The Ongoing Issue with Immunotherapy
Over a hundred years on – are immunotherapies really worth their salt?
Immunotherapy is known to have been loosely invented by a New York based doctor, William B. Coley.
By blending a beef broth with Streptococcus bacteria, he formulated the first treatment by injecting it into an Italian-man suffering from an inoperable neck tumour.
Although this man went on to recover, with the tumour reducing in size significantly over the course of a month; during this time he suffered some pretty serious side effects, developing a fever and vomiting frequently during throughout his recovery.
It’s been well over a hundred years since Coley’s first pioneering breakthroughs and despite the development of supporting technologies, the simple fact remains that immunotherapies remain somewhat volatile and risky – even for cancer patients who are suffering from inoperable diseases.
A recent study undertaken by outspoken immunotherapy critic Vinay Prasad has revealed that only 10% of the US population currently dying of cancer would benefit from the treatment. As much as we need to take Mr. Vinay’s assessments with a pinch of salt, especially when you consider how vocal he has been for a number of years concerning immunotherapy; it’s also worth at least considering his view point, instead of rushing into a decision that could cost a fortune and potentially leave cancer patients much worse off.
The average cost of a US-government sanctioned treatment runs well into six-figures (around $150,000), but with the technology behind the treatment currently considered as ‘poorly understood’. The question remains as to whether companies like Merck and Bristol-Myers Squib are taking advantage of their dubious position, as they’ve already pocketed $9bn from sales of their breakthrough checkpoint inhibitors.
Despite these large sales numbers , it’s still questionable whether or not this form of immunotherapy is truly beneficial for a wider cross-section of cancer patients. A similar thing can also be said for CAR-T treatments. A complex combination of cell and gene therapies, this treatment was considered to be cutting edge when it first broke on to the scene in 2017.
The first CAR-T therapy treatment broke more than a few boundaries when it was cleared by the FDA. It was the first ever gene therapy to be given approval to go to market, with the first treatment focused on cases of leukaemia in children. This breakthrough led to an opening of the floodgates for similar CAR-T therapies developed by competing firms and focusing on different conditions. These new CAR-T treatments included the more common lymphomas in adults, where trials declared an astonishing 50% rate of complete cancer removal.
These are promising results and will no doubt go some way to diminishing the concerns that potential patients might have, before they lay down the necessary dollar for the treatment. However, with treatments rising in price over the last year (costs for that particular lymphoma treatment have settled at an astonishing $475,000) the question remains as to whether these ‘cures’ are being made for the sake of humanity or the sake of profit alone.
A near half-million dollar price tag is a lot of money, a sum that only a handful of sick people would be able to afford, especially considering the potential risks of the treatment. In 2016, five leukaemia patients died from massive brain swelling in Japan, similar cases have occurred at the University of Pennsylvania, as well as the National Cancer Institute – posing the question as to whether our scientists can really be trusted any more than their dubious forefather, Coley.
The immunotherapy industry has certainly come on leaps and bounds since it’s original incarnation over a century ago, however it might take another century still for it to become both affordable, safe and effective.
Skin Cancer: The Basics
Skin Cancer – the most common of all Cancers.
What is it?
Skin cancer is the generic term given to any kind of cancerous multiplication of cells that develops within the skin. Often overlooked, the skin is essentially another organ of the body. Made up of several layers it plays an essential role in the body, protecting the underlying muscle tissue and bones.
Although there are many different types of cancer that can develop within the skin, the two most common types are basal cell skin cancer and squamous cell skin cancers – both of which occur withing the epidermis.
Basal cell skin cancer
The most commonly occurring type of skin cancer. Mostly affecting adults with fairer skin, they can crop anywhere on the body but are most often found in places that are exposed to the sun more – such as the face, head, neck and ears.
Those most at risk of developing the condition are people who burn easily without tanning, people who work outside or live in sunny places and those who regularly use tanning beds.
Although they can vary in appearance by a great deal – BCCs are often first recognised as scabs that do not heal. They may appear as flat, scaly marks or protrude more from the skin in the form of lumps. Left to their own devices, these lumps can cause an ulcer which can disfigure the patient. BCC treatments included laser removal, surgical removal and photodynamic therapy.
Squamous Cell Skin Cancer
Squamous skin cancer grows much faster than Basal Cell Cancer. The people at risk of developing the disease fall into the same demographics as those at risk of BCC. Both diseases display relatively similar symptoms, with a few differences that define their treatment.
