Tumour-treating electrical fields, a Victorian gout remedy, and an anti-cancer 'virus’. Meet the scientists tackling our most feared disease in some truly innovative ways.
Despite the billions spent in pursuit of cures , it remains essentially mysterious. We do have a far better idea of what might give us cancer. Fewer people smoke, dietary awareness has increased and many known carcinogens have been removed from the environment. Yet the disease goes on killing much as it has always done. “If you look at the death rate from cancer, there’s no dramatic change over the last five decades,” says the cancer specialist David Agus, author of The End of Illness. A realist might say we are losing the battle against cancer except where we are winning it.
But there are grounds for optimism. New technologies are opening new avenues of possibility. And at the cutting edge of the battle against cancer are dozens of projects currently under way all over the world. Some are lavishly funded, some operate on shoestrings, some are pursuing simple objectives, others are pushing the frontiers of science. What they have in common is a belief that humans can do far better against our most feared disease. Here are just some of them.
Prof Tim Illidge: the magic bullet
In his laboratory in Manchester’s Christie Institute, one of the largest cancer treatment centres in Europe, Prof Tim Illidge is busy developing what he hopes will become a “magic bullet” against certain cancers. He is a pioneer in the use of radio-immunotherapy, or training the body’s immune system to recognise – and destroy – cancer cells.
Immunotherapy — altering cells in a laboratory to make them better at fighting cancer — has been known about for some time. The problem with it is that as tumours become more advanced, they become less visible to the attacking cells. Radio-immunotherapy adds the refinement of precisely targeted radioactive molecules that can spot and “zap” cancer cells without damaging healthy tissues.
Prof Illidge gives the example of Mel, a retired ambulance driver who was faced with an aggressive course of chemotherapy. “Instead, by attaching a radioactive molecule to an anti-cancer antibody, we used his immune system to kill the tumour cells,” Prof Illidge says. “It’s significantly better for patients as it’s quicker with fewer side effects. We call it the 'magic bullet’. Mel was delighted, and even managed to keep his ponytail.”
Prof Jim Mccaul: the 19th-century gout cure
Just as nothing can be too futuristic in cancer treatment, so nothing can be too old-fashioned. Prof Jim McCaul, a head and neck cancer specialist at Bradford Royal Infirmary, is conducting a trial using a 19th-century gout remedy.
Lugol’s Iodine was invented by French physician Jean Lugol in 1827, and has been used for everything from cleaning cuts to purifying water. One of its more interesting features is an ability to stain healthy cells – those capable of storing glycogen – to a chocolatey-brown colour, while leaving cancerous or pre-cancerous cells a paler hue. The importance of this discovery is that surgeons operating on mouth and throat cancers currently have no reliable way of knowing how much tissue to remove. Pre-cancerous cells may be left behind or perfectly healthy ones cut out.
The iodine trial, believes Prof McCaul, could lead to the current 10mm margin around the cancer being reduced to 2mm. “It’s a simple idea,” he says, “but it can take a lot of the guesswork out of surgery. We have tests going on in 12 sites and the results are encouraging. Previously, we would have expected to have 32 per cent of patients left with pre-cancerous cells. That’s down to four per cent.”
Prof Jay Bradner: the miraculous molecule
Every cancer pioneer builds on the work of others. Prof Jay Bradner, a myeloma (bone marrow cancer) specialist at the Dana-Farber Institute in Boston, took as his starting point the breakthrough discovery in the Eighties that all cancer was tied into genetics. The problem might be inherited or the result of exposure to outside agents such as smoke or radioactivity, but in the end the cancer resulted from abnormalities in the genes. Little wonder, then, that the Human Genome Project, which set out to map the body’s 20,000-plus genes – and reveal the exact method by which the genes went wrong – prompted such excitement.
It didn’t turn out to be so simple. The genetic coding of a malignant cell could look completely normal. Something else must be making it malfunction. Many researchers, including Prof Bradner, believe that the epigenome – basically the gene’s on-off switch – may hold the key.
“You might ask yourself, with all the things cancer’s trying to do to kill our patient, how does it remember it’s cancer?” Prof Bradner said in a recent TED talk. “When it winds up its genome, divides into two cells and unwinds again, why does it not turn into an eye, into a liver, as it has all the genes necessary to do this? The reason is that cancer places little molecular bookmarks, little Post-it Notes, that remind the cell: “I’m cancer; I should keep growing.” Prof Bradner’s response? To develop a molecule that would “prevent the Post-it Note from sticking” and trick cancer cells into forgetting they were cancer.
Focusing their research on a very rare but virulent cancer, midline carcinoma, Prof Bradner and his team eventually came up with JQ1, a molecule to target the protein that causes it. And as they watched their molecule in action under the microscope, their excitement only increased: “The cancer cells, small, round and rapidly dividing, grew these arms and extensions,” said Prof Bradner. “They were changing shape. In effect, the cancer cell was forgetting it was cancer and becoming a normal cell.”
