Using the Immune System to Defeat Cancer

T-cells attacking a tumour

How Top Researchers are Starting to Think like Natural Therapists

This blog is a slightly condensed version of an online artilce titled 'A cure for cancer: how to kill a killer'. We have taken out sentences and phrases to shorten the article without detracting from its content, and added headings. You can click here to read the original article.

One of the roles of the immune system is to seek out and destroy any cells in the body that are foreign, damaged or not where they should be, including cancer cells. Many natural therapists stress the importance of improving the immune system when anyone wishes to decrease their risk of developing cancer or to help prevent it recurring. So it is good to see cutting-edge medical research looking at ways to help the immune system get rid of cancer. (We must stress that we do not claim to be able to treat or prevent cancer.)

Revolutionary work on the body’s immune system and a host of new drug trials mean that beating cancer may be achievable.

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.”

Old Cancer Treatments

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.

Using the Immune System to Treat Cancer

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. (We would disagree with this- as cancer cells are believed to develop in every person's body, the immune system is the reason why cancer doesn't develop in everyone.) 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. It would also fly in the face of what every practising oncologist had been taught about cancer and how to fight it. It took 15 years, says Krummel, before they could finally test whether what worked in mice would translate to people.

Results with Immunotherapy

Blocking the brakes on the immune system turned out to cause serious toxicities in some patients. “We learned pretty quickly that immunotherapy was not a free ride,” explains Dr Jedd Wolchok, a cancer immunotherapist and one of the primary investigators in the clinical trials for Allison’s anti-CTLA-4 drug. “But we were also seeing some remarkable things.” For some of the metastatic melanoma patients in the study, even terminal stage 4 patients only days away from hospice, the drug effectively cured their cancer.

“You never forget that,” Wolchok explains. “And at the time, we really had nothing that would work for metastatic melanoma.” In 2011, that anti-CTLA-4 drug would gain approval as ipilimumab (trade name Yervoy) for use treating melanoma; it has since been approved to treat kidney and colorectal cancer. As a drug, it has saved many thousands of lives. But as a proof of concept, the success of ipilimumab proved that the immune system could, in fact, be weaponised against cancer. It also kicked off the search for newer, better immune checkpoints.

The first to be discovered was called PD-1. Its discoverer, Dr Tasuku Honjo of Kyoto University, shares this year’s Nobel in medicine. PD-1 is part of a sort of secret handshake that body cells give a T-cell, telling it: “I’m one of you, don’t attack.” Cancers co-opted this secret handshake, tricking T-cells into believing they were normal, healthy body cells. But that handshake could be blocked, creating a more precise cancer-killing machine with far fewer toxic side-effects than blocking CTLA-4.

In December 2015, the second generation of checkpoint inhibitors (called anti-PD-1 or anti-PD-L1, depending on whether they’re blocking the T-cell or tumour side of the handshake) was used to unleash the immune system of Jimmy Carter and clear an aggressive cancer from his liver and brain. The news of the 91-year-old’s miraculous recovery surprised everyone, including the former president himself.

The Future

For many people, “that Jimmy Carter drug”, the anti-PD-1 drug pembrolizumab, approved in 2015 and sold as Keytruda, was the first and only thing they’d heard about cancer immunotherapy. Keytruda is currently one of the most widely used of the new class of drugs, approved for use against nine different types of cancer in the US, and a smaller number in the UK, and that list is growing rapidly, as is the number of acronyms for the dozens of new checkpoints being tested. The immune system remains the deep ocean ecosystem of the human body. We’ve barely begun to plumb its depths.

For researchers such as Chen and others, this is our penicillin moment in the war on cancer. As a drug, penicillin cut infection rates, cured some bacterial diseases and saved millions of lives. But as a scientific breakthrough, it redefined the possible and opened a fertile new frontier for generations of researchers. Nearly 100 years after the discovery of that one simple drug, antibiotics are an entire class of medicines with a global impact so profound that we take them for granted. Invisible terrors that plagued and poisoned mankind for millennia are now casually vanquished at a high street chemist. “We’ve only just discovered the checkpoint inhibitors,” Chen says. “So it’s the breakthrough – we’ve just discovered our penicillin.”

... It’s hoped that, with checkpoint inhibitors releasing the brakes, the immune system can effectively finish up what the chemotherapy starts. There are so many ongoing trials it’s impossible to typify their stages or results, but several have been positive. The European Society for Medical Oncology recently announced the first modest immunotherapy success against triple negative breast cancer, a horribly aggressive disease found primarily in younger women, which has stubbornly resisted previous treatment options.

Nor are checkpoint inhibitors the only immunotherapy of cancer. ... Another promising technique ... called chimeric T-cell therapy, or CAR-T, re-engineers a patient’s killer T-cell into a sort of robocop cancer killer, creating a startlingly powerful living drug capable of adapting to match cancer for a lifetime. CAR-T has already wiped out certain forms of childhood leukaemia. These are claims that simple cancer drugs can’t make.

The word cure can now be used in oncology,” says Dr Axel Hoos, an immunologist and former global medical lead for the Bristol-Myers Squibb immune-oncology programme. “It’s no longer fantasy or a cruel promise that you can’t fulfil. We don’t yet know who will be the lucky patients who will be cured, but we have seen cures already.”

Hype can be dangerous, just as false hope can be cruel. There’s a natural tendency to invest too much hope in a new science, especially one that promises to turn the tables on a disease that has, in some way, touched everyone’s life, and sober caution is required. Right now, there are only handful of immunotherapies available. The majority of patients respond partially or not at all and some even develop and acquire resistance to the disease. But the minority of cancer patients who have been shown to respond to these drugs experience remissions measured not in extra weeks or months of life, but in lifetimes. “Such transformative, durable responses are the unique value proposition of the cancer immunotherapeutic approach,” Chen says. But it’s important to note that that potential is different from a guarantee of any one outcome for any individual patient.

