UCLA treatment brings health, hope for kidney cancer victims
Successful immunotherapy to expand nationally pending approval
of FDA
By Ben Gilmore
For patients with advanced kidney cancer, options are few and
far in between. Most advanced patients have a life expectancy of
only 10 months and are resistant to chemotherapy, according to the
American Cancer Society’s 1994 data.
However, a new treatment developed by doctors at the UCLA School
of Medicine has shown the highest success rates of any treatment
for the cancer and is about to be tested on a national level,
researchers say.
The complex treatment was pioneered by Dr. Steve Rosenberg at
the National Cancer Institute in Maryland and conducted for five
years by Dr. Arie Belldegrun and Dr. Robert Figlin of the UCLA
Kidney Cancer Program.
After the surgical removal of the cancerous kidney, natural
cancer-fighting cells (called tumor-infiltrating lymphocytes or
TILs) produced by the patient’s immune system are extracted from
the kidney, explained Nancy Moldower, a clinical research nurse at
UCLA’s Kidney Cancer Center.
After extraction these cells are cultured for about 55 days at
the Applied Immune Sciences center in Torrance, where they multiply
and become "killer" cells that can more effectively attack the
tumor, said Dr. Benjamin Bonavida, a professor of microbiology and
immunology at the UCLA Medical School.
Finally, the cells are returned intravenously to the patients
where they fight off the cancerous tumor, Moldower said. The UCLA
Kidney Cancer center reports that 44 percent of patients treated
showed partial or complete responses.
"This is much more successful than chemotherapy," said Bonavida.
"Most patients don’t respond at all to chemotherapy."
Because of the complexity of the culturing process and expense
of the drugs, the treatment carries a price tag of $20,000,
Moldower said, adding that most health-insurance policies,
including Medicare, would cover the treatment costs.
The approach is an example of immunotherapy, an important new
field that utilizes the body’s own defense systems to fight
disease, added Sherie Morrison, a UCLA professor of molecular
biology.
Although the immunotherapy approach posts impressive numbers, it
is by no means an easy treatment or guaranteed cure-all for
patients.
"It’s a rough treatment, no doubt about it," said Moldower.
"It’s chronic and prolonged. Patients experience fever, chills,
fatigue, nausea and diarrhea."
Furthermore, "complete or partial response" does not mean
complete remission of the cancer, cautioned Bonavida.
While discomforting, this treatment is clearly bearable for
cancer patients.
"The majority of the patients are tolerant of the side effects,"
said Moldower.
Now, Applied Immune Sciences, the sponsor of the study, is
expanding the treatment to several major U.S. cities, including
Seattle, Chicago and Dallas. While the UCLA study only looked at 25
patients, the national study will look at over 200.
If the national trials go well, the FDA is likely to approve the
new treatment and make its use widespread, Moldower explained.
"FDA approval is still two to five years away," she said. "But
it’s looking very promising."
Ironically, the component of the treatment which causes the
adverse side effects, interlukin II, is already FDA-approved, said
Moldower. Interlukin II, a growth factor which causes the TIL cells
to multiply and become better cancer-fighters, is included in the
intravenous treatment.
However, the treatment’s use of TIL cells, which do not cause
side effects, is still pending FDA approval, Moldower said.
"The national trials will have to go well. For the FDA to
approve something new it really has to be worth it," she
explained.