Whereas basal cell cancers very rarely have the risk of infecting other parts of the body, squamous cancer cells have a higher chance of doing so.
Additionally, if these cells are allowed to spread around the body then the resulting symptoms can be serious and painful.
Stages of Skin Cancer
Staging is not often applied to cases of BCC as this rarely spreads to other parts of the body. Squamous Cancer cells, however, carry a greater chance of this occurring – because of this the Doctor may sometimes use a scale to give the patient an idea of the progression of the disease.
Stage 0
Often referred to as Bowen’s disease or carcinoma situ. The cancer remains in an early stage and is not visible to the naked eye.
Stage 1
At the first stage of the disease, the cancer measures 2cm or under across and has 1 or less than one high risk features. These are as follow:
- the cancer appears very abnormal under the microscope
- the cancer starts on the ear or lip
- the cancer has begun to grow into a space around a nerve
- the cancer has developed into the lower dermis
- the cancer has grown to be more than 2mm thick
Stage 2
The cancer is now larger than 2cm across and displays 2 or more of the aforementioned risk features.
Stage 3
This stage signifies that the cancer has spread to another part of the body. By this point the cancer has either grown into the bones of the face (such as the jaw or around the eye) or it has spread to a nearby lymph node (and is less than 3 cm across).
Stage 4
The final stage of skin cancer, the disease has now spread to the spine, ribs or skull. After spreading to a lymph node on the same side of the body.
Treatment
As with most cancers, the most common treatment is the use of surgery. Favoured earlier on, whilst the growths are still in their infancy, surgeons cut away the cancer and close the gap with stitches.
For more complex cancers, Mohs micrographic surgery is considered to be one of the most effective methods of isolating and removing the cancerous cells.
A technique developed in the 1930s, a microscope is used to inspect the skin close up, allowing surgeons to identify how much more skin needs to be removed.
In addition to these treatments, medical professionals could well recommend a number of alternatives such as: radiotherapy, vismodegib (a variant of chemotherapy), imiquimod cream and photodynamic therapy.
How Does Cancer Work?
What is Cancer and how does it affect us?
Although cancer effects hundreds of thousands of people in the UK every year, it’s easy to not have a firm grasp on the basics of how the disease actually works.
How Does It Start?
Cancer is a disease that can start surreptitiously. Many of the symptoms that cancer sufferers usually exhibit can be innocent enough, when taken alone. Irregular bowel movements, breathlessness and unexplained weight loss are all symptoms that could be presented by any number of other illnesses, which can lead to difficulties in diagnosis.
In normal cells, messages are received and sent which informs them when to grow and stop. If enough ‘grow’ messages get sent through, the cell will follow that instruction. Cancerous cells are formed by messages that give the cell the wrong instructions, leading it grow uncontrollably and divide more frequently.
How Do Cancer Cells Survive?
Cancer cells cheat death through a number of ways. In a healthy body, every single part of your body is made up of a optimum number of cells. Deviation from this number normally results in cell suicide, however cancerous cells find a way around this. A protein, called p53, usually ascertains whether a cell should be repaired or destroyed.
Cancerous cells often have a slightly adapted p53 protein, which allows them to ignore the self-destruct order and continue to multiply. Once the defective cells have avoided destruction they can then spread across the body freely.
How Does It Spread?
Metastasis is the name given to cancer cells that spread throughout the body. Non-cancerous cells are programmed to stay attached to their fellow cells and environment. If they happen to become detached from their home, they are programmed to self-destruct.
As we’ve mentioned, cancerous cells have a way out of this fail safe. This allows them to drift throughout the rest of the body, using the blood stream as a means of transportation. These cells can then go on to form secondary tumours which can make it even more difficult for healthcare professionals to find.
How Can It Be Destroyed?
Cancer is currently tackled using three different medical procedures. Surgery is the most primitive form of treatment, requiring a surgeon to physically cut the offending tissue out, it’s considered the best method of treatment, whilst the disease is still in it’s early stages.
Radiotherapy is a process that has seen vast improvements over recent years. Using a beam of radiation, doctors can target cancers with a surprising amount of accuracy, thanks to recently developed imaging techniques. Finally, chemotherapy is perhaps the most well-known form of treatment for cancers. An aggressive form of treatment, it effectively poisons the whole body killing any cells that are multiplying rapidly.
