Sign up with GoogleLightscribe
Banned
- Joined
- Sep 10, 2007
- Messages
- 5,695
An interesting article on the ancient history of cancer immunotherapy.
Cont.
Coley’s Cancer-Killing Concoction
On October 1st 1890, William B. Coley, a young bone surgeon barely two years out of medical school, saw one of his first patients in private practice at the New York Memorial Hospital. Although he’d only finished his residency earlier the same year, he'd already gained a good reputation and many considered him a rising star of the New York surgical scene.
The seventeen year old patient had a painful, rapidly growing lump on the back of her right hand. She had pinched the unlucky appendage between two railway carriage seats on a transcontinental trip to Alaska some months before, and when the bruise failed to heal she assumed the injury had become infected. However the bruise turned into a bulge, the pain steadily worsened, and her baffled doctors were eventually compelled to call for Dr. Coley. As a surgical man, Coley would never have guessed that this innocuous referral would take his career in a totally new direction-- into an unusual branch of medicine now known as cancer immunotherapy.
At first Dr. Coley was also uncertain about the diagnosis. But as the girl’s condition rapidly deteriorated– with the lump becoming larger, more painful, and associated with the loss of sensation in some of the surrounding skin– the awful truth became apparent. She had a sarcoma, a type of cancer that affects bone and connective tissue in the body. Unfortunately, 19th century medicine offered very few treatment options.
On November 8th, Coley amputated her arm at the elbow. Although the operation appeared to go well, the girl– named Elizabeth Dashiell– developed severe abdominal pain three weeks later. Soon thereafter she noticed more lumps in her breasts and armpits, signs that the cancer was metastasizing, or spreading. She rapidly lost strength and died on January 23rd 1891, a scant three and a half months after her initial consultation, with a traumatized Dr. Coley at her bedside.
Elizabeth’s death hit the young surgeon hard. While a more experienced physician might have shrugged away the apparent failure and moved on, Coley was determined to do something. His ensuing efforts culminated in the development of a famous fluid that, for a time, appeared to promise the fulfillment of that long-held dream: a universal cure for cancer.
Coley began by poring through the hospital’s records, looking for clues from previous sarcoma cases that might lead to better treatments in the future. He soon found what he was looking for: the case of a German man who came to the hospital with an egg-sized sarcoma in his left cheek some seven years earlier. There were several attempts to excise the tumour but none of them were successful-- each time the cancer came back, as aggressive as before. The final operation could only partially remove the huge mass, leaving an open wound that subsequently became infected.
The unfortunate immigrant was deemed a terminal case.
Yet four and a half months later, the man was discharged with no trace of disease. Coley personally tracked down the former patient to verify that the miraculous cure had taken place. Indeed, the man was healthy and happily settled into his new life in the United States. The records showed that after the wound became infected with a commonplace bacterium, Streptococcus pyogenes, the patient went through several bouts of fever. With each attack of fever the tumour shrank until eventually it disappeared entirely, leaving only a large scar under the left ear. Coley surmised that the infection had stimulated the German’s immune system– as evidenced by the repeated fevers– and that it was this immune response that had caused the eradication of the cancer.
The story so convinced Coley that he– perhaps cavalierly– contrived to contaminate his next ten suitable sarcoma cases with Streptococcus. His initial approach was to inject a solution of live bacteria deep into the tumour mass on a repeated basis over several months. The first patient to undergo this treatment was a bedridden man with inoperable sarcoma in the abdominal wall, bladder, and pelvis. Using this experimental method, the patient was cured spectacularly. He staged a full recovery, and survived another twenty-six years before dying from a heart attack. But subsequent results were mixed; sometimes it was difficult to get the infection to take hold, and in two cases the cancer responded well to treatment but the patients died from the Streptococcus infection.
Coley’s discovery, as it turns out, was actually a re-discovery. The idea of a link between acute infection and the resolution of tumours was not new, and the phenomenon of infection-related "spontaneous regression" of cancer has been documented throughout history. A 13th century Italian saint was reputed to have his tumour-afflicted leg miraculously healed shortly after the malignant growth burst through the skin and became infected. Crude cancer immunotherapies working along similar lines to Coley’s early experiments were known in the 18th and 19th centuries, and may extend back to the time of the pharaohs. Ancient writings suggest that the renowned Egyptian physician Imhotep may have used a similar infect-and-incise method to treat tumours.
But Coley took those first important steps in dragging this old remedy into the twentieth century. After the fatalities with the ‘live’ version of his therapy, he developed an improved fluid containing killed bacteria of two different strains, Streptococcus pyogenes and Serratia marcescens. This was based on the idea that the dead bacteria would still have the immune-stimulating capability of their living brethren (in the form of purported ‘toxins’), but not share their inconvenient tendency to cause death.
His invention became variously known as ‘Coley’s Toxins’, ‘Coley’s Vaccine’, ‘Mixed Bacterial Toxins’ or ‘Coley Fluid.’ The treatment was met with considerable success, with one study in 1999 suggesting that it was at least equally as effective in treating cancer as conventional modern therapies. With due care in dosing and management of the induced fever, it was also remarkably safe.
Although Coley took the concept of immunotherapy much further than his pharaonic forebears, he had no clear idea how his toxins actually worked, and the tools did not yet exist for him to find out. But given the rapid scientific progress at the turn of the last century, he reasoned that a deeper understanding of his therapy would arrive soon enough. Although the true extent of his "Toxin" success has been questioned by historians, the validity of his approach has never been seriously called into doubt. Indeed his results are regularly cited in the cancer research literature to this day.
Cont.
