Cancer used to be a death sentence. Today, seven out of ten patients live at least ten years after diagnosis. An SvD journalist met with some of the world's most prominent researchers and asked how close we are to solving the cancer puzzle. He also tells the story of one patient.
It's a miracle I'm still alive, says Dewey Stringer, 76. He made a fortune on black gold in the American oil city of Houston and led a life that others can only dream of. But five years ago, life hit the brakes. Not even money could save him.
He was diagnosed with kidney cancer, and within a year the tumor grew so much that it passed through the affected organ.
His kidney was removed, and a doctor at a local private hospital announced that the operation was successful. But that was not the case. Just a few months later, metastases were found in other organs, primarily in the lungs.
“I was told that this is such a particularly aggressive trait, you cannot cut him off, and he does not respond to chemotherapy and radiation,” says Dewey Stringer.
He lost ten kilograms, and even his favorite dish, the classic Texas beef tenderloin, did not make his appetite. Now he mostly sat or dozed in the shade in his garden. He planned to spend the last days in a hospice so as not to burden his family.
“Nobody could do anything, they promised me six to nine months. That is, it was simply a death sentence."
For a long time, any cancer diagnosis meant just that. Death Sentence. Before the breakthrough in the form of radiation therapy, no one could even hope to overcome such a disease. Few patients have been able to prolong their lives with surgery and the latest in anesthesia. But with radiation therapy, it became possible to heal cancer patients or at least relieve their pain.
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In the early 1950s, when chemotherapy was introduced, approximately 30% of patients could survive for several more years after being diagnosed. Around the same time, scientists first linked smoking to cancer.
Since then, the development of medicine has gone by leaps and bounds. Combination regimens and hormone therapy have become more accurate. In the 2000s, precision drugs and targeted drugs appeared. They are directed precisely at cancer cells and do not affect healthy ones.
Much good is happening in the field of cancer treatment today. The survival rate is increasing, the relative mortality is falling.
The measure of success is ten-year survival, that is, the number of patients who live at least ten years after diagnosis. In 1980, the figure was around 30% for men and just over 40% for women. The latest figures from the Swedish Social Welfare Office show an increase of about 69% for both men and women. On average, three out of four patients live at least five years after they become ill.
Cancer resistance has amazed scientists at all times. But maybe soon cancer will cease to be a fatal disease? In other words, are we about to solve his riddle?
Dewey Stringer heard about this quite by accident. The Anderson Cancer Center in Houston, one of the world's largest cancer hospitals, which admits up to 130 thousand people a year and simultaneously conducts more than a hundred studies involving 4 thousand patients, has been experiencing so-called immune therapy. The center was staffed by Jim Allison, a Texas immunologist and one of two developers of this new treatment.
“I came back to life and tried to get a meeting with Jim Ellison and his wife Padmani Sharma. Then there was no immune therapy for kidney cancer, but I begged and begged, and in the end I ended up on the line of applicants to participate in a research project specifically related to my kind of aggressive cancer.
He was allowed to participate - for 60 thousand dollars a month. He was ready to sell an exclusive villa in Galveston, near the NASA Space Center, which houses the manned space flight control center.
“But then another miracle happened. Once I was just researching my insurance, and then the doorbell rang. The insurance company suddenly decided to shoulder the cost of the clinical trial.”
Many metastases by that time had grown from peas to the size of a grape. Both lungs were affected, Dewey Stringer completely lost his appetite and, in fact, was already dying. After the first injection in August 2015, he didn't feel better. The second and third also failed.
“A friend called me, he just wanted to know if I was still alive. He asked if I would like to go with him to hunt birds, as we had gone many times before. And for some reason I agreed. We returned empty-handed, but in the evening we began to grill the meat, and I suddenly became terribly hungry, ate the pieces one by one. And that's when I realized that something had happened."
In 2018, after years of controversy, the Nobel Prize in Medicine was awarded for immune therapy. It was shared by James Ellison and Tasuko Honjo of Japan. It is possible that as technology advances, this breakthrough will revolutionize cancer treatment. Research is now being carried out in relation to various types of advanced oncological diseases.
“All cancer research is about understanding the processes. Why does a cell start dividing when not needed? Why doesn't she stop doing this and destroy herself as she should? We have always focused on targeting cancer cells. And immune therapy works differently. We use the T cells of the immune system to destroy tumor cells,”explains Klas Kärre, one of Sweden's leading oncologists.
