Last month the Nobel prize in medicine was awarded for two breakthrough scientific discoveries heralded as having ‘revolutionised cancer treatment’ and ‘fundamentally changed the way we view how cancer can be managed’.
One of them went to a charismatic harmonica-playing Texan named Jim Allison for his breakthrough advances in cancer immunotherapy.
His discovery had resulted in transformative outcomes for cancer patients and a radical new direction for cancer research.
And yet many cancer patients and even some doctors have hardly heard of cancer immunotherapy or refuse to believe it.
Those who have struggle to make sense of the new menu of options and sort reasonable hope from overblown hype.
‘The emergence of cancer immunotherapy has occurred so quickly it’s hard for scientists – let alone physicians and patients – to keep track of it all’ explains Dr Daniel Chen – a Stanford oncologist and researcher who helped bring some of the new cancer breakthroughs from lab to clinic.
‘The tidal wave of data is still teaching us fundamental concepts about the interaction of the human immune system and human cancer’.
It’s also bringing us important new approaches to the treatment – and possibly the cure – of cancer.
‘So this data needs to be disseminated as quickly as possible’.
It’s estimated that nearly 40% of us will be diagnosed with cancer in our lifetimes and until very recently we’ve had three basic options for dealing with that news.
We’ve had surgery for at least 3,000 years.
We added radiation therapy in 1896.
Then in 1946 chemical warfare research led to the use of a mustard gas derivative to poison cancer cells and the advent of chemotherapy.
More recently we also started poisoning cancer through drugs that attempt to starve tumours of nutrients or blood supply.
Those traditional ‘cut – burn and poison’ techniques are effective in about half of cases.
It’s a laudable medical accomplishment that also leaves behind the other half of cancer patients.
According to the World Health Organisation’s international agency for research on cancer that translates to 9,055,027 deaths worldwide in 2018 alone.
Our usual defence against disease is our immune system.
It does an excellent job of sorting out what doesn’t belong in the body and attacking it – except when it comes to cancer.
For 100 years the reasons behind that apparent failure were a mystery.
Jim Allison’s breakthrough was the realisation that the immune system wasn’t ignoring cancer.
Instead cancer was taking advantage of tricks that shut down the immune system.
But what if you could block those tricks and unleash the immune system’s killer T-cells against the disease?
The trick Allison’s immunology lab at the University of California Berkeley found – involved a protein on the T-cell called CTLA-4.
When stimulated, CTLA-4 acted like a circuit breaker on immune response.
These brakes – which he called checkpoints – kept the cell killers from going out of control and trashing healthy body cells.
Cancer took advantage of those brakes to survive and thrive.
In 1994 the lab developed an antibody that blocked CTLA-4.
‘Roughly it’s like taking a brick and jamming it behind the T-cell brake pedal’ explains Dr Max Krummel – immunologist who had worked with Allison on CTLA-4.
When they injected it into cancerous mice the antibody jammed behind CTLA-4’s brake pedal and prevented the T-cell attack from being stopped.
Instead the T-cells destroyed the tumours and cured the cancer.
What they had found would eventually win the Nobel.