At least two women with cervical cancer that was certain to kill them are alive today, thanks to a new treatment that involves finding immune cells in their own bodies that recognize and attack the tumors.
The approach has been used before in the deadly skin cancer melanoma, a rare bile duct cancer, and now a similar tack is working for some patients with cervical cancer, researchers told a meeting of cancer specialists with the American Society for Clinical Oncology.
It’s a very small trial and only a third of the patients were helped much, but they were patients with absolutely no hope at all – one of those last-minute miracles that almost never happen in real life.
Arrica Wallace of Manhattan, Kansas is one of them. “I discovered that I had stage III cervical cancer on July 1, 2011,” Wallace, now 37, told NBC News. She was shocked – like most American women, she had gone for regular Pap smears that are supposed to detect changes long before they become cancer, and her tests had been normal.
The young mother got a full barrage of treatment. “In all, I had 32 rounds of chemo, I had 25 days of radiation and I also had brachytherapy, internal radiation treatment before the trial treatment,” Wallace said. “My doctors … were pretty aggressive because I was young and healthy enough to handle the treatment side-effects.”
“They told me I would likely not survive more than year.”
But it didn’t work. The cancer came back. “So I went to MD Anderson (cancer center in Houston) to perhaps enter a clinical trial, but they told me all they could do was control my cancer with chemo. They couldn’t cure me,” Wallace said. “They told me I would likely not survive more than year.”
It was devastating news for a young mother of two children, who are now 15 and 11.
Then Dr. Christian Hinrichs of the National Cancer Institute called Wallace’s physicians and asked if she could take part in a clinical trial he was helping run. It’s the same team that developed the therapy used to save the life of a woman with bile duct cancer.
“Aricca had been aggressively treated with every kind of chemo that had reasonable level of activity against her cancer,” Hinrichs said.
“Her prognosis was terrible. There was no chance she would be cured, and chemo in that setting was more likely to have toxic effects rather than therapeutic. She had run out of options. Almost no one in this situation lives more than two years, and it is unlikely she would have lived more than one year.”
Hinrichs and colleagues were trying a new approach that involves finding and amplifying the body’s own immune response to cancer. It sounds easy and reasonable in theory, but it hasn’t worked well when researchers have tried it. This time, they went after cells called T-cells.
“Our T-cells keep us alive every day. They protect us from invaders. Invaders could be viruses, bacteria, parasites and we don't realize that they play also a big role in fighting off cancer cells,” says Dr. Michel Sadelain, director of the center for cell engineering at Memorial Sloan Kettering Cancer Center in New York.
Cervical cancer is almost always caused by a virus called HPV, or human papillomavirus. It transforms normal cells into tumors cells that proliferate uncontrollably. Often, T-cells can keep this under control, but sometimes they cannot and that is when cancer develops. Patients need the right kinds of T-cells and they need enough of them. “All too often patients have a few of those t-cells but not enough to control the cancer,” Sadelain said.
Hinrichs’ team cut out pieces of Wallace’s tumors and looked for T-cells that seemed to be specifically primed to attack the HPV-mutated cancer cells.
“This report in particular shows that in patients with HPV positive cervical carcinoma you can grow out the T-cells from surgical specimens, amplify them to generate an army of these T-cells, reinfuse them in to the patients and sure enough, at least in some patients, these T-cells traffic through the blood stream find the cancer and destroy it,” said Sadelain, who was not involved in the research.
It’s not often that cancer researchers report on results with just a handful of patients, but the National Cancer Institute team says the results are really startling.
“We’ve treated nine patients. Three patients had major shrinkage of their tumors,” Hinrichs said. One was only helped for three months, but in Wallace and another patient, the tumors appear to have vanished.
CT scans from Aricca Wallace of Manhattan, Kan., show how her tumors (indicated by yellow arrows) shrank 18 months after treatment. Now they are gone.
Wallace was anxious when she went to hear her first results. “They told me not to expect that much,” she said. But in just a month, her tumors had shrunk by 50 percent. “I cried. I couldn’t believe it actually worked,” she said. And 22 months later, her latest scan, done just last week, shows she is cancer-free.
“Now I am no treatment, no medicine, no nothing,” says Wallace.
The approach is not painless. Patients must undergo chemotherapy to suppress their immune systems and make room for the new cancer-targeting cells. It means days in hospital isolation. They also get a drug called Interleukin-2 to stimulate the new cells. “Interleukin-2 makes the cells grow, proliferate, and become activated to kill the tumor,” Hinrichs said.
“Now I am no treatment, no medicine, no nothing."
“We were thrilled to see these patients with complete tumor regression. It is kind of a mixed set of feelings for me that while two of these patients had great responses. The treatment changed their lives. There were plenty of other women who were not helped by this treatment. We’re certainly trying to come up with better approaches.”
It’s possible this approach may work against other cancers caused by HPV, including head and neck cancer, and National Institutes of Health researchers are recruiting patients now for the trials at the NIH Clinical Center. It’ll also have to be shown, but it might be that recruiting the immune system earlier on in patients might work better.
“We want to know whether this type of approach can be extended to other HPV-caused cancer and possibly to other cancers caused by viruses,” said Hinrichs.
And Sadelain cautions that the approach is very dependent on the patient’s own immune system. “Not every patient may have T-cells, preexisting T-cells (that recognize tumor cells). If that patient does not have such cells there is nothing to grow in this approach,” he said.
"These are not genetically engineered or genetically modified T-cells," Hinrichs told a news conference on Monday. "These are naturally occurring T-cells that were present in the tumor."
But in those who do have them, it could represent a lifelong cure, says Dr. Richard Schilsky, chief medical officer for the American Society for Clinical Oncology. “Not all patients respond, but if they do respond, their responses are very long-lasting because the immune system has a memory,” he said. “This is a huge change.”
Results that could be tried in large numbers of patients will be years away, experts caution. And it’s always possible cancer can return even in patients whose tumors have seemingly vanished.
“Today I live every day to the fullest, enjoying every minute with my family, keeping things in perspective and never taking a moment for granted,” says Wallace.
Courtesy Aricca Wallace
Aricca Wallace, with her youngest son Marccus, 10, while Arricca was getting an experiment treatment at the National Cancer Institute.
First published May 31 2014, 10:36 AM