He is a professor at the Karolinska Institute (one of the largest medical universities in Europe, located in the vicinity of Stockholm - ed.), As well as a member of the Nobel Committee in the field of physiology and medicine and chairman of the Research Commission of the Swedish Cancer Foundation.
Immune therapy uses the body's immune system to fight cancer
The immune system is made up of organs, tissues, cells, and molecules. One of its tasks is to get rid of bacteria, viruses and abnormal cells, such as cancer cells. Immune therapy uses various techniques to make the immune system more successful in finding and eliminating tumor cells.
Immune therapy options
Inhibitors of checkpoints of the immune response (checkpoint inhibitors). These drugs block the inhibitory mechanisms of the immune defense. The so-called checkpoints are a natural part of it, and their job is to prevent an overly powerful immune response. By blocking them, the drug helps the immune cells to act more strongly on the tumor.
Monoclonal antibodies. These are proteins of the immune system, created in laboratory conditions, they bind to specific points in tumor cells. Monoclonal antibodies mark them, making them easier for the immune system to detect and destroy.
CAR-T cell therapy. This therapy enhances the ability of leukocytes (white blood cells) to fight cancer. The patient's own cells are modified in the laboratory and become "killer cells", which are then reintroduced into the patient's body.
At first glance, it seems that the immune defense should react directly and immediately attack aggressive cells. But there are special mechanisms that block it and "turn it off" when it is not needed.
The discovery by James Ellison and Tasuko Honjo helps to contain these mechanisms. In other words, the treatment enhances the immune system's natural ability to attack cancer cells.
“In many cases, the results are excellent, for example in patients with malignant melanoma and metastases, as well as lymphomas, certain cancers of the bladder and lungs. And if the two therapies are used together, the effect is especially strong,”says Clas Cerre.
We are meeting 71-year-old Jim Ellison at the Anderson Center. There he and his wife Padmani Sharma have offices and a laboratory. The wife is also a professor and oncologist, her work has received several awards, and she also works on immune therapy. Allison and Sharma got married in 2014: "We talked about T cells all the time anyway."
Since the 2018 Nobel Prizes, Allison has a crush on Sweden. He took a friend, U2 guitarist Edge, with him to the celebrations. Beyond science, music has always meant a lot to Ellison. He himself plays the harmonica, often toured with various blues bands and the big band The CheckPoints, and even played with country legend Willie Nelson.
By pure coincidence, it is on these October days that the names of the 2019 medicine award winners become known. I ask what this award means to Ellison.
“Lots of invitations and interviews. She gave me a platform from which I can speak and listen to me. In Congress, I also said that research should be intensified. The current administration in the White House has drastically cut spending, and this is scary. I would never have earned a Nobel Prize if I had no money for scientific work."
The prize was awarded for his demonstration of how CTLA-4 protein inhibition can be prevented. Tasuko Honjo did the same, but for yet another PD-1 brake protein.
Jim Ellison conducted the first experiment in 1994 on mice. Then the protein "inhibiting" immunity was blocked by antibodies. The mice with tumors that received this protein survived, the rest died.
“That was the first time we understood how it works. We watched cancer cells being destroyed. And then we realized that the immune system can save us from cancer."
In the late 1990s, the first human patient was treated. He had prostate cancer. In 2001, a case of a woman with advanced skin cancer, when metastases were already present in the brain, liver and both lungs, attracted much attention. The case was hopeless, and immune therapy was tried as a last resort. After four months, almost all of the cancer cells were gone.
But Jim Ellison still had to jump over his head to convince some pharmaceutical company to invest in his research. He eventually found a small biotech firm. In his experience, large pharmaceutical companies are often not interested in supporting patients who are expensive and then die anyway. They prefer to produce medicines for people with heart disease or diabetes, that is, for chronic patients who live long, which means they have time to pay off.
His drug was approved only in 2011.
In the field of cancer treatment, scientists are achieving more and more significant results, but there are more and more people suffering from cancer.
It seems like cancer has always been a part of human life. As life expectancy increases, more and more people get sick: they even say that each of us will die of cancer, unless we have time to fall prey to some other ailment. Cancer has recently topped the ranking of the most common causes of death in Sweden.
