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In Western Europe, cancer is just as common a cause of death as heart disease. In Poland, it will be similar in a few years, most likely in 2020. Therefore, scientists are developing newer and newer methods of cancer treatment. Will they finally manage to overcome this disease?
– Cancer is becoming the main risk factor for premature death – emphasizes prof. Witold Zatoński, head of the Department of Epidemiology and Cancer Prevention at the Oncology Center – Institute in Warsaw. However, he adds that despite the general increase in the incidence of cancer, which is associated with an aging population, more and more cancers are becoming less fatal. An example is breast cancer in women. Since the 90s, it has caused fewer and fewer deaths in the US and UK due to both better detection and improved treatment effectiveness. In the US, five-year survival is achieved in 90 percent. women, in Poland – in 75 percent. female patients. Among women, mortality from cancer of the stomach, cervix, endometrium and ovary is also decreasing. This is due to, among others the fact that women are more and more often and willingly subjected to cytological tests, but also to new methods of treatment.
The – rak
We wrote more about targeted therapies in the XNUMXth issue of “Żyjmy Dłużej”. Now let’s remind you briefly: their action is to use a drug that will attack and destroy only cancer cells, while saving healthy tissue. This means that the therapy is safer and has fewer side effects. The most widely used targeted therapy is in the treatment of breast cancer in Poland. And it is the most common cause of cancer in women. The results of genetic and molecular tests decide whether the patient should undergo such treatment. The standard is that after the diagnosis of the neoplasm and determination of its type and histological subtype, the pathologist evaluates the genetic profile of the neoplastic tissue section. This is to confirm or exclude the presence of a given genetic disorder for which a dedicated treatment has been developed.
Return to immunotherapy
Currently, the mainstay of cancer treatment is specialized combined treatment (chemotherapy, radiotherapy, surgery). However, when metastases develop, most patients still cannot be cured. Therefore, scientists decided to return to immunotherapy, the aim of which is to activate the body’s immune system so that it fights the cancer itself. Over the decades, numerous failures have been reported for this method, so it seemed only to have a place in a medical museum. However, when the new drug was approved for the treatment of metastatic melanoma in 2011, it turned out to be a breakthrough. Non-specific immunotherapy – ipilimumab is an anti-CTLA4 monoclonal antibody that inhibits the mechanisms of systemic immunosuppression in order to induce an anti-tumor response. It is used in a unique way in the form of only 4 doses every 4 weeks. Studies have shown that after just 3-4 doses of drugs, the life of patients is significantly longer. And the latest results (for over 1800 patients) presented at the European Cancer Congress in September 2013 indicate that about 20 percent. patients treated with this drug live up to 10 years. Until today, about 20 patients have been treated with this drug. people around the world.
Interestingly, the same drug is also active, for example, in non-small cell lung cancer. That is why he received the prestigious Prix Galien award in 2012 for the contribution of drug research to improving people’s lives.
Future immunotherapy
Works on new immunomodulating preparations acting on the checkpoints of the immune system (such as the PD-1 receptor and its PD-L1 ligand) are also very promising. Clinical trials for these drugs are still ongoing, but first results show that anti-PD-1 and anti-PD-L1 therapies may be helpful for patients suffering from lung cancer, kidney cancer and melanoma. – It seems that the best results are achieved with the combination treatment – anti-PD-1 antibodies with ipilimumab – says Piotr Wysocki from the Greater Poland Cancer Center.
Clinical trials are currently underway on the effectiveness of the use of a combination of drugs – mainly anti-PD-1 and anti-CTLA4. They are also conducted in Poland. It is important because treatment with ipilimumab is still not reimbursed in our country.
At the Congress of the American Society of Clinical Oncology (ASCO), positive results of immunotherapy with the oncolytic modified herpes virus HSV-1 administered intratumally in advanced melanomas were also presented.
Monoclonal antibodies
Monoclonal antibodies have made a significant progress in the treatment of chronic lymphocytic leukemia and are also used in the treatment of non-Hodgkin’s lymphoma and myeloma.
This is a relatively new method of treatment – although the first attempts to use these substances in oncology were initiated at the end of the 1975th century. However, it was not until 1980 that Köhler and Milstein published a technique for creating cell lines capable of producing monoclonal antibodies of animal origin, for which they were awarded the Nobel Prize. Rapid advances in genetic engineering allowed for further trials involving monoclonal antibodies. In XNUMX, the first report of the safe use of an antibody in a patient with recurrent lymphoma appeared.
So far, the US Food and Drug Administration (FDA) has approved 8 monoclonal antibodies. In addition to those already mentioned, they are used in disseminated breast cancer and advanced colorectal cancer. Of course, the intensive search for new preparations from this group is still ongoing.
Antibodies are part of the body’s natural defense against infection. They recognize damaged cells and destroy them. Monoclonal antibodies are medicines that are made by humans with the intention of recognizing certain types of cells. In the course of treatment, for example, in non-Hodgkin’s lymphomas, monoclonal antibodies are used to target and destroy lymphocytes. Monoclonal antibodies are given by drip (intravenously), usually on an outpatient basis.
Nitroglycerin is helpful too
But these are not the only lines of research. Scientists also took a closer look at the already known drugs used in other diseases. Nitroglycerin – a popular vasodilator drug given in acute attacks of ischemic heart disease to stop coronary pain – has been shown to be effective in treating cancer.
Research from Queen’s University scientists has proven this and identified a mechanism that may explain why the human immune system is sometimes unable to get rid of cancer. Researchers analyzed the role that hypoxia plays in cancer development. They found that hypoxia in cancer cells is linked to the overproduction of a key enzyme, ADAM10, which makes cells resistant to attack by immune cells. However, when a nitric oxide mimic, such as nitroglycerin, was injected into the cells, hypoxia was stopped and the cancer cells lost their defenses against an attack by the immune system. Research results indicate that nitroglycerin can be used as a factor improving the natural response of the immune system to cancer.
How about sugar?
Polish scientists are also continuing their efforts to find a new cancer-fighting drug. Recently, prof. Tomasz Ciach from the Faculty of Chemical and Process Engineering of the Warsaw University of Technology. He claims to have invented a groundbreaking method of dealing with cancer. Well, tumors “love” sugars. That is why the method he developed uses nanoparticles, i.e. microscopic transporters, smaller than viruses that have a sweet lure in them. Tumors attract such nanoparticles together, thanks to which the drug precisely reaches the cancer cells. – Then the nanoparticles break down and release the drug that enters the nucleus and damages the DNA of cancer cells – explains Prof. Hang.
Research on the method has been going on for two years. It has been tested on mice for six months. You will have to wait for the next phase, because it is an expensive and complicated procedure. Will it be a breakthrough?
Tekst: Agnieszka Katrynicz