Heidelberg, Germany – It started for Georgios Kessesidis with a swollen lymph node and night sweats. He constantly felt listless and went to doctors time and again to find out what was wrong.
“The diagnosis was always bronchitis or asthma, since I had hay fever,” said Kessesidis, who lives in the German city of Reutlingen and is now 27 years old. Months – and many doctor visits – later, he learned what was really ailing him: lung cancer.
“I expected all sorts of illnesses, but certainly nothing like that,” he recalled. The cancer was already very advanced, and medical experts concluded that it was incurable and there was no point in operating.
Today Kessesidis looks perfectly healthy. “I feel really good,” he said.
What happened?
At first Kessesidis received chemotherapy, but his tumour continued to grow. Then he learned of an opportunity to participate in an international immunotherapy trial, which he has been doing since June 2014.
“This therapy, this drug, has activated certain immune cells able to recognise and kill tumour cells,” explained his doctor, Dirk Jaeger, director of medical oncology at the National Centre for Tumour Diseases in Heidelberg, Germany.
Activating the body’s own immune system to fight cancer is an old vision among doctors. The trouble was: for decades, it never seemed to work. Last century, many desperate patients signed up for immunotherapy experiments, but died anyway.
It’s still too early to say whether Kessesidis has been cured, and the immunotherapy he got won’t work for all lung cancer patients.
The German Cancer Research Centre (DKFZ) in Heidelberg explains that the body’s immune system recognises some kinds of tumours better than others. For instance, it can be trained to fight melanoma, the most serious type of skin cancer.
New immunotherapies are being developed particularly for these patients.
So far, however, there are no immunotherapies that are sufficiently effective in combating other types of cancer. Results of clinical trials on colorectal and pancreatic cancer, for example, have been far less promising, Jaeger said. Trials are now under way around the world, and many companies are developing immunotherapy drugs.
“There’s a kind of gold-rush fever - in the pharmaceutical and bio-technology industries too,” remarked DKFZ chief Otmar Wiestler.
Jaeger said a drug very similar to the one that Kessesidis is taking in the trial was recently approved in the United States. Experts expect approval in Germany in about a year, with costs for a patient to run between 15,000 and 20,000 euros (about 17,000 to 22,600 dollars) a year.
Kessesidis pays nothing for his drug because the costs are being picked up by the large drug company funding the trial, Jaeger said.
Cancer patients can learn about available trials, and their locations, through the DKFZ’s cancer information service.
The US-based journal Science put cancer immunotherapy at the top of its list of scientific achievements in 2013, when the “treatment strategy, decades in the making, finally cemented its potential,” it said.
“A new chapter in cancer research and treatment has begun,” the magazine wrote at the time.
A year later, most of the therapies remain experimental and at various stages of development.
“Immunotherapy has long been a dream of cancer medicine,” Wiestler said. “Cancer cells are alien cells, and you’d think that our immune system would recognise them.”
But when cancer starts, the immune system fails, and for a long time doctors didn’t know why.
“Today they do,” Wiestler said. “Tumours can hide from the immune system and then simply aren’t recognised as being alien. What’s more, cancer tissue builds a protective barrier that prevents immune system cells from recognising cancer cells and invading the cancer tissue.”
Armed with this knowledge, scientists in recent years have been developing completely new strategies to reactivate the immune system and use it to combat cancer cells.
While some patients, like Kessesidis, respond surprisingly well to immunotherapy drugs, Wiestler said, “none of us can predict at present whether these responses are long-term and we can then truly say we’ve got a cure.”
Other patients don’t react to immunotherapy at all “and we don’t really understand why,” Wiestler said, adding that scientists in this field were still learning.
Jaeger sounded a slightly more optimistic note, saying that Kessesidis wasn’t a major exception. “We’ve got quite a few patients who’ve responded similarly,” he said. “Not all of them, but quite a few.”
Kessesidis comes to Heidelberg for his therapy every two weeks and receives an infusion. In the current, early phase of the trial, the main aim is to see what side effects are caused by the drug. In the beginning, Kessesidis said, he had mild diarrhoea and his psoriasis worsened intermittently.
Jaeger wouldn’t offer a prognosis on whether his patient would continue to respond positively to the drug and finally defeat his tumour. “We all hope so,” he said.
Sapa-dpa