It's a medical nightmare: a 24-year-old manendures 350 surgeries since childhood to remove growths that keep comingback in his throat and have spread to his lungs, threatening his life.Now doctors have found a way to help him by way of a scientific coupthat holds promise for millions of cancer patients.
Thebizarre case is the first use in a patient of a new discovery: how tokeep ordinary and cancerous cells alive indefinitely in the lab.
Thediscovery allows doctors to grow "mini tumors" from each patient'scancer in a lab dish, then test various drugs or combinations on them tosee which works best. It takes only a few cells from a biopsy and lessthan two weeks to do, with materials and methods common in mosthospitals.
Although the approach needs muchmore testing against many different types of cancer, researchers thinkit could offer a cheap, simple way to personalize treatment withouthaving to analyze each patient's genes.
"Wesee a lot of potential for it," said one study leader, Dr. RichardSchlegel, pathology chief at Georgetown Lombardi Comprehensive CancerCenter in Washington. "Almost everyone could do it easily."
An independent expert agreed.
Forinfections, it's routine to grow bacteria from a patient in lab dishesto see which antibiotics work best, Dr. George Q. Daley of Children'sHospital Boston and the Harvard Stem Cell Institute said in an email."But this has never been possible with cancer cells because they don'teasily grow in culture," he said.
The newtechnique may reveal in advance whether a person would be helped by aspecific chemotherapy, without risking side effects and lost time if thedrug doesn't work. "Pretty nifty," Daley wrote.
In the case of the 24-year-old, described in Thursday's New England Journal of Medicine, lab-dish tests suggested that a drug used to treat a type of blood cancer and some other unrelated conditions might help.
It'snot a drug that doctors would have thought to try, because the mantechnically does not have cancer. But his lung tumor shrank after a fewmonths of treatment, and he has been stable for more than a year. Hestill has to have operations to remove throat growths that keep comingback, but only about once every five months.
Theman, an information technology specialist in suburban Washington whoasked to remain anonymous to protect his privacy, has recurrentrespiratory papillomatosis, or RRP. It's usually due to infection atbirth with certain types of a virus, HPV, that causes genital warts.
Thecondition causes wartlike growths in the throat, usually around thevoice box. These growths usually are noncancerous but can turnmalignant, and even benign ones can prove fatal if they spread to thelungs. The main treatment is surgery, usually with lasers to vaporizethe growths and keep them from choking off the airway or making it toughto talk.
About 10,000 or more people in theU.S. have the disease, said Jennifer Woo, president of the RRPFoundation. Woo, 29, is a medical student at Georgetown and one of theresearchers on the study. She also has the condition but said it isconfined to her throat and has required only about 20 surgeries so far.
The man in the study has a much more serious case.
"Iwas diagnosed when I was 3 or 4. At first, I had to have surgery every 7to 10 days," the man said in a phone interview. "I get short of breathand my voice will get more hoarse."
Two yearsago, the growths to his lungs became extensive and life-threatening, andhis physician, Dr. Scott Myers, described the condition at a meeting ofGeorgetown hospital specialists. "It's crushing the airway," Myerssaid.
Doctors suggested that the new labmethod pioneered by Schlegel and others might help. It borrows an ideafrom stem cell researchers: adding mouse cells for nourishment, plus achemical that prevents cell death to an ordinary lab culture medium.That enabled healthy and cancerous cells to keep growing indefinitely.
Researchersgrew "mini tumors" from the man's lung mass and from healthy tissue andscreened various drugs against them. One proved ineffective. Anotherworked against the tumor but at too high a dose to be safe. The thirddid the trick.
A similar approach could let doctors screen drugs for cancer patients.
"Whatcould be more personalized than taking this person's cell, growing itin culture, finding a drug to treat them and then treat them?" said DougMelton, co-director of the Harvard Stem Cell Institute. The Georgetownmethod gives an answer quickly enough that it could save lives, he said.
TylerJacks, a cancer researcher at the Massachusetts Institute of Technologyand former president of the American Association for Cancer Research,said the next step is to show that this could work for many differentcancers and that it leads to better outcomes in patients.
"It seems to have worked in this one instance, but other tumors might prove to be more challenging," he said.
TheNational Institutes of Health paid for much of this work and hasalready sent research teams to Georgetown to learn the method. About adozen other universities have done the same, Schlegel said.
So far, his lab has grown prostate, breast, lung and colon cancer cells.
Georgetown University is seeking a patent on the method.