- Michael English, from Surrey, was told to prepare for the end after 13-year battle
- He was first diagnosed with aggressive stage 3/4 prostate cancer back in 2005
- Doctors tried various treatments, but the stubborn cancer always returned
- Now, he’s been given the all-clear after ten doses of controversial new treatment
Michael English is living evidence that we may finally have discovered a powerful secret to beating cancer. Astonishingly, this long-sought answer lies hidden inside our own bodies.
Not giving up: Michael was allocated palliative care nurses, to make his seemingly inevitable death as painless as possible. Conventional medicine had waved the white flag
Michael, a 72-year-old retired electrical engineer from Surbiton in Surrey, was first diagnosed with advanced and aggressive stage 3/4 prostate cancer 13 years ago.
Each time doctors tried the latest treatment on him, be it hormones, drugs, radiotherapy or chemotherapy, his tumour was beaten back until it had apparently disappeared.
But four times since 2005 the cancer returned, as each time a few of his tumour cells managed to evade medicine’s best weapons.
They did this by mutating their DNA — adopting a new genetic guise that was resistant to all the therapies that had been tried.
Michael was allocated palliative care nurses, to make his seemingly inevitable death as painless as possible. Conventional medicine had waved the white flag.
For millions of cancer patients and their families, this is a familiar and tragic story.
But now the tables are being turned. For British scientists are discovering that the very thing that can make cancer cells so relentlessly lethal — their ability to mutate and evade our best treatments — may also be their Achilles heel.
Researchers are discovering that each time the cancer mutates its DNA, it creates a tell-tale biological fingerprint. What’s more, our own immune systems can be taught to recognise these fingerprints, and then to attack and destroy these enemies within, so that they never come back.
This new avenue is called cancer immunotherapy. There are several types of immunotherapy treatments, which either help the immune system attack cancer directly or boost it more generally.
Last year Michael was inducted into a medical trial of a new immunotherapy drug by Professor Johann de Bono, the head of clinical studies at the Institute of Cancer Research in London.
This may have seemed beyond optimistic. Not only was Michael past last chances in terms of conventional therapy, his intestines had been left so ravaged by previous doses of radiotherapy to kill tumours there that his gut was perforated, causing him crippling stomach infections. He was so ill there was little point subjecting him to abdominal surgery to repair this.
Indeed, Michael was so ill that after only ten intravenous doses of the experimental drug pembrolizumab (branded as Keytruda), administered once every three weeks, he was taken off the trial. To complete the therapy he should have received a further 29 doses.
Nevertheless, Professor de Bono’s team gave him MRI scans to check his progress — and found his tumour had disappeared.
That was in April last year. Destroying the cancer rendered Michael strong enough to receive the stomach surgery he needed. He had another cancer scan last week and he’s still clear. ‘It is absolutely incredible,’ he says.
Professor de Bono describes Michael’s result as ‘profound and spectacular’.
What’s more, this science could be repeated in future for millions of patients, experts believe.
What made Michael, despite his frailty, such a good candidate for the trial is the fact that his cancer had aggressively mutated its DNA several times to evade conventional treatment — making it a good test for pembrolizumab’s mutation-targeting powers.
‘Patients like Michael have a defect in a gene called CDK12, which controls how a cell can repair faults in its DNA,’ explains Professor de Bono.
This defect causes one in ten cases of prostate cancer. When the gene goes awry, DNA faults run rampant, causing cells to turn cancerous and replicate. The gene also gives tumours a deadly advantage — they change their DNA so quickly that they evade being wiped out by conventional drugs.
‘However, this could be an Achilles heel, because it also causes an increase in jumbled-up DNA that the immune system can more easily recognise as a threat,’ adds Professor de Bono.
To target the cancer cells, first you have to stop them from evading detection by the immune system by ‘cloaking’ themselves in proteins that identify them as healthy tissues. A new class of drugs rolled out over the past seven years, called ‘checkpoint inhibitors’, which include pembrolizumab, ‘unmask’ the cancer cells by blocking their fake cloaks.
Our immune cells can then identify them as dangerous and destroy them. The idea behind cancer immunotherapy is not new. Yet it’s taken more than a century to prove its worth.
New York surgeon William Coley first explored the theory of using a patient’s immune system to fight cancer in the 1890s, after hearing of a man who recovered unexpectedly from cancer following a serious skin infection. Mr Coley believed the infection provoked the patient’s immune system to attack anything that looked alien, including the cancer cells.
He vaccinated ten other cancer patients with cocktails of bacteria and claimed that, in several cases, this spurred their immune systems to destroy tumours. But the medical establishment refused to believe his patients had even had cancer.
Man-power: New York surgeon William Coley first explored the theory of using a patient’s immune system to fight cancer in the 1890s
Instead, cancer surgeons backed the new — and then highly dangerous — radiation therapy as their best hope of a cancer cure-all (the precursor to what we now know as radiotherapy).
Mr. Coley’s ideas languished for a century until an immunologist, Charles Janeway of Yale University, challenged a longstanding basic assumption — that our immune defenses work simply by recognizing things that haven’t been in the body before and attacking them.
But if that were true, Dr. Janeway wondered, how could we ever eat a new food without suffering an allergic response? In the late Eighties, he realized that we must have two systems operating: one for detecting alien substances in our bodies; and another that learns to recognize which aliens are threats and flags them for the attack.
The implications were revolutionary. If our immune system could learn in this way, then it may also be taught to destroy another threat: cancer cells.
TEACHING IMMUNE SYSTEM TO ATTACK
But no one believed Dr Janeway. His idea was shunned until the early 2000s, when international scientists finally began to appreciate its potential. For this, others were awarded the Nobel Prize in 2011. The accolade should arguably have been Dr Janeway’s but he had died in 2003 of lymphoma.
A similar fate befell Ralph Steinman, who discovered the key biological mechanism behind Dr Janeway’s ideas — a spiky-looking cell that switches on our immune systems by identifying dangerous invaders.
Dr. Steinman, an immunologist at Rockefeller University in New York, christened his discovery of the dendritic cell. But when he revealed his theories about the cells’ curative potential at medical conferences in the early 2000s, he was considered outlandish.
Nevertheless, Dr. Steinman worked doggedly on using the cells to create cancer-killing vaccines. His colleague, Antony Rosen, now a professor of medicine at Johns Hopkins University, recalls: ‘He was confident enough that it didn’t matter to him that nobody had seen it before and everybody rejected what he said’.
Dr. Steinman’s investigations involved extracting dendritic cells from a patient, exposing them in the lab to the patient’s cancer cells — ‘teaching’ them to recognize them as threats — then injecting the dendritic cells back into the patient’s body in order to prime their immune system.
Dr. Steinman pursued his goal with deadly urgency. In 2007, with his work still at an early point, he was diagnosed with aggressive pancreatic cancer and told he had only months to live.
He experimented on himself — trying three previously untested vaccines based on dendritic cells exposed to cells from his tumor.
Leave a Reply