Friday, November 14, 2008

3rd Lesson learned at NCI Translates

I think it is truly apropos that I talk about this lesson today, the day after we hear that Sydney remains with no evidence of disease. While I certainly can't blame her success on the Nestle vaccine that she received I certainly can blame this last set of tests on it. The timing was very interesting. Perhaps that is the reason I am so sensitive to this lesson.

While at the NCI I had a job. I was an advocate for the agents pathway - biochemical targets and drug screening. My job was to identify how approximately 30 different medical abstracts fit into the agents pathway - one of the 6 "road maps" that I have been discussing over the last few days. I was supposed to apply the information and to help researchers figure out where they fit in the whole translational scheme. I was to get them thinking of the patient, the challenges, the process as a whole. My subject matter, biochemical targets and drug screening, was certainly interesting and something that I was capable of discussing but was not my true passion when it comes to research. It was for this reason that when I was not officially working I made my way through several of the other 30 or so sessions. I really had an opportunity to see the breadth of cancer research. As you know, I always have an ulterior motive. My goal was to find something new that could have applicability in neuroblastoma. I was looking to make that connection - to find that next most promising hope. To be honest, I found many promising agents, biospecimen discoveries, new imaging modalities and interventive devices. I even learned a tremendous amount of truly interesting facts on diet and lifestyle changes that have impact on cancer. It was all very interesting. But, nothing held the promise nor shook me to the core like the sections on immune response modifiers.

The idea of using the immune system to fight cancer is not a new one. After all, that has been the whole idea behind both the antibody therapies that Sydney has been on and the vaccine. I have said it before and I was certainly not the first. The immune system is the best weapon that we have against disease. It brings tools to bear that we can only dream of recreating in the lab. I don't think anyone would disagree that if we could get the immune system to identify cancer it would have no problem producing a cure. It has everything needed to do the job. The problem seems to be that we just have not been able (as of yet) to get the immune system to identify and kill the cancer cells as they should.

I was amazed by the abstracts and posters that I viewed in the immune response modulators sections of NCI Translates. It seemed that poster after poster I reviewed I found examples of cancer vaccines and other immunological approaches having dramatic success at defeating cancer. I saw whole tumors disappear and people achieving complete remissions - all of this and without many of the toxicities that we see with chemotherapy or radiation. It became evidently clear (in my mind at least) that this was the key to our success. More than any other session, it was the brains within this room that the cure lived.

The more I read and reviewed, the more of a believer I became. It seemed that at every turn I was introduced to a new idea on how to leverage the immune system to defeat cancer. More often than not I was seeing some successes. Now, don't get me wrong. I did not actually stumble on the cure. Their was not something sitting in that room that I could put my finger on and say was the cure for neuroblastoma. But, what I did see were many successes. The best part was that in these sections I saw the most dramatic effects. While in my "agents" sections I might have seen a new chemotherapy that had significant activity it was certainly not to the extent that I was seeing in the immune response modifiers sections. Furthermore, the toxicities were far less and in many cases their were no long term side effects seen at all. It became apparent to me, more than ever, that this was the future. This is what was going to lead to our cure.

While I will flatly say that I believe that immunotherapy will be our cure for cancer there are many problems with this approach. First, it is ungodly expensive. It really is. Second, it is risky. Mucking with the immune system can come back to bite you. You have to be extremely careful. Third, although we have discovered and produced many incredible tools to help the immune system do its jobs most (if not all of the best ones) are held on the shelves of pharmaceutical companies not allowed to be used. This last one just blew me away. But, I can not tell you how many times a researcher had been turned down time after time trying to get a promising new drug into patients because it was held as intellectual property of a drug company that was unwilling to carry it forward. There are so many drugs out there that we know work but that we just can't use - literally just sitting on a shelf. For those of you that have been waiting for 3 plus years for the Sloan Vaccine. Guess why? It was one of these very types of drugs that has held this promising therapy up for so long.

This will come as a surprise to many with neuroblastoma - especially those that have antibody therapy. Did you know that there are drugs that are 10 times better than GM-CSF or beta-glucan at stimulating key components of the immune system? Did you know that they exist now, that they have been shown to be much better, and that they are just sitting on a shelf somewhere. They are. I feel confident in saying that we would be light years ahead of where we are today in cancer research if we could just get a hold of these drugs. It is disgraceful.

So, I really began this entry to talk about how blown away I was by the successes that I saw with vaccines and other immune response modifiers. For me, it was that moment that a light went off in my head. In fact, I am madly planning a path at how we will jump on the coattails of many of these successes. While I still fervently hold the belief that the cure to our future is with the immune system I think the major lesson to come out of this is the problem of the pharmaceutical companies. They are killing cancer research. And, at the very least, they are slowing our pursuit for the cure. (if you would like to argue this point please feel free to write.) I don't know the answer. I don't know how to fix it. What I can tell you is that after being heavily involved in cancer research over the past five years I have seen dedicated researchers, scientists, and oncologists working as hard as possible to get us to a cure only to be hindered time and time again by a pharmaceutical company. The researchers are not our problem!

I have to muster enough purpose to figure this out.

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