Cancer – Crutchfield Dermatology

New advances in the war on cancer: living cell therapy

On April 6, 2016, we discussed several new successful treatments against cancer in the Minnesota Spokesman-Recorder article “Good news: We are winning the war on cancer.” This is an update on one of those treatments we referred to then as combination cell, or chimeric cell, therapy. Researchers and reporters alike are now calling it “living cell therapy.” It works well and has been approved to treat certain resistant childhood leukemias and adult lymphoma. Unfortunately, results against solid tumors are not yet favorable. Success rates as an FDA-approved treatment is greater than 70 percent, which is remarkable considering that, in the recent past, these cancers, failing traditional therapies, were incurable. There are particular types of immune cells called T-cells that are the real powerhouses when it comes to fighting disease and cancer. Doctors can perform a pretty slick trick where they extract a T-cell from a patient’s body and mix it with a specific virus. That is why it has been called combination cell, or chimeric cell, therapy. This virus infects the T-cell and directs it to produce unique sticky proteins on its surface that recognize novel proteins on the cancer cells. They fit together like hand and glove. These living therapy T-cells float freely in the blood and recognize blood-born malignancies. They bind to the malignant cells in the blood and obliterate them. This type of living cell therapy works best for specific blood-borne malignancies, especially those of the liquid form, such as leukemia and lymphoma. Here’s how it works: Leukapheresis Special immune T-cells are isolated from a patient’s blood using a particular filter. These cells are then frozen and sent to a unique laboratory that transforms them into living treatment cells. Cell programming In the lab, the T-cells are mixed with a specific virus that causes the T-cells to make unique proteins on their surface that can later recognize and stick to leukemia or lymphoma cancers cells. Multiplication These newly programmed T-cells are grown and multiplied over a million-fold in the laboratory, so they are in large enough numbers to fight cancer when they are needed later. Quality review The new group of programmed and multiplied cancer-fighting T-cells are specially checked and screened to make sure that they have only the desired cells with unique cancer-fighting properties. Lymphocyte reduction The number of lymphocytes in the patient is reduced so that when a large number of the newly programmed lymphocytes (originally from the cancer patient, but now grown to much larger numbers) can be more easily given back to and accepted by the patient and can function at optimal levels. Living cell drug infusion The newly programmed cancer-fighting T-cells are slowly injected back into the cancer patient. This is done over several minutes. Cancer cell death via cytokine storm The cancer-fighting T-cells can sense what size job they need to do and can increase their numbers even more inside the body, if needed. They can then launch an all-out attack on the cancer cells, killing them. During this attack, the cancer-fighting cells release many substances called cytokines that enable the most effective attack. This release is called a cytokine storm. It usually occurs one to two weeks after the T-cells are injected back into the cancer patient. The cytokine storm can make the patient feel like they have the flu. Oddly, that is considered a good sign, except in a few cases where the storm can be so severe it can harm or even kill the patient. Doctors are getting better and better at treating and handling the storm, so most patients do well. A costly process The process of transforming normal immune T-cells into cancer-fighting cells is called CAR-T production, for “Cancer Antigen Receptor T-cells.” It is an extremely expensive process: Currently, the cost to produce CAR-T cells for injection is just short of $500,000 per treatment. Prices may come down as the techniques to develop CAR-T cells improve. Additionally, researchers are devising ways to make the CAR-T cells recognize multiple targets on cancers cells rather than the single target employed now. The ability to identify various targets on a cancer cell will make the CAR-T cells more efficient and will increase the number of successful treatments. There are over 50 CAR-T studies underway. In conclusion Although the war on cancer is not over, I’m delighted to report that right now we have some of the best tools ever available in the fight. In fact, former president Jimmie Carter used some of these tools to have a complete remission of malignant melanoma that metastasized to his brain. If you or a loved one is diagnosed with cancer, it’s not the same prognosis that it was even a few short years ago. Talk to your physician about a combination of therapies including traditional surgery, radiation, and chemotherapy along with the new strategies including CAR-T living drug cancer treatments and many other new cancer therapies. The war on cancer has never looked better than it does today.

