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Research Advocacy: ThyCa and the 2008 AACR ScientistóSurvivor Program
Round 2: Progress, Youth, and Hope
By Joel Amromin,
ThyCa Los Angeles Support Group Co-Facilitator and Board Member for
ThyCa: Thyroid Cancer Survivorsí Association
This year was my second year representing ThyCa as a participant in the American Association for Cancer Research Scientist-Survivor Program (SSP). The SSP was held in connection with the 2008 AACR Annual Meeting. I saw many of the same people, the meeting had the same format, and I got the same pampering and tired feet.
But this year there was a difference. Last year I heard many speakers and learned a lot about cancer and cancer research. I got a snapshot and a few highlights of what was happening at that time. However, the SSP is a three-year program.
This time, because I was at last yearís meeting, I could sense the pace of progress in cancer research that was not obvious last year. Much of this progress has resulted from the mapping of the human genome and the associated understanding of chain reactions in normal and cancerous cells.
I also took a closer look at the demographics of research presenters. I came away with hope.
Last year, Dr. Jean-Pierre Issa from the M.D. Anderson Cancer Center talked to us about epigenetics, which, in simplified terms, is the study of those parts of the DNA and associated cell mechanisms that are not genes. These play critical roles in the cellís ability to translate the genes into instructions for building the right proteins at the right time.
Dr. Issa said that therapies based on epigenetics were still primarily applicable only to liquid tumors, but that Steven Sherman, M.D., also of M.D. Anderson, was starting to look into epigenetics in solid tumors. (Editorís note: Dr. Sherman is a thyroid cancer specialist and is a ThyCa medical advisor.)
This year, Dr. Sherman spoke about New Directions and Targeted Therapies in a session on thyroid cancer. He described using Decitabine in Phase 1I clinical trials to see if it can restore radioactive iodine uptake in patients with metastatic papillary or follicular thyroid cancer that is unresponsive to radioactive iodine I 131.
Regardless of the trial outcomes, seeing this presentation highlighted the exciting progress being made as cutting-edge epigenetic research moves into the clinical arena, even if only in early trials.
Another area that showed significant progress from last year was the field of individualized therapy. Medicine has always looked for treatments that provide the most benefit to the most people. That made a lot of sense. If youíve got a dollar, put it where you get the most results. That made sense for antibiotics, digestive disorders, analgesics, etc.
But broad-spectrum research hasnít worked as well for many cancers and other rare conditions. A tumor isnít a simple externally induced inflammation or infection. A tumor is a change in the base mechanisms of a single personís cells.
These changes can be caused by many factors, but most of then are genetic or epigenetic changes and that allow cells to multiply uncontrollably. Not only is each type of tumor different from others; the cellular pathways and mutations can vary from person to person, even though they have the same type of cancer.
Traditionally, cancer has been treated by a broad spectrum of chemicals, along with radiation treatments and often surgery. Usually, the chemicals are combined in groups of two or three because we donít know which one, if any, will work for a given patient.
At this yearís conference, there was a big emphasis on developing ways of treating patients with procedures that specifically target that patientís tumors and only the tumors, thereby minimizing side effects. This has been made possible by DNA vaccination, which Dr. Ron Levy described to the SSP participants.
What is a vaccine? A vaccine is a preparation that improves immunity to a particular disease. Early vaccines were simply living or dead disease organisms, or key parts of those organisms, that triggered a response by the bodyís immune system. When the real disease came around, that immune response was ready to attack it.
DNA vaccines are small bits of the patientís own DNA that have been modified to attack that tumor or aid in its treatment. They are grown in the lab and injected back into the metastatic tumor. The cells incorporate themselves back into the patientís DNA and replicate.
Once in the body, they proliferate, triggering the bodyís own immune system to fight the tumor. Furthermore, they actually spread antigens throughout the body, enabling the body to fight the cancer at remote locations. This produces a lasting immunological response to the tumor.
DNA vaccines work only because we are able to identify specific genes, modify them, and reinsert them into the patient. The beauty is that the treatment is specific to that patient because it is made from that patientís own DNA. The changes that produce the immunity are tested in the lab, instead of in the patient, with samples of that patientís tumor.
The point here is that DNA vaccination doesnít depend on the development of a broad-spectrum chemotherapy that can be used with many patients. Rather, it is the development of a general-purpose technology that allows specific treatment for each patient.
This is a radical paradigm shift that ultimately not only can reduce suffering, but also has the potential to reduce the cost of treatment and bring treatment to those for whom no broad-spectrum treatment is available.
Last year, as I wandered around the poster sessions, I concentrated on looking for specific topics that might relate to thyroid cancer. I found only one.
This year there were a few more. There was even an excellent session devoted to thyroid cancer.
But I also spent time looking at who was presenting the posters. These were almost universally young people (young from the standpoint of my seventh decade). Iíd say the vast majority were graduate students. Their enthusiasm was palpable. Granted, there were many times when I saw people sitting in front of their posters with no visitors. But I also saw a lot of posters that generated animated discussions. People were truly excited about what they were seeing and were exchanging ideas about it, stimulating possible further research.
Many of these posters were studies dealing with just a tiny piece of a puzzle. No doubt, in most cases they were part of a larger project being run by a supervising professor or team leader.
But these young people are the future of cancer research. In a few years, they will be making the next major breakthroughs. They will be become the leaders and they will be making the major announcements and presentations at the AACR meeting and other conferences.
Which leads me toÖ
I donít know if we will ever completely eliminate cancer. Itís a disease of mutation, which is random.
But as I sat through sessions and looked at posters, I saw significant progress. That progress is accelerating because of the new tools that have been created from our greater understanding of the human genome.
This is exciting medicine that I believe has the potential within our lifetimes to reduce cancer to a treatable condition.
For many people, cancer will be prevented or, if contracted, turned into a chronic, manageable disease.
Simple bacteria and viruses used to kill and maim thousands of people at a time. But today we understand them and have ways of preventing and treating them.
I donít believe we will eliminate cancer, either. But we are getting tantalizingly close to real preventions and treatments.
I donít believe most people see this progress. The only face of cancer that they see is family and friends suffering, dying, and occasionally beating cancer. They see the misleading headlines about cancer research and wonder why ďwe donít get anywhere.Ē
They donít have the opportunity to come to a conference such as AACR to see the ďmiraclesĒ that the future holds.
I have seen them and the army of people making them, and that gives me hope.