearby nerve structure.
"The gradual destruction of healthy bone material increasingly affects the musculoskeletal system through fractures," says Prof. Dr. Kurth.
After doctors have determined the type, size and location of the malignant tumor, they initiate appropriate therapies. These include chemo, radiation and anti-hormone therapy. In the former, cell toxins inhibit the proliferation of cancer cells, but also attack healthy tissue. In order to more effectively damage tumors, physicians rely on radiation therapy in which they bombard malignantly altered structures with X-rays or electric radiation. Certain breast and prostate cancers can be affected by blocking hormones that stop growth.
The surgical removal of tumors proves to be particularly difficult for secondary tumors in the backbone. "There are further developments here," explains Prof. Dr. med. Kurth and describes the procedure: "With the help of the so-called STAR ablation, we melt away spinal metastases, destroying radiofrequency energy, ie heat, selectively malignant tissue, without endangering sensitive neighboring structures.