One cure for one cancer

Ms Stacy Erholtz is cured in the Mayo Clinic of advanced myeloma by modified viruses.

The Mayo Clinic:

In a proof of principle clinical trial, Mayo Clinic researchers have demonstrated that virotherapy – destroying cancer with a virus that infects and kills cancer cells but spares normal tissues – can be effective against the deadly cancer multiple myeloma. ….. Two patients in the study received a single intravenous dose of an engineered measles virus (MV-NIS) that is selectively toxic to myeloma plasma cells. Both patients responded, showing reduction of both bone marrow cancer and myeloma protein. One patient, a 49-year-old woman, experienced complete remission of myeloma and has been clear of the disease for over six months.

Research report here in Mayo Clinic Proceedings (no paywall, thanks!); WAPO.

“Patient 1” has a name: Stacy Erholtz, and we owe her not only our admiration but thanks for allowing us to put a human face to the antiseptic research prose.

The researchers and the Mayo media people studiously avoid the word cure. It’s understandable: there was too much premature talk of silver bullets in Nixon’s “war on cancer”, and it’s important not to raise false hopes. But, but. This news does raise true ones. It’s the most striking proof imaginable that the viral approach being pursued by many teams of researchers really can work: bringing back a human patient from death’s door to a near-normality she hasn’t enjoyed for 10 years. Some might quibble and say we should wait for a whole year or three years’ remission before calling it a cure. If we have to wait until she dies of something else, then the term is unusable. On the understanding that the risk of relapse is still there, from whatever unknown genetic and environmental factors caused her cancer to grow in the first place, I propose to call it a cure.

It is one cure of one cancer, not a cure in the sense of a replicable treatment for a class of cancers, still less the cure – which is probably unattainable, as cancer is a large and diverse family of mutinies. Unlike the typical situation in the social sciences, there is no real doubt about causality. Ms Erholtz wasn’t taking any other anti-cancer drugs; they gave her a massive shot of agents designed to have an effect; five minutes later she had a splitting headache; two hours later she “started shaking and vomiting”, with a high fever; 36 hours later, the large tumour on her skull started shrinking, and carried on shrinking. Causation isn’t the problem.

Replication is. The same treatment had much less effect on the unlucky other patient. What was the difference? Since cancer cells are mutinous parts of a unique individual, the effect could have been tied to rare or even unique features of Ms Erholtz’ genome or immunological history. The Mayo researchers are starting a larger trial in September to sort this out. But the Grendel they are tracking back to its deathly lair is wounded and leaves a trail of fresh blood.

The other reason to talk prudently of cures is that they are still the proper goal. Lewis Thomas got it right (citation in an earlier post of mine on a parallel proof-of-principle cure for an AIDS patient): the expensive, drawn-out treatments of yesterday and today are second-best medical technology. True high medical technology is simple (though based on complex knowledge) and generally cheap: cures like penicillin for syphilis, preventions like the polio vaccine.

Medical progress has recently been advancing expensive treatments rather than cheap cures, and this has been a major driver of the universal trend to rising costs of health care. It may carry on like that. But it ain’t necessarily so.

I know I do go on about this. Personal reasons, you understand. They don’t make me wrong.

Author: James Wimberley

James Wimberley (b. 1946, an Englishman raised in the Channel Islands. three adult children) is a former career international bureaucrat with the Council of Europe in Strasbourg. His main achievements there were the Lisbon Convention on recognition of qualifications and the Kosovo law on school education. He retired in 2006 to a little white house in Andalucia, His first wife Patricia Morris died in 2009 after a long illness. He remarried in 2011. to the former Brazilian TV actress Lu Mendonça. The cat overlords are now three. I suppose I've been invited to join real scholars on the list because my skills, acquired in a decade of technical assistance work in eastern Europe, include being able to ask faux-naïf questions like the exotic Persians and Chinese of eighteenth-century philosophical fiction. So I'm quite comfortable in the role of country-cousin blogger with a European perspective. The other specialised skill I learnt was making toasts with a moral in the course of drunken Caucasian banquets. I'm open to expenses-paid offers to retell Noah the great Armenian and Columbus, the orange, and university reform in Georgia. James Wimberley's occasional publications on the web

3 thoughts on “One cure for one cancer”

  1. I'm really hoping it works out this time in clinical trials, which are finally being run this fall by the Mayo Clinic. There have been earlier experiments with it, as Ars Technica has pointed out, which didn't pan out, but the idea is certainly sound in my honest opinion.

    1. The Mayo doctors used a massive dose – 100 billion viruses. (The multiplication presumably costs very little.) They and, far more important, the patients were able to take the high risk because the latter were dying, As far as I can make out, the viral GM was irrelevant to the cure: MV-NIS simply has a gene added that allows the virus to be tracked. The anticancer work could have been done by the plain MV virus, of which the Edmonston strain has modified itself in the lab environment by accident to become more effective against myeloma. Perhaps directed evolution might be a simple approach to developing therapeutic strains – just feed the little buggers the right sort of crap to live off.

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