In 1951 When Henrietta Lacks was treated for a cancerous tumor the method they used was to tie a stick of Radium next to the tumor, she had cervical cancer, and send her home.
Henrietta Lacks’ cells were used to produce the first human cell line that has, since her death in 1951, been used to study the human cell in too many ways to list here. Her cells, The HeLa cell line, is still used today. Her story, and that of her cells, has been told well by Rebecca Skloot. Really an amazing story and a good read – go get this book, see readings at the end.
Before Henrietta’s treatment chemotherapy drugs had been discovered. The first, apparently, as an offshoot of chemical warfare gases used in World War I. These two basic treatments, radiation and chemotherapy, along with surgery (cut the damn thing out) ruled cancer treatment for many years. These are still used, in some forms and on some cancers today.
Many chemotherapy drugs today are more effective and less toxic to the body than previously. At least that is the hope. But these therapies must, let us exude optimism, be on the way out as they devastate the bodies they are introduced into. However, this may not be the right way to look at this. Its turns out the mechanisms that allowed some chemo drugs to be helpful, block cell cycles, a major research avenue. But, at least initially, it wasn’t known exactly how they worked. Though many drugs might be designated as chemo drugs, the new wave of drug should probably be referred to as something else to cause a separation between the older drugs and newer therapies, let’s call the older chemo traditional-chemo.
What other possible treatments of potential treatments exist. Here is a quick list.
- Improve existing therapies: More targeted traditional-chemo and radiation.
- Disrupt the cell cycle. Cells that replicate must go through a pathway the allows them to eventually separate into two cells. If these pathways can be disrupted the cells will stop dividing. As stated above a ‘chemo’ drug may do these things. And I took on the manicure traditional chemotherapy above.
- Enhance the immune system. Allow our body to clear out those nasty cells. It is next to impossible to find a single nasty cell (malignant cell) in the human bodies 200 trillion cells (I was up all night counting). Cells are small.
- Kill everything and replace the immune system. This whole process looks to be fucking horrible, but it does extend lives (about 30% respond to it).
Number 2, pathway disruptors.
In the cell cycle, calls go through ‘steps’, that’s what I’m going to call them for now. These ‘steps’ are a way for cells to check that they actually want to divide and they have everything set to allow division. One of the most studies are the Phosphoinositide 3-kinases (PI3Ks). There are many types of them and that will be messy so I’m just going to deal with some of the basics of kinases by analogy. Imagine climbing a stairway. In order to do so unimpeded, you must clear a step of a big toy your son left behind. You bend down and pick the toy up. You then proceed to the top of the stairs. Now imagine something prevents you from bending over. You stop halfway up your climb out of the basement into the first floor of cell division. In this way – well, very kind of, in this way, targeted therapies might stop cancerous cells from dividing.
However, you knew there was going to be a however didn’t you, some cells are able to bend over. And other cells might have an alternative pathway they can employ, they sweep the toy out of the way with their foot for example.
Number 3, enhance or aid the immune system.
In my brief look at the vast field of cancer research it appears to me that this area has had the most success. Everything from infusion of mono-clonal antibodies (these attach to tumors and guide the patient’s own white blood cells in for the attack), to drugs that unmask the tumor in other ways (they tend be able to hide from pathways (see above) dang these treatments are actually overlapping). An unmasked tumor then tends to fall into a cascade to, what is called, programmed cell death. Guess what the cell does at the end of this cascade?
Recent Nobel prize recipient James Allison worked on drugs like these. Actually he probably still does work on these. At any rate, he is wicked smart and we are lucky to have folks like him trying to save the rest of us slobs.
Number 4 above, is perhaps really an Immune system change. The life-extending but devastating to the body therapy called Car-T. In this therapy a small amount of the patient’s bone marrow is removed and cleaned. The patients then get hammered with chemo, killing the rest of their bone marrow, and the immune system bascially (and ideally all the cancerous cells in the body). The bone marrow that was ‘cleaned’ then gets put back in. (put back in, is the technical term). With some luck (no that’s not right), with some ability, the bone marrow grows back, its free of cancer, and the patient recovers (after a long period avoiding anything that might cause infection).
There is great promise and many people, millions, are helped each year. But still no panacea. True-life extenders, combination therapies, are deployed to greater effect. Part Immune booster, part cell cycle disruptor (or exposer), and perhaps a bit of traditional chemo thrown in because why not. But alas no panacea, as yet.
Just a quick word on out-there treatments. It’s possible that somewhere in my poor attempt at summarizing cancer therapies above is the ‘cure’ for cancers, or at least many types of cancers. But there is always the possibility that the next big, big, break comes from something on the weird side. For example, Nanoparticles and Micro-robots: Tiny particles injected into a patient. These would deliver toxic chemo drugs or other substances directly to the tumor. This would reduce side effects. There are plenty of odd possibilities, and some truly wacko ones like “rubbing Kale on it”. Ignore the truly bonkers folks if you can. THE EARTH IS NOT FLAT.
Readings:
The Watson below is the same Watson that discovered the structure of the DNA molecule. The Watson and Crick paper on DNA (1953) is certainly worth a read. Although I included Watson’s paper below I’m not actually sure it’s worth a read. JThe books are though. Siddhartha Mukherjees’ book is amazingly well done.
Siddhartha Mukherjee. 2010. The Emperor of All Maladies: A Biography of Cancer. New York City: Scribner.
Skloot, Rebecca. 2010. The Immortal Life of Henrietta Lacks. New York City: Random House.
Watson, James. 2013. Oxidants, antioxidants and the current incurability of metastatic cancers. Open Biology 3: 120144.
FYI: The world of cancer research is filled with articles that are dense and hard to access, like this:
Chen R, Gopal AK, Smith SE, and more. Five-year survival and durability results of brentuximab vedotin in patients with relapsed or refractory Hodgkin lymphoma. Blood. 2016; 128: 1562-1566.
And full of conference results like this:
Lunning MA, and lots of others. 2017. Combination of tgr‐1202, ublituximab, and bendamustine is safe and highly active in patients with advanced DLBCL and follicular lymphoma.
Go explore the world of cancer research, I dare you.