For more than half a century, surgery, radiation and chemotherapy were the only treatment options available for the millions of people worldwide battling cancer. All of these treatments have severe side effects and are more used to extend or improve life. Now, researchers at Fred Hutchinson Cancer Research Center and other labs throughout the country are making remarkable advancements in a new type of therapy that’s giving an increasing number of patients their lives back completely.
When 64-year-old retired filmmaker Paul Hopkins was diagnosed with a rare skin cancer called desmoplastic melanoma a few years ago, his doctors had nothing but bad news for him. The condition came with about an 18 percent survival rate beyond five years, and traditional cancer treatments like chemotherapy and radiation were notoriously ineffective against it.
The cancer initially appeared as small spot on his cheek which eventually spread to lymph nodes in his neck and chin. Even after targeted drug therapy, his doctors found a three-inch-long tumor in his thigh. An active hiker, sailor and outdoorsman, Hopkins was faced with the prospect of giving up his life’s passions, and, with the cancer now at stage four, a likely slow and painful death.
"It was fall when this was happening,” he recalls. “The leaves were dying, and I was feeling like that, you know. I was kind of going inward and feeling that same sense of preparing to die.”
But a lucky break and fortuitous timing rekindled his hopes.
In January 2014, Hopkins switched insurance providers in a last-ditch effort to fight the cancer, and he was soon in the offices of Dr. Sylvia Lee, a Fred Hutch researcher and clinician at Seattle Cancer Care Alliance. “They were just going to start a program. It was brand-new, and it just happened to hit at exactly the right moment.”
Paul was accepted as the fifth patient in a clinical trial for a new type of treatment known as immunotherapy. The specific treatment was known as TIL, or Tumor Infiltrating Lymphocyte therapy.
“TIL therapy is taking a patient’s actual tumor, surgically ressecting it, and then growing T-cells out from that tumor," explains Dr. Lee. “The idea is that there are certain T-cells or white blood cells that have already infiltrated the tumor and they’re trying to attack the tumor, but the tumor is putting them to sleep. If you can take that piece of tumor into the laboratory and take those actual cells that have already recognized the tumor, make them more powerful, grow them out into the billions and infuse them back into the patient, you’re taking advantage of the patient’s own ability to recognize the cancer and augmenting that so that it can eradicate the cancer.”
For Paul Hopkins, his entire life was riding on this seemingly simple but medically radical idea.
Immunotherapy was first explored as a treatment for cancer back in the late 1800s, when American bone surgeon William Coley began injecting cancer patients with bacteria to provoke an immune response. His work had some beneficial results, but also caused some patients to develop infections that further deteriorated their health. Because of this and the long-held belief that because cancer came from within the body a patient’s immune system could not recognize it, immunotherapy was largely dismissed as a viable treatment until a few decades ago.
“In the 1980s, we started to use monoclonal antibodies,” explains renowned Fred Hutch immunologist and oncologist Dr. Stanley Riddell. “These are antibodies that would target molecules on cancer cells, and that was sort of the first evidence that you could use an immunotherapy and have a big effect in cancer. Our interest here at the Hutchinson Center has been more on T-Cells.”
T-cell immunotherapies like TIL therapy have blown the field of immunotherapy treatments for cancer out of the water, and a rapidly growing array of immunotherapy treatments are revolutionizing cancer research. Riddell’s lab has been working on a series of clinical trials that use synthetic receptors that are bio-engineered into a patient’s T-cells. These super-charged T-cells not only kill the cancer but also divide and grow within the body, continuing to recognize and destroy cancerous tumors with remarkable results — up to more than 80% in leukemias, lymphomas and other forms of cancer. And they’ve shown promising results in solid mass tumor-forming cancers as well.
The next goal for Riddell and these emerging therapies is to go after the most common forms of cancer like breast and lung cancer. The hope is that clinical trials for some of these notorious forms of the disease can begin later this year at the Hutch. “It’s evolving so quickly right now, and I think that we still don’t fully understand how to bring all of these things together. But it’s so exciting because I think the next decade is going to allow us to do that,” says Riddell. At a recent overcrowded talk at the Hutch, he adds, “We’re at the starting line, but I think we’re at the starting line where we know that we’re in a race that we actually can win.”
Hopkins is a living testament to that fact. Just a week after his TIL therapy, he could already feel his tumors shrinking and at only 12 weeks there wasn’t a trace of cancer in his body.
“If I had gotten this cancer five years earlier, I would have had no hope. Now I feel like there’s a chance that I’m going to be able to get back to everything I love, and it’s like a miracle as far as I’m concerned.”
A native of Calgary, Canada who cut his teeth in the documentary industry of Washington, D.C., Nils moved to the Pacific Northwest in 2009 after working on a National Park Service film about Mt. Rainier and falling in love with the area. He has been producing non-fiction content for thirteen years, from broadcast and independent documentaries to museum films and non-profit PSAs. One of his most recent films, 'Beyond the Visible’ which reveals the inner workings and transformational science of the Very Large Array Telescope in New Mexico, was just awarded the 2014 Cine Golden Eagle Award for non-fiction storytelling. Nils lives in Seattle with his wife and two kids.More stories by Nils Cowan