Good News: We Are Winning The War On Cancer

In the war on cancer, we are living in unique and wonderful times. The last several years have shown the development of several new approaches to the treatment of cancer that are proving to be very promising and effective.

In the past, the three most important strategies in the treatment of cancer involved surgery, chemotherapy and radiation. With a better understanding of our immune system, we’ve been able to develop four new specific strategies that are targeting and treating cancers better than ever.

Stop Cancer

Checkpoint inhibitors

The immune system is incredibly powerful, and if it is turned on completely the immune system can attack normal tissues causing widespread destruction and even death. As a result, the immune system operates with a safety guard, a kind of “braking system,” to keep it from turning full on and launching an attack on healthy cells.

These safeguards are called “checkpoints.” Many cancer cells exploit this protective mechanism by sending signals to the immune system that they are normal; they are okay; don’t attack. Because of this trick, many cancer cells can avoid detection and destruction from the immune system.

Scientists have now discovered ways of introducing drugs made from custom-made proteins that rev up and turn on the immune system. By allowing the immune system to pass the checkpoints, they are called “checkpoint inhibitors.”

The immune system, specifically the T-cells of the immune system, have to pass through several checkpoints before they can be unleashed and turned on. These checkpoints are for our safety.

If you can get around the checkpoints, you can turn the immune system on to attack. And that’s what the checkpoint inhibitors do; they rev up the immune system so that the T-cells can attack the malignancies.

The war on cancer has had significant advances, especially to liquid- or blood-born cancer such as certain types of leukemia and lymphoma. However, when it comes to solid malignancies such as cancer of the lungs and skin, many of the checkpoint inhibitors are providing high hopes, especially in clinical trials. In fact, almost 25 percent of patients with advanced solid tumor malignancies have shown promising remissions and or excellent responses to these types of treatments.

Vaccine

Immune cell vaccine

The second strategy in attacking cancers is a cancer cell vaccine. In this type of system, specific immune cells that normally patrol the system looking for abnormal cells and malignant cells are taken from the patient and mixed with their tumor cells, outside the body.

This process educates these types of immune attack cells, called dendritic cells, to recognize the malignant cells better than they did inside the body. Then they are put back into the body, and they attack cancer. This is partially similar to the way vaccinations work, hence the term “immune cell vaccine.”

Combination of chimeric cell therapy

The third type of strategy in treating malignancies involves something called the combination cell or “chimeric cell.” There are particular types of immune cells called T-cells. There is a pretty slick trick where they extract a T-cell from a patient’s body and mix it with a specific virus.

This virus infects the T-cell and causes it to have special sticky proteins on its surface. These sticky proteins are excellent at recognizing specific malignancies, especially those of the liquid form, that is, blood-born malignancies such as leukemia and lymphoma.

Cancer Cells

These combination cells float freely in the blood and recognize blood-born malignancies. They bind to the malignant cells in the blood and destroy them. The reason they call them chimeric cells is because they are a combination of two types of cells — an immune cell and a virus.

Microbiome enhancement

The fourth new strategy in the war on cancer involves something entirely unique. It involves something called the microbiome. The microbiome is composed of all the bacteria that live within our bodies, typically in a safe and friendly manner.

It includes but isn’t limited to most of the bacteria that live in our gastrointestinal tract (gut). These friendly bacteria live within us in a complementary manner and often can produce different proteins and chemical signals that assist our immune system in doing a better job.

Microbiome

Many people eat certain yogurts called probiotics to increase the nature of good bacteria in their gastrointestinal tract. In fact, it’s found that certain compositions of bacteria seem to be present when the immune system does a better job of fighting off malignancies.

Scientists are right now studying the different types of probiotics and bacteria that can live in our bodies that will support immune health and the ability to fight malignancies. The microbiome is so important to our overall health that I view it as another organ!

In conclusion

Although the war on cancer is not over, I’m delighted to report that right now we have some of the best tools ever available in the fight against cancer. In fact, former president Jimmie Carter used some of these tools to have a complete remission of malignant melanoma that metastasized to his brain.