Prof Yoram Palti: the tumour-treating hat
The key feature of cancer is mitosis, the phenomenon of errant cells dividing and multiplying to form a tumour. One of the core goals of cancer researchers has been to find a way to stop this, and prevent cancer’s ability to spread. Prof Yoram Palti, founder of a small cancer treatment company, Novocure Ltd, based in Haifa, Israel, has developed the idea of using electrical fields that can disrupt the abnormal behaviour of chromosomes in the affected cells and prevent them splitting.
The company’s TTF (tumour-treating fields) device consists of a battery pack and electrode pads that are worn under a hat for 20 hours a day. Roger Stupp, a prominent American researcher who has championed it, says: “When I first saw it I thought it was completely voodoo, goofy, nuts.” Yet trials suggest TTF can significantly slow the spread of brain cancers, and the company is developing a new range for breast and lung cancers.
Danny Hillis: could proteins unlock cancer?
Danny Hillis, a self-described “inventor, entrepreneur and computer geek”, admits cutting an unlikely figure in the rarefied world of cancer research. Yet his capacity for fresh thinking – as an engineering student at Harvard, Hillis pioneered the concept of parallel computers that is now the basis for most supercomputers – prompted his conviction that the world is thinking about cancer in entirely the wrong way. Rather than being seen as something to be treated with drugs and procedures, Hillis believes cancer should be prevented at source. How? One answer Hillis, a flamboyant Californian, offers, is proteomics, the study of proteins.
Hillis believes proteins hold the real secret of cancer. The trillions of cells in the human body, he says, are in constant conversation, working co-operatively almost like the operating system of an advanced computer. The proteins are the main carriers of information within the system. When they relay false information, the body reacts wrongly and gets sick. This, essentially, is what causes cancer. Proteomics can give us a means of “listening in” on what the body cells are saying, and knowing when something is going wrong.
Hillis is no lone wolf. The pioneering oncologist Dr David Agus shares his view that “cancer” is not one disease and that the conditions that fall under it are far more varied than the medical establishment is prepared to admit. The problem for disciples of proteomics is that not everyone has the same kind of protein network, meaning that a way has to be found to “map” the human body on an individualised basis. Scientists at Applied Minds, the research and development company that Hillis co-founded in the Los Angeles suburb of Burbank, are busy searching for the answer.
Prof John bell: the anti-cancer virus
A man-made virus that can attack cancer cells has long been a dream of medical researchers – but for decades has remained just that. The possibility first arose from a celebrated 1951 case of a young girl with leukaemia who contracted chickenpox, sending the cancer into remission. The euphoria that followed soon subsided as complications became apparent, notably the tendency of the immune system to fight off the virus.
New hope is emerging with the development in Ottawa, Canada, of JX-595, an engineered virus that appears to overcome the early problems. It is based on the vaccina virus, used in the development of smallpox vaccine. Unlike previous anti-cancer viruses it has few ill effects on the healthy parts of the body and can be administered into the bloodstream, rather than directly into the tumour.
“We are very excited,” says Prof John Bell at the University of Ottawa, the project’s lead researcher, “because this is the first time in medical history that a viral therapy has been shown to consistently and selectively replicate in cancer tissue after infusion into humans.”
Dr Timothy Ley: whole genome sequencing
Sometimes cancer seems to know exactly who it is after. Last year it went after Dr Lukas Wartman, a renowned leukaemia specialist at Washington University. Dr Wartman, 34, had already fought off two youthful bouts of leukaemia. His chances of surviving a third were virtually non-existent.
But he had one advantage: his colleagues at the university’s pioneering genome institute. Last July, the unit’s assistant director, Dr Timothy Ley, set the team to work on a very special project, fully sequencing the genes of Dr Wartman’s cancer cells, his healthy cells, and his RNA, a close chemical cousin to DNA. It had never been tried on this type of cancer before, and it required the institute’s scanning machines and supercomputer to run around the clock. But they found the problem – a rogue gene that was producing large amounts of a certain protein, spurring the cancer’s growth.
Astonishingly, although it was only approved for kidney cancer, there was an available drug to attack this gene. Dr Wartman’s leukaemia is now in remission.
Whole genome sequencing is a complex, uncertain and expensive undertaking. When the Apple boss Steve Jobs had run out of other options to combat his pancreatic cancer, he underwent a similar process to Dr Wartman, reputedly costing him $100,000. Yet simpler variations of the procedure are becoming available, and Dr Ley believes the big advances are still to come. “This is the most powerful diagnostic tool we’ve ever had,” he says. “The more sequencing we do, the more we understand these mutations.”