Cancer is found in approximately 63,000 Swedes every year. Compared to the situation 50 years ago, the figure has almost doubled. According to forecasts, in 25 years it will reach 100 thousand.
Here's another interesting figure: 340 thousand. So many people in Sweden are currently living with cancer. In 25 years, there will be 600 thousand citizens in the country who have ever faced such a diagnosis.
The increasing prevalence of cancer is primarily due to population growth and an increase in life expectancy. Cancer is most often diagnosed in old age, usually after 70 years.
According to statistics, every year 23 thousand people die from cancer - about the same as 50 years ago. Considering that the population has increased from 8 million to 10 million, we can say that the relative mortality rate has decreased by 20%.
“Research has made many treatment regimens more effective. But we have advanced not only in the field of oncology. The entire health care system has improved. Antibiotics are more accurate and overall patient care is better. For example, the treatment of heart complications, which often occurs in cancer patients, has become better,”says Klas Cerre.
Diagnostics also plays an important role. Many types of cancer are now detected earlier, sometimes even so early that the tumor is still completely harmless, even if it is registered as cancer.
Agnes Wold is a physician and professor of clinical bacteriology at the Salgrens Academy at the University of Gothenburg. In her opinion, the statistics of survival rate makes no sense. It gives a distorted picture of how many patients survive cancer.
“The most important thing is active diagnostics. For example, mammography also finds cancer that cannot be found in any other way - and no one dies."
It is noteworthy that as many patients are dying now as 50 years ago, she said.
"And mortality from cardiovascular disease has been cut in half since the 1980s."
Claes Cerre agrees that the share of low-risk tumors in the statistics somewhat embellishes it.
“This is primarily about breast and prostate cancer, but this is less than a third of all cases. And for most of the cancers, there are no active diagnostic methods that detect tumors at an early stage."
But mortality has dropped and the chances of surviving are higher today than 50 years ago, he stresses.
“Definitely. But a lot depends on what kind of cancer we are talking about."
In four years, Dewey Stringer received a total of 63 courses of immune therapy. They dispersed his own immune defenses, so that tumors, these aggressive metastases that would otherwise have taken his life long ago, either significantly decreased or disappeared altogether.
Of course, there were some side effects. He goes to the toilet twenty times a day, all the time he feels tired, he suffers from wounds and itching.
“I went through a crazy way, it was the worst and at the same time the best thing that happened to me. I started a foundation, all of which goes to the Anderson Center. Funds for health care are being cut, but on the contrary, they should allocate more money for research. Special blood tests are needed, which can quickly detect a tumor and track its growth. All the time waiting for an answer, like now, is just barbarism."
The unusually long heat wave in Houston is declining. But when we sit on a bench in a hospital yard, the temperature in the shade reaches 35 degrees. Dewey Stringer has called a taxi, but I have time to ask him the last question: has he beaten cancer now?
"Probably. But the fear remains. I can wake up because my toe itches and be completely sure that I have a tumor there. Cancer is always bad, and even harder for loved ones. I was ashamed for a long time when I remembered how I behaved with my wife when I got sick. But now we are even closer."
Jim Ellison is always very moved when patients talk about how immune therapy has helped them fight cancer. This is a real victory after all the obstacles and vicious attacks from colleagues, pharmaceutical companies and the US Food and Drug Administration. Everyone thought that he was doing nonsense, and this is not science, but voodoo.
And also the cancer has not passed his relatives. Jim Ellison grew up in the mining town of Alice, Texas. My father was a family doctor. Mom died of lung cancer, and my brother left melanoma early. The second brother passed away from prostate cancer in 2011, the same year Jim Ellison's drug was approved. But the brother did not have the opportunity to receive treatment that would probably have saved his life.
Jim Ellison himself was also diagnosed with prostate cancer, and he recovered thanks to his own immune therapy.
How Good Is Immune Therapy?
“Today, millions of Americans with advanced oncology are receiving immune therapy. It is not a substitute for other treatments, but a supplement. Different immune therapies can also be combined with each other - this is most effective."
However, immune therapy is still expensive, costing about a million SEK for a year. Medical insurance may cover it, but not everyone in the US has the funds to do so.
We are entering a large laboratory of 70 people doing cancer research on a global scale. Jim Ellison believes that the next big breakthrough will be genetic engineering combined with other methods.
"It will be a giant leap forward."
Fredrik Mellgren