If you or a loved one is diagnosed with cancer, it’s not the same prognosis that it was even a few short years ago. Talk to your physician about a combination of therapies including traditional surgery, radiation and chemotherapy along with the four new strategies discussed today, including checkpoint inhibitors, immune cell vaccines, chimeric cell treatment for blood malignancies, and manipulation of a patient’s microbiome, the friendly bacteria that live within us that can augment our immune system.

The war on cancer has never looked better than it does today.

Charles E. Crutchfield III, MD is a board-certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.

Why should I care about bladder cancer?

Approximately 75,000 people die every year from bladder cancer in the United States. Although bladder cancer can occur at any time, it most commonly occurs after age 70. It is in the top five cancers for men and in the top 10 cancers for women. The good news is that if detected early, it can be treated quite effectively. The bad news is that although treated, it can recur.

What is bladder cancer?

The bladder is a storage organ for urine before it passes out of the body. The tube that leads from the bladder out of the body is called the urethra. The bladder is very similar to a balloon in that it can expand and decrease in size as it fills and empties.

The wall of the bladder has several layers. Most commonly, bladder cancer will occur on the very inner layer of the bladder. As bladder cancer grows and progresses, it can affect the middle and outer layers, including the muscle layer of the bladder.

In worst case scenarios, parts of the cancer can break through the muscle layers and spread throughout the body. This is known as metastatic cancer. The best thing to do is catch bladder cancer in its earliest stages, when it solely affects the inner lining of the bladder, before becoming invasive and affecting the muscle, or metastasizing.

Bladder cancer on wall of bladder

What causes bladder cancer?

Causes of bladder cancer are poorly understood, but we do understand there are certain risk factors, including: smoking, exposure to radiation near the bladder, exposure to caustic chemicals used in the manufacturing industries, as well as certain anti-cancer medications that can also increase the risk for developing bladder cancer. Repeated bladder infections with parasites are rare in the United States but common throughout the world, and can also be a risk factor for developing bladder cancer.

How is bladder cancer diagnosed?

Possible signs and symptoms of bladder cancer can include blood in the urine and changes in bladder habits that include: increased frequency of urination, or inability to pass urine despite having the urge to do so, pelvic pain, back pain, or pain with urination. Most commonly, blood in the urine (that causes the urine to appear bright red or orange) is the initial warning sign.

Remember, there are many causes for blood in the urine, and bladder cancer is just one. Anytime there is blood in the urine, no matter what the cause, it should always be evaluated by a physician.

Tests to diagnosis bladder cancer include special urine tests to evaluate for cancer cells, imaging studies (CT scans), and the gold standard test, a procedure called a cystoscopy. This is where the physician uses a small, flexible tube with a camera. The tube is inserted through the urethra and visualizes the inside of the bladder.

Additionally with a cystoscopy, if an area or spot looks suspicious, the cystoscope also has the ability to take a small sample of tissue for additional evaluation by a pathologist (biopsy).

How is bladder cancer treated?

Once the diagnosis of bladder cancer is established, treatment options are designed based on the type of bladder cancer, how aggressive the bladder cancer is, and how far it has progressed. Evaluation includes determining if the cancer is just on the inner layer of the bladder, involves the middle or outer layers including the muscle of the bladder, or if it has broken through and metastasized to other parts of the body.

The exact treatment for bladder cancer will be determined by the physician, oncologist, and sometimes, urologic surgeon. Sometimes the entire bladder needs to be removed. If this is the case, there are many options for such a patient to collect and dispel urine. The treatments for bladder cancer include immunotherapy, chemotherapy, radiation therapy, surgery and/or any combination of these.

As was mentioned earlier, the upside for bladder cancer is that it’s easily treated if caught early. The downside is that it has a tendency to recur, even with successful initial treatment.

After being successfully treated for bladder cancer, it is very important to see your doctor on a regular and lifelong basis for appropriate monitoring and the very best long-term outcome.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.

Oral Cancer: a sneaky yet preventable killer

By Dr. Charles E. Crutchfield III and David Hamlar, MD, DDS

According to the Oral Cancer Foundation, someone dies from oral cancer every hour of every day in the United States alone. This serious mouth disease, which pertains to the mouth, lips or throat, is often highly curable if diagnosed and treated in the early stages.

Continue reading Oral Cancer: a sneaky yet preventable killer