Advanced life savers for cancer: From science fiction to reality — Brendan J. Gomez

NOVEMBER 16 — Once science fiction, the treatment of cancer using genetic modification is now a reality. Gene and immunotherapy are now bringing vast life-saving options for people diagnosed with cancer. But more needs to be done to raise awareness of this in Malaysia.

In Malaysia, more than 100,000 people have cancer — and that is only registered figures. It is the fourth leading cause of death in the country. In 2018, the highest new cases in Malaysian females are due to breast cancer, and the highest for men are lung and colon cancer.

Cancer is the uncontrolled or unregulated growth of cells in our body. Gene therapy is the editing or replacement of genes in cells that have gone haywire. The easiest way to think about gene therapy is surgery. But instead of surgery on the whole person and being wheeled to the operating theatre, gene therapy is seen as surgery on specific problematic cells in our body.

While immunotherapy is a strategy in improving our immune system to recognise and attack cancer cells. It is similar to equipping our air force with the latest missiles and guiding system.

Gene therapy and immunotherapy make up a suite of advanced clinical approaches that are known as targeted or precision therapy. Advances in precision therapy in the next few years lends promise to do away with the need for chemotherapy and radiotherapy, in particular cancers detected in the early stages; as well as lends promise for where surgery is not possible.

Chemotherapy is often known as “carpet bombing” — it takes out the enemy, but there is quite a bit of unwanted causalities. Thus, more traditional chemotherapies are known for side effects that include hair loss, mouth sores, nausea, bowel issues and skin problems.

Much of the advances in cancer treatment today are due to breakthroughs in genetics, immunology, virology, cell biology, and the related sciences. With the human genome mapped out, researchers have been successful in identifying specific genes that contribute to specific cancers.

Recently, our own Malaysian scientist Dr Serena Nik-Zainal was awarded the Dr Josef Steiner Cancer Research Prize Award 2019 for her breakthrough in holistic interpretation of the cancer genome. Based on her research, tumours can be analysed using new bioinformatics methods which will help with targeted therapies.

To simplify the complexities of gene therapy, there are three key aspects to this technique. We first need to know which gene is causing the type of cancer in question. We then need to know how to repair or replace this gene. And we also need to know what vehicle to transport this fix to the targeted cells.

One recent scientific advancement in gene therapy is known as CRISPR-cas9. CRISPR-cas9 is likened to a science-fiction scissors so small that it can cut and replace our genes that are defective. This tool is valuable for example in switching off a gene in cancer cells that continue to replicate and grow.

While one scientific advancement in immunotherapy is known as CAR T. Here, a person’s T-cells are extracted, modified and placed back into the person so as it now has the ability to recognize and destroy cancer cells.

Scientists are still trying to address multiple challenges in the use of gene and immunotherapy. One such challenge in gene therapy includes finding an efficient vector or vehicle to deliver the “gene fix” to targeted cells. This is partly due to our immune system that can attack a foreign vehicle used in the transportation process.

Another challenge is in production, i.e. in taking what works in research labs and mass producing these therapies with high quality control. The latter contributes to the current high-cost of such advanced strategies to treat cancer.

No matter the challenges, advances in gene and immunotherapy continue exponentially around the world as confidence grows in breakthroughs achieved in treating cancer. In 2017 alone, 2,600 clinical trials were completed or were approved in 38 countries.

Examples of approved products available in the market include Gendicine (for head and neck cancer), Kymriah (for acute lymphoblastic leukaemia), Yescarta (for B-cell lymphoma), Olaparib (for breast and ovarian cancer), and Ibrance (for breast cancer).

This year a new drug called Larotrectinib has shown promise to treat a wide range of tumours. Known as tumour-agnostic, drugs such as Larotrectinib target common biochemical pathways across different types of tumours including sarcomas, brain, kidney, and thyroid tumours.

To better understand advances in cancer detection and treatment, the Department of American Canadian Education (ACE) at HELP University is organising a seminar-cum-forum on 16th November 2019 at their campus in Damansara.

Highly acclaimed speakers include Dr Lim Kue Peng of Cancer Research Malaysia and Dr Murallitharan of National Cancer Society Malaysia.

The event is open to all, including medical professionals, cancer survivors and the general public. For registration and further information, please go to https://helpxcancer.org or https://HELPUSCanada.weebly.com.

* Brendan J. Gomez has a first-class honours in genetics, and postgraduate degrees in psychology under the US Fulbright programme.

** This article is not meant as medical or pharmaceutical advice for cancer patients. Those seeking treatment need to consult with a medical professional, and preferably an oncologist.

*** This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.

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