Closing in on a 'Cure' Posted Saturday, September 21, 2002 by ctustis
Sept. 20 - Andy Kilpatrick, a member of the National Honor Society,
didn't dare think about college six years ago. He was in a fight for his
life against melanoma, a very lethal type of skin cancer.

His parents Mary and Tom remember the horrible moment they got the news,
and Andy's first words: "Am I gonna die?"

Her son's cancer was a cruel irony for Mary Kilpatrick. She is a
radiation therapist for cancer patients and she has seen hundreds who
didn't make it. This time, the patient facing death, was her then
15-year-old son.

"I knew how dangerous this was," she says. "I knew melanoma was a deadly
form of skin cancer. I knew that there were not a lot of good treatments
out there for melanoma," she told ABCNEWS' medical editor Dr. Timothy
Johnson.

But for Andy and others like him, there's a new and very promising
treatment in the fight against cancer. And now, the still highly
experimental technique, which harnesses the body's own immune system, is
being developed by researchers for widespread use.

The Cancer Kept Winning

Andy Kilpatrick's cancer not only threatened his life, but scarred him
emotionally and physically from the moment it was first diagnosed with a
pimple-sized tumor on his knee.

"It's [cancer is] my life. And really anything that I remember as
anything I could call my adult life from maybe 15 on, I've been
experiencing my melanoma and treatments with it," he says.

Between treatments, the family was determined to maintain whatever
teenage innocence for Andy they could. But all the while the cancer kept
winning. He developed huge tumors in his pelvis and on his shoulder. At
one point, Andy's doctors discovered the melanoma had spread to his
brain.

Just before surgery to remove the tumor, he said something to his mother
she has never forgotten. "If he didn't make it through, through the
surgery, that, that would be OK, that he'd had a wonderful childhood,"
recalls Mary.

Andy survived the brain surgery but the melanoma continued to grow in
other parts of his body. By now, his best hope was at the National Cancer
Institute with Dr. Steven Rosenberg.

Teaching the Body to Fight Cancer

After 25 years of research, Rosenberg and colleagues at the Institute in
Bethesda, Md., have finally found a way to harness the power of the
body's immune system to fight off this deadly cancer. And some speculate
this new approach could also treat many other cancer types, and possibly
serious immunological diseases such as AIDS.

"I think it's an extremely important advance, and it has the potential
for changing the way we do a lot of cancer therapy," Dr. Alan Rabson,
deputy director of the National Cancer Institute, told Johnson "We're
going to have to see whether it's reproducible in other laboratories, but
I think at this point it looks like it's a major advance."

By using a combination of chemotherapy, hormones, and the patient's own
immune cells, Rosenberg's group successfully shrank Kilpatrick's
malignant tumors, along with the tumors of five others who participated
in the 13 patient trial.

The report "is clearly significant in that it demonstrates a significant
improvement in the response rate for patients with melanoma," concurs Dr.
Lee Riley, Chief of Surgical Oncology at St Luke's Hospital in Bethlehem,
Pa. "This is even more impressive considering most of these patients
already failed very aggressive chemotherapy or immunotherapy treatments."

The treatment approach used in the study is part of what scientists call
immunotherapy, which uses drugs, hormones, cells, vaccines, and even gene
therapy in an attempt to coax the body's own immune system into action to
combat disease.

Similar experiments harnessing the body's own immune system have been
tried before but have not come close to this level of success.

Several Treatment Strategies

The new therapy's success lies in the combined use of several treatment
strategies.

"We start by destroying the body's own immune system of the cancer
patient that's not doing the job. We then replace it with the patient's
own cells that we've previously removed and 'educated' outside the body
so that the cells can attack and destroy the cancer," Rosenberg explains.

Specifically, tumors from each patient were removed surgically and the
tissue treated in the lab to separate out the special lymphocytes - white
blood cells - that can recognize and destroy the tumor.

While these fighter cells are being grown up in the lab, patients are
treated with two chemotherapy drugs that wipe out the immune system and
prepare the body to accept the new and improved lymphocytes.

When the cells are ready, they are transferred back into the blood of the
patient by transfusion, and interleukin hormones are given to help keep
the cells active and fighting.

Experts also point out that the treatment's success is even more
impressive since all of the patients in the study had been through every
other type of available cancer treatment - chemotherapy, surgery,
radiation - to no avail.

A Life Restored

This new technique came just in time for Andy Kilpatrick who had
plummeted to the threshold of death in the fall of 2000.

"And at that point he was in desperate condition, on narcotics to control
pain, bedridden, swollen extremities, volleyball-size tumor in his
pelvis, jutting out of his shirt," remembers Rosenberg.

The research team decided to try the latest version of their new therapy,
and almost two years later, Kilpatrick is a sophomore at Colgate
University, clear of cancer.

"Seeing Andy just enjoy himself is, is absolutely great. It's the way it
should be," says his father.

Andy agrees. "It's just really great to be able to make long-term plans
once again. Because I couldn't for a really long time."

Treating Skin Cancer and Beyond

Because the therapy is still at the beginning stages of development,
Rosenberg is conservatively wary of raising unrealistic expectations.

"It's certainly the best that we've done, but there are still patients
that don't respond, and some of the patients that do respond, don't
respond completely, and so we certainly have a ways to go, but I think we
have broken through a barrier that we've tried to confront for many
years."

And while all of the responding patients in the study still had
significantly reduced tumors at their last check-ups, the researcher's
don't know how long this regression will last. Ideally, the patient's new
tumor-fighting immune system will hunt out and destroy all the cancerous
tumor cells throughout the entire body, leaving the patient cancer-free.

Rosenberg's team is laboring furiously over new ways to improve the
therapy, which they will test in larger numbers of patients. They also
hope to expand the treatment for people with more common cancers as well,
though the group and other experts acknowledge that this may be a long
and hard road.

"Melanoma may be relatively uniquely responsive to immune approaches
because the body seems to recognize the tumor innately," explains Dr.
Frank Haluska, director of melanoma research at Boston's Massachusetts
General Hospital and the Dana-Farber Harvard Cancer Center in Cambridge,
Mass.

Apparently, not all cancer cells have the specific proteins, called
antigens, that sit on the surface of the cell and act as targets for the
immune system to home in on.

"There's obviously a lot we still don't understand, and we're working
literally around the clock - there's somebody in our lab every minute of
every day working on these problems."

Because of the therapy's difficult, expensive, and highly experimental
nature, it is only available at the National Cancer Institute.

"Every treatment that we give is unique for that individual patient, and
it's quite labor intensive," says Rosenberg.

Despite these limitations, cancer experts remain very enthusiastic about
the future of these findings.

"This is still a very early study with only a limited number of patients,
but if this can be reproduced in other centers, it has the potential to
benefit many patients," says Dr. Jay Brooks, chair of hematology/oncology
at The Ochsner Cancer Institute in Baton Rouge, La.

For more information on cancer and its treatment, call 1-800-4-CANCER, or
click to the NCI's Cancer Information Service"

From ABC News http://abcnews.go.com/sections/living/2020/immuno_cancer_patient_2020_020920.html