The Last Word On Nothing

Eleven years ago this week, my 67-year-old mother died from a brain tumor. It was Glioblastoma multiforme, an insidious fourth-stage cancer that, without treatment, usually kills within three months. Treatment options are miserable for the patient and not terribly effective; for those who opt for surgery and radiation/chemo, the cancer almost always returns within a year or so. We chose hospice care, and my mom died at home two months and 13 days after her diagnosis, voiceless and shrunken, a husk of the woman she’d been. (I’ve posted about her on LWON before.)

The same cancer killed a 49-year-old friend of my husband’s and mine in 2014. This gentle and much beloved man spent his final months beaten down by two surgeries and hopped up on steroids, fighting for access to an experimental drug under the FDA’s compassionate use policy. (He had “flunked out” of the clinical trail for various reasons, but the drug had by that time been formulated for him.) With an inept doctor as his advocate, approval was slow and, by the time permission came to begin the infusions, our friend was already dying. We can’t help but wonder whether the drug might have saved him if administered months earlier.

With all that behind me, whenever I see “brain cancer” or “glioblastoma” in a headline, I can’t help but read on, skimming ahead in search of good news. Sometimes I think maybe, just maybe, researchers are actually going to find a way to wrestle this life-sucking monster to the ground.

Many scientists are devoted to the task, as glioblastoma is the most common and aggressive of the primary brain tumors. And it seems that immunotherapy, despite early failures of the approach, is back on the lab bench as a promising way toward a cure.

Immunotherapy is about boosting a person’s own defenses rather than introducing entirely foreign (and toxic) chemicals that run rampant and kill both good and bad cells while beating the patient senseless. Modern drug makers are now coming up with personalized vaccines aimed directly at newly metastasized cancers, which could steer us away from harsher, more scattershot treatments.

One reason glioblastoma (among other cancers) is so hard to beat is it somehow makes itself invisible to the immune system, jamming signals that would otherwise alert the body to the invasion. Tissue surrounding tumors is often alive with immune cells that are maddeningly feeble, chemically blocked from doing their job. Scientists have been trying to break down this wall for decades.

Having watched brain tumors do their dirty work, I’m excited about the newest therapeutic vaccines that go straight to the source. They could become the medical Trojan Horse that allows troops to infiltrate before the enemy gets wise and shuts the gates.

The vaccine our friend was hoping would save his life, now in Stage III clinical trials, is that kind of weapon. Most of us think of a vaccine as a weakened version of a disease-causing mircroorganism that lets us build up immunity to that disease. This is a different animal. My understanding is fairly superficial, but here are the basics: The drug makers start with the patient’s own immune cells, specifically dendritic cells—the masters of the immune system, what some researchers call the General in the system’s Army. They then mature and differentiate the cells outside of the body, and load them up with biomarkers from the tumor to “educate” them about their target. These newly mature, energized, and smart dendritic cells, when injected into the cancerous mass, mobilize the whole immune system, not just one part (e.g., T cells), to efficiently destroy the enemy.

Researchers expect the vaccine will reestablish the flow of information between the body’s friends and foes, letting the immune system hear the order to fight. It may also make tumor cells more sensitive to chemotherapy, for a one-two punch. (Ideally, we can stop using chemo entirely someday. We’re not there yet.)

The “same” cancer in two people isn’t actually identical; that some people respond well to treatment and others don’t reminds us that this is fingerprint-personal stuff. So it’s hard not to have confidence in medicine that is tailor made for a single person. The vaccines are so individualized that they are named for each patient: Mine, should I need one, would be called JennyVax.

While I’m familiar with this particular vaccine because of our friend, it is far from the only one in development. As you might expect, there are a number of other research groups forming their own drug companies and trying alternative approaches, all seeking the magic bullet of a powerful and nontoxic personalized cancer vaccine. Competition in science always brings me hope, especially in this case. Cancer is infuriatingly crafty, and the treatments must be smarter than the disease. The more experts and tactics we have in play, the better. (Breaking away from the war metaphors, I like to picture the glioblastoma research groups as track teams, the runners leaping microscopes and handing off pipettes, their colleagues cheering them toward the finish where the big solution awaits. It’s a tough race, but victory is so sweet that I know the scientists must be running their asses off.)

Though sadly too late to help two people I loved, it does seem the research race is paying off and we are gaining ground on brain cancer. And after decades of poisoning patients with barbaric treatments that make them sicker before they get marginally better, we may find the real cure is inside of us. The trick now is back on the battlefield, finding the right messenger to sneak the orders through.

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Disclosure: The author owns stock in the company that makes the vaccine she described.

Also, the author made some necessary revisions after the initial posting of this article.

Photo: Shutterstock