CANCER BLOGS: Dedicated to T. S.

“The identifying of disease sites became gradually more specific as diagnostic tools, such as the stethoscope, were invented. With the aid of improved technology in the making of lens systems, it came to be appreciated that organs sicken because the microscopic cells within them sicken. Having identified the minute locus in which disease originates, doctors next turned their attention to finding the primary inciting agents that make normal physiology go awry. This is where things stood in the middle of the nineteenth century.”
-- Sherwin B. Nuland, “Doctors: The Biography of Medicine,” 1988

Fast forward to 2008.

In what follows, I will try to describe in layman’s terms three basic approaches to treating cancers.

The first is a tumoricidal approach. Because the cancers cells are fast growing, the idea is to kill all fast growing cells, which includes many, many cells that are highly beneficial to the body: like white blood cells produced in the bone marrow (this is why I suffered excruciating bone pain after being injected with Neulasta--the marrow is stimulated to produce white blood cells, thus putting tremendous pressure on the bones from the inside out--and why one becomes neutropenic, which means having a compromised immuno-defense system); and cells in the mucous of the anus and throat ([mucositis] this is why the lesions at the back of my tongue developed to the point of causing me talk like a Goth teenager who just had three tongue rings put in, although some said it improved my singing); and nerve cells having to do with fine motor skills (which is why I couldn’t hold a guitar pick, put money in a parking meter, turn over the ignition in my car with one hand, zip and button my pants, pay for gas at the pump with a credit card, and perform various other mundane activities).

I’m talking about chemotherapy. In my case, R-C.H.O.P.. What does this stand for? Rituximab, or Byebyehari, as Hindu psychics call it, is a monoclonal antibody (a biologic therapy that produces antibodies that attach directly to antigens on the cancer cells surface). Cytoxin (cyclophosphamide) is a DNA altering drug that changes the DNA, the building blocks of genes, to prevent cell growth. Hydroxyldaunorubicin (say that when you’re drunk) is an anti-tumor antibiotic that interacts with DNA and decreases cell survival. Oncovin (vincristine) damages cell structures that are required for a cell to divide. Prednisone is a type of steroid drug known as a glucocorticosteroid, a manmade version of a natural hormone produced by the adrenal glands. The main effects of prednisone and similar steroids seem to be due to their anti-inflammatory properties and their ability to alter immune system responses. For example, prednisone helps prevent white blood cells from traveling to areas of the body where they might add to swelling problems (such as around tumors). It also seems to help with the treatment of certain blood cancers (such as leukemias) by causing some cancerous white blood cells to commit suicide. Prednisone also causes one to bounce off walls, speed basket-weave, and eat like a horse. After reading this, why, you might ask, doesn’t this witches brew of toxins kill the patient, in my case, me? Because cancer cells are metabolically more active, they suck up the poisons more rapidly than normal fast growing cells. Those were layman’s terms, dude?

Here's a second approach. This treatment strategy seeks to augment the defense system of the host (see earlier post, "Oncological Darwinism"). How? By stimulating T-cell production. One such therapy utilizes Interleukin-2, the only drug approved in the US for the treatment of metastatic RCC (renal cell carcinoma). It is also approved in many other countries. But IL-2 isn't just a drug. IL-2 is a natural part of your immune system, a messenger protein called a cytokine, which activates parts of your immune system. IL-2 does not kill tumor cells directly like classical chemotherapy. Instead, IL-2 activates and stimulates the growth of immune cells, most importantly T-Cells, but also Natural Killer Cells (NK Cells), both of which are capable of destroying cancer cells directly.

There are several types of T-Cells but, without going into detail, certain T-Cells are capable of killing tumor cells if they recognize a specific antigen on the surface of the tumor cell. Antigens are normally proteins. Each T-Cell is specific for only one antigen but you have many different T-Cells. NK Cells have the ability to kill tumor cells without needing to recognize a specific antigen (I'm not sure how!). While this sounds good, NK cells are weaker cancer killers than T-Cells. The so-called LAK cells (lymphokine activated killer cells), which were used in some of the early immunotherapy experiments, are actually NK cells. The crude analogy I will use here is this: imagine cancer cells as runners trying to get to the finish line, what drugs like IL-2 try to do is position so many healthy runners (T-Cells) in the race that the cancer cells never get to the finish line, or at least take their not so sweet time in getting there. I might add that IL-2, like chemo and interferon treatments, has some, shall we say, uncomfortable side effects, but like chemo, they can be dealt with. I might also add that in December I will probably be asked to consider an interferon regimen to deal with my hepatitis C, which had been on the back burner while I was dealing with the non-hodgkins lymphoma. Gee, isn’t life fun!

The third approach has to do with slowing down the growth of tumors to the point that the cancer can be dealt with as a chronic rather than acute (a nice word for fatal) condition. Drugs like Sutent (Sunitinib), for instance, interfere with and modify cellular processes in term in terms of DNA/RNA replication. Sunitinib (Ojibwe for Man-With-Sore-Kidney) inhibits proteins in the body’s cells that promote the growth of tumor blood vessels. Sunitinib is used to treat advanced renal cell carcinoma (RCC, a type of cancer that begins in the cells of the kidneys). Sunitinib works by blocking the action of the abnormal protein that signals cancer cells to multiply. This helps stop or slow the spread of cancer cells and may help shrink tumors.

Finally, a word about radiation. Many cancer research hospitals, like the University of Michigan Hospital, and the Institute Curie in Paris are now taking a new approach to radiation therapy called Tomo Therapy. More than 150 of these systems are now in operation around the world. The benefits of Tomo Therapy are these: in terms of treatment, by using CT imaging done on the day of the radiation rather than from the past week or month, it integrates a dynamic approach that emphasizes a case by case holistic assessment of the moment; this, in turn, allows a sharper focus, in terms of the precision with which the radiation is delivered to the tumor, and the angle of delivery, thus minimizing the exposure of healthy tissue; the combination of assessment of the moment, and accuracy of delivery, facilitates the possibility of altering the treatment plan at any given time. In short, Tomo Therapy offers a more fluid, less static, approach to radition therapy.

That’s All Folks – Randy

PS: Best wishes to T.S. and Candy K.