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GUEST EDITORIAL |
Neurosurgical Institute Cedars-Sinai Medical Center Los Angeles, CA 90048
Editor’s note: At the invitation of Senator Arlen Specter (R-Pennsylvania), testimony was heard before the United States Senate Subcommittee on Appropriations on May 7, 1997, commemorating the 25th anniversary of the enactment of the National Cancer Act. The following is an excerpt of the testimony given by Dr. Keith L. Black, Director of the Neurosurgical Institute at Cedars-Sinai Medical Center, Los Angeles, California. Look for future excerpts in The Oncologist.
As a physician specializing in the treatment of cancer, I have had to watch hundreds of patients die from cancer because current treatments have limited benefit. I know of no disease that can strike a patient more tragically than cancer. However, I can say with absolute certainty that the medical and scientific communities are on the verge of major breakthroughs in our ability to control this dreadful disease. Unfortunately, I can also say with absolute certainty that tens of thousands of Americans will die because critical research remains unfunded or underfunded, slowing the development of new lifesaving treatments by years.
Never in the history of mankind have we had such an opportunity in medicine. We are literally witnessing an explosion in our understanding of cancer. Every week, new genes which regulate the process of cancer are being discovered. We now have an incredible knowledge of cancer– what makes a cancer cell a cancer cell, what cancer cells need to thrive, and what signals cancer cells to self-destruct and die. With more research our knowledge will be even greater. We also now have the remarkable ability to manipulate genes within cells, to actually direct cells to do what we want them to do. This process, one of the many new treatments we now have, is called gene therapy.
This combination of increased knowledge and powerful new techniques to manipulate cells provides opportunities we could only dream of just five years ago. Let me give you just one example of how we are now using this new knowledge. I specialize in the treatment of malignant brain tumors. The most common brain tumor, the malignant glioma, is responsible for 15,000 deaths in the United States each year. The median survival time from diagnosis to death without treatment is 12 to 16 weeks. With conventional cancer treatments, including surgery, radiation and chemotherapy, the median survival is 28 weeks.
Because of new research findings, we now know that malignant brain tumors are able to grow in the brain and escape destruction by our immune system because they release a protein into the brain which suppresses or "turns off" the immune system. This protein is called transforming growth factor beta (TGFß).
We are able to take tumor cells and genetically engineer them in our lab so that they can no longer make TGFß, thereby uncloaking these tumor cells to the immune system. We’ve shown in lab experiments that rats with untreated brain tumors all died. However, rats with brain tumors treated with the genetically modified vaccine all survived. We found that rats given the vaccine were able to develop immunity against these tumors and their brain cancer was completely eradicated. Based on these studies, we now have a clinical trial where tumor cells are removed from patients during surgery, genetically engineered to make a cancer vaccine, and then re-injected into patients with brain cancer.
Six weeks ago we treated the first patient with the vaccine, a 36-year-old man with three young children whose brain tumor was growing despite two brain surgeries and radiation therapy. His tumor appeared to have stabilized after his first vaccine injection.
This is just one of literally hundreds of novel approaches now under development for the treatment of cancer. When plans to start this experimental trial were first announced a year ago, my office received over two thousand phone calls, faxes, and e-mails from desperate patients hoping to participate in this trial because they had failed conventional treatments. Due partially to limited funding the trial started just six weeks ago. I would venture that most of the patients who called my office have now died. Even with the study under way, only twelve patients can be entered into the trial, out of potentially thousands who could be treated. This is the most painful reality, knowing that our patients will die because our country has not made cancer research a higher priority.
To continue rapid progress requires increased funding for not only basic research to continue our understanding of cancer, but also for the translation of research into clinical trials for patient care. Our national budget for cancer research should be at least twice the current funding levels. We no longer wonder if we will find a cure for cancer but when. America has an incredible opportunity to conquer this deadly disease. Increasing funds for cancer research could now accelerate by years the development of new and more effective treatments for cancer, literally saving tens of thousands of American lives.
Keith L. Black, M.D.
Director, Neurosurgical Institute
Cedar-Sinai Medical Center
Los Angeles, CA 90048
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