And as Wolchok told me: “Immunotherapy is not a free ride.” There are the toxicities that occur when a T-cell response in unleashed. ...

Several doctors tell me that the goal of treatment, if a cure isn’t possible, is holding on for the next breakthrough. If and when it comes, patients and doctors need to be ready to understand it. “After all,” says Chen, “there’s nothing more useless than therapeutic breakthroughs against cancer that people don’t know about.”

The immune system is an amazing thing, but when it is not working properly the person could experience chronic infections, fatigue, allergies, food intolerances, auto-pmmune disorders, or even develop cancer. You may like to also read Why a Good Immune System is Vital for Your Health.

The Coronavirus- What We Know so Far

The Coronavirus

How Dangerous is It?

There has been widespread concern and even anxiety about the rapid spread of the coronavirus across several continents. So how worried should we be? Whilst the trajectory of this outbreak is impossible to predict, and the situation is rapidly evolving, here is what we know so far about the current outbreak.

Human coronaviruses (HCoVs) have long been considered inconsequential, causing the “common cold” in otherwise healthy people. However, the emergence of the SARS-CoV in the early 2000s and MERS-CoV in 2012 caused global epidemics with alarming morbidity and mortality.

The current outbreak is caused by a novel (new) strain from the coronavirus family. This virus is so new that it does not yet have a name- it is currently being labelled by the WHO as the 2019 novel coronavirus or 2019-nCoV.

The virus is thought to have originated from a seafood market in Wuhan, a central Chinese city. Currently, all confirmed cases of the virus in Australia are in individuals who have recently visited Wuhan. There have not been any human-human transmission occurring in Australia, although such cases are expected, and have occurred in China.

As at 29/1/20, the virus had been responsible for approximately 130 deaths. In all of these cases, the individual had suffered from an underlying condition, was elderly or frail, and therefore their immune system had a reduced ability to mount an appropriate response.

The main causes for concern relate to what is not known about the virus:

  • It is not known how virulent this strain of coronavirus is
  • It is not known how it is transmitted or how long it lives on surfaces; however, it thought that coming within a 1-metre radius of an infected person increases the likelihood of transmission
  • It is not known if the person is able to transmit the virus before symptoms appear

Thankfully, the 2019-nCoV appears to have a much lower fatality rate than previous coronavirus outbreaks such as SARS and MERS, or other deadly viral diseases such as Ebola. The current estimated fatality rate of the 2019-nCoV is 2.17%(1). Individuals who have died from this coronavirus are individuals who would have been at similar risk from a common seasonal influenza, which helps to contextualise the danger from this outbreak. However, it is possible that the virus could mutate and become more deadly.

For perspective, the mortality rate of SARS was 10%, MERS was 36%, whilst the Ebola virus killed half of all individuals infected.(2)

Avoiding It

Current recommendations to help prevent the spread of the virus are common-sense ones which are applicable to viruses such as influenza, and especially apply to people travelling or working in healthcare. The WHO recommendations(3) include:

  • Regularly wash your hands with soap and water for at least 20 seconds
  • Cover your nose and mouth when sneezing or coughing with a tissue or flexed elbow. Avoid coughing into your hands. Throw the tissue into a closed bin
  • Avoid close contact with individuals who display cold and flu-like symptoms
  • Avoid touching your eyes, nose and mouth. (A face mask may help you to remember to not touch your face)
  • Avoid travel if you have a fever or a cough
  • Avoid travel if you are immune-compromised or have a chronic illness, or if you are regularly in close contact with individuals with such conditions
  • If you have a fever, cough or difficulty breathing, seek medical care early, and share your travel history with your health care provider; let your doctor know before you present to their clinic that you have respiratory symptoms so that you are not kept waiting with other patients
  • If you feel unwell during your travels, notify your travel crew
  • Eat only well-cooked food while travelling

What Symptoms to Look Out For

The Federal Government has issued the following guidelines(4) on identifying if someone may have a coronavirus infection.

‘If the patient satisfies the epidemiological AND clinical criteria (listed below), they are classified as a suspected case:

Epidemiological criteria

  • Travel to Wuhan City (Hubei Province, China) in the 14 days before the onset of illness, OR
  • Travel to an area with evidence of sustained human-to-human transmission, or a declared outbreak, within 14 days before onset of illness, OR
  • Close contact in 14 days before illness onset with a confirmed case of 2019-nCoV.

Clinical criteria

  • Fever or history of fever (?38 °C) and acute respiratory infection (sudden onset of respiratory infection at least one of: shortness of breath, cough or sore throat), OR
  • Severe acute respiratory infection requiring admission to hospital with clinical or radiological evidence of pneumonia or acute respiratory distress syndrome (i.e. even if no evidence of fever).’

Prevention is Better than Treatment

Because of the way viruses mutate, new ones will always develop from time to time. Some of these will be relatively mild, and others will be more virulent. Apart from supportive care and avoiding infected persons, there is very little that can be done medically to treat a virus. So the best defence against any virus (or any other infection) is to make sure that your own immune system is strong enough to deal with it quickly and effectively. There are many aspects to your immune system, so if you would like to boost yours or to have it assessed, please book in for a free Comprehensive Assessment. (Terms and conditions- the Assessment is a completely free service, with no obligations whatsoever.)

  1. https://www.health.gov.au/news/coronavirus-update-at-a-glance
  2. Email 29/1/20 from BioMedica Nutraceuticals
  3. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
  4. https://www.acupuncture.org.au/wp-content/uploads/2020/01/novel-coronavirus-2019-ncov-information-sheet-for-primary-and-community-health-workers.pdf
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