“The Quantum Theory of Cancer Treatment”
by Amanda B. Keener
Nova Next, July 20, 2016
I’m writing with a feature idea for Nova Next that could fit under the “Personalized Medicine” Storyline.
I recently spoke with Silvia Formenti, an oncologist and researcher at Weill Cornell Medical College who’s been working for over a decade on a way to transform radiotherapy for metastasized cancer from a palliative treatment to a curative one. She and others are doing this by combining radiation therapy with immunotherapy, two treatments that are normally administered separately. In doing so, researchers are making use of a usually rare event called the abscopal effect, which occurs when radiotherapy of one tumor shrinks tumors elsewhere in the body.
The effect has been described by handfuls of case reports about patients with metastasized cancers who, after undergoing localized radiation treatment, experienced unexpected partial or complete remission. In 2004, Formenti demonstrated that it was possible to induce the abscopal effect on purpose by giving mice an immune cell growth factor. This meant that a fluke phenomenon could potentially be harnessed and radiation could be used to damage tumors, turning them into internal vaccines of sorts.
Nowadays, immunotherapy, which usually involves activating the immune system to turn it against tumors, is rapidly gaining traction, but Formenti says when she first presented her data, many of her colleagues didn’t believe the effect was mediated by the immune system. Undaunted, she demonstrated that the effect also occurred after giving mice the T cell check-point inhibitor, ipilimumab (anti-CLTA4), which is now in clinical trials in combination with radiotherapy.
In July, Formenti published her first proof-of-concept study in humans in the Lancet, showing the cytokine GM-CSF induce abscopal responses in cancer patients receiving radiotherapy. Currently, there are about fifty clinical trials testing combinations of radiotherapy and immunotherapy to make use of the abscopal effect.
Formenti says that since there is now a “nice critical mass of people working on this,” she is planning sessions for the annual meetings of both the American Association for Cancer Research (Spring 2016) and the American Society for Radiation Oncology (Fall 2016) so that clinicians and researchers can brainstorm about how to standardize this approach. In the future, this treatment could completely change the conversations radiation oncologists have with patients with metastasized cancer, changing their goal from shrinking a few tumors to improve comfort, to actually eliminating the disease.
In addition to Formenti, I’ve also spoken with Michael Lim, a neuro-oncologist at Johns Hopkins who is doing a trial of ipilimumab combined with radiation for brain metastases. Other people I could interview include Jedd Wolchok, an oncologist at Memorial Sloan Kettering Cancer Center who co-authored a clinical case study that showed immune changes in a patient experiencing the abscopal effect.
Thanks so much for considering,