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New attack on cancer change the cell

Groundbreaking research brings new hope to some people with late-stage lung cancer thanks in large part to a Bermudian cancer researcher.

Malcolm Brock, associate professor of surgery and oncology at Johns Hopkins Kimmel Cancer Center, was a senior author of a study using epigenetic therapy to treat lung cancer.

The new treatment approach targets the genetic material of cancer cells, stopping them from multiplying uncontrollably.

The study was published last week and appears in the December edition of the journal, Cancer Discovery.

In that study, 45 patients with late-stage lung cancer received a two-drug combination which saw them live, on average, two months longer than they were expected to.

Dr Brock explained that his research looked at getting rid of cancer tumours not by killing the cells but rather, by changing them.

Chemotherapy patients are given the highest possible dosage their bodies can withstand in an effort to kill the cancer cells.

In so doing there is often collateral damage as other cells are destroyed as well.

According to Dr Brock, a big problem with this approach is that if even a few cells survive the chemo attack, they can grow and re-establish themselves as a cancer tumour.

“Resistance can come up very quickly,” said Dr Brock. “Cancer cells are very, very, very smart.”

Azacitidine, a chemotherapy drug, was developed in the 1960s to be used at its maximum dosage. In the 1990s scientists noticed that lowering the dose caused the drug to act completely differently, Dr Brock said.

“The cell changes its behaviour and starts to become more and more like a normal cell,” said Dr Brock.

In the study patients received azacitidine with a newer drug, etinostat. According to Dr Brock some patients responded well to the treatment and had tumour shrinkage.

The study also found that in some patients, the treatment did not shrink the tumour but instead did something else.

Exactly what, they are not sure. But the results for Dr Brock have been exciting. He said because the dosage is low, patients feel better.

According to Dr Brock, some of the patients that did not appear to respond to the treatment were feeling well enough to resume chemotherapy and had that work.

“Some we sent to hospice to die,” he said. “We actually had people call us many months later and tell us ‘hey you sent me off and my oncologist gave me a regimen of chemo and I’ve been well.”

Dr Brock said this unanticipated result has led researchers to look more closely at what the two-drug combination is physically doing to cancer cells.

“We might be changing some of the composition of the cancer cell that made it resistant to chemotherapy,” he said. “It looks like we are changing the cancer cell itself to make it more vulnerable. [It] seems like we are making aggressive cells less aggressive.”

And patients are not only having success with chemotherapy after the epigenetic treatments, they are also having success with experimental therapies.

Dr Brock said there are a few hypotheses as to what actually takes place in the epigenetic treatment.

“We may be unmasking certain proteins that the cancer was trying to hide but now are visible,” he said.

“The potential is huge. Nobody has been able to know this type of thing before. It’s the first foray into this. Although it is a small study, it is the first time this low dose treatment has been shown to work in solid tumours.”

On average patients in the study lived six months with the epigenetic treatment.

The average survival rate with standard treatment is four months.

Eight people died before they could receive a second epigenetic treatment, seven are still alive including two that have survived over four years.

One survivor was on hand when the study was released last week.

In January of 2009, his lung cancer had spread to his liver, (a situation that usually results in death), where he had a few tumours.

By August of that year, the tumours were non-existent and have not returned.

Dr Brock said the story is an unusual success. “We are trying to figure out why. We’re not 100 percent sure yet,” he said.

“It’s new and different, intriguing; and as everyone is saying over here, it’s groundbreaking.”

Bermudian Dr Malcolm Brock last week published groundbreaking research in treating solid lung cancer tumors.

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Published November 15, 2011 at 1:00 am (Updated November 15, 2011 at 7:49 am)

New attack on cancer change the cell

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