Immunotherapy" Conquering Cancer from the Inside | Arthur Brodsky | TEDxWilmingtonSalon

so I'm a pretty big dude [Music] I'm pretty social so when you add those two things to get science pops up and a lot of the conversations I have and before long I'll usually mention immunotherapy and the most common reaction I get is what's that then I'll say that immunotherapy uses our immune systems to cure cancer and at that point I'll see a lot of people's curiosity turned to skepticism and some people ask if it's like an alternative medicine or something I understand that I mean the idea at first that your immune system cares cancer does sound a little bit like wishful thinking but I assure you that immunotherapy is very real and very legit in fact I'm sure you're already familiar with immunotherapy you've just never heard it called that so basically immunotherapy is just a way to help our immune systems fight disease we've already used it against polio and tuberculosis and smallpox and many other diseases we call them vaccines but they're really just a form of immunotherapy however fighting something that's clearly an outsider like a virus or bacteria is one thing fighting cancer is something else it's it's much harder and it's because the disease is much more complex and much more subtle it's our own cells that are rebelling against us above all what makes cancer cancer is its uncontrolled growth but if you look beyond that growth cancer is extremely complex and that's why we're good at treating tumors when they're small before they advance but as they get larger and they progress and they develop new tactics our current treatments surgery chemotherapy and radiation don't really work that well which is why cancer still kills one of every four people in this country luckily we've learned a lot more about both cancer and the immune system and we've gotten much better at using immunotherapy to empower patients immune systems and help them to overcome cancer and conquer it with their own bodies so it was actually immunotherapy actually started 125 years ago with a New York City surgeon named William B Coley he read about a patient whose neck his tumors all over his body disappeared after he got a really bad infection and he was intrigued by this connection so he decided that he would purposely infect to try to cure them and crazily enough he actually didn't need any permission for this back then probably wouldn't have gotten it today but in 1891 he actually treated a man named Zola infected him with bacteria and he had several large tumors including one in his throat that made it so he couldn't even eat and he was near death and although he actually almost died from the infection within two days his tumor started to shrink and he soon resumed his normal life Coley and a few other doctors had some successes with Coley's toxins as they came to call them but a lot of doctors didn't really take the approach seriously our technology wasn't that advanced then and the technique didn't true it was hard to replicate and beyond anything else we just didn't really know that much about the immune system in fact Cole himself didn't even realize that the immune system was responsible he thought that it was something in his mixture itself that was directly poisoning the cancer cells hence the name toxins so like the pacemaker and a lot of other breakthroughs in the history of Medicine immunotherapy also benefited from a little bit of luck in the beginning fortunately for us too while the medical establishment largely largely dismissed Coley's work not everybody forgot about it one was his daughter Helen who in 1953 founded the Cancer Research Institute or CRI or I actually work now now in 1953 no one believed in immunotherapy and CRI for several decades was the only organization that actually was devoted to advancing it and one of one of the we still actually fund a lot of researchers around the doctors and scientists around the world not only to figure out base the basics of the immune system and how it works but more importantly taking that knowledge and then translating into life-saving medicine and probably no one and no one has been more important to immunotherapy or CRI than Lloyd Jay old here and he actually worked at the same cancer center that dr. Coley did which is now called Memorial sloan-kettering and I think it's safe to say that without his contributions I mean no therapy definitely wouldn't be where it is today one of the most important things that he is one of the most important contributions was he helped us figure out how the immune system identified other cells and it does this by looking at the molecular markers on cells so in in this case it can look it looks at our cells determines if they're healthy or not and then figures out if it needs to do anything about it and The Situation's a lot more complex than this there's a lot more types of markers a lot more types of cells but this is good at capturing the idea that at the root of the immune systems power is its ability to physically interact with and make sense of molecules on other cells and although you don't really need to pay attention to the colors too much just going forward keep in mind that anything that's red is involved in the immune system's ability to to recognize and then go after the cancer so the way that the immune system does this is actually pretty complicated so I'm just going to cover a few of the basics first we've got general immune cells that basically you're on Lookout duty as you can see they don't have any of those red receptors to actually target the cancer because that's not what they're designed to do but as tumors grow and start to disrupt their surroundings these immune cells that are alerted and then they start to do a little recon and they'll figure out they'll go and on our active cancers markers and figure out what it looks like and then after that it can actually coordinate a overall ramune response and develop customized cells that are specially designed to target the cancer now our immune system will normally do this and help protect us but unfortunately tumors often develop ways to protect themselves against the immune system and sometimes the immune system needs a little help which is where immunotherapy comes in so one way that tumors are protected from the immune system is through molecules called checkpoints which you can see here these receptors on the cells now when these checkpoints get bound they actually act as an off switch and they shut down the immune cells so that they can't attack the cancer anymore luckily we've developed checkpoint immunotherapy drugs called checkpoint checkpoint blockers that act as a send in a sense caffeine they help keep the immune system active and awake and so when these checkpoint blockers going - here you can see that they interfere with that receptor and prevent it from being turned off and help the immune system stay on and carryout continuing to eliminate the tumor the first checkpoint was actually FD got FDA approval five years ago and since then we've got several more have been approved for several types of cancers and they've helped many patients that were previously untreatable in melanoma which was the first cancer that they were approved for they've actually doubled five-year survival rates already unfortunately they don't work on all tumors so to tackle these harder to treat tumors we're starting to use the checkpoint immunotherapy is in combination with other immunotherapies that I'll be talking about in a little bit and the goal of this is to basically stimulate and empower and enable the immune system to go after cancer we're also realized that some of our old treatments also have the ability to stimulate the immune system so we're starting to use those in combination with immunotherapy as well one of these is radiation for the longest time we just use radiation to directly kill the cancer cells which is good but more importantly when the radiation hits the cells it can cause them to release their markers which will alert the immune system and allow it to come in and it'll see what the cancer looks like and this allows it to eliminate the rest of the cells that are still there and the using radiation in combination with immunotherapy is actually what helped former President Jimmy Carter when his melanoma metastasized to his brain the doctors first his appétit with radiation and then they added one of those checkpoint blockers that I talked about to give his immune system a little boost and allow it to continue finishing off the cancer another way that we can stimulate the immune system is through viruses just last year actually the FDA approved a modified herpes virus to treat melanoma and they did this this works by they first removed the bad genes that cause herpes and replace them with good genes that help the immune system so after these viruses are modified they're injected into the tumors where they infect the cancer cells and then the first thing that happens is the cells will start to produce that molecule that will recruit the immune system then the cancer cells will die and then when they die they'll release their markers which further stimulates the immune system and allows it to form a strong attack against it we're also developing more personalized immunotherapies and one of these is called car t-cell in this doctors take immune cells from the patient and then they actually help make them into it they transform them into a stronger version that's better at finding and targeting the cancer and there's a number of ways they can do this and we still honestly don't know the best one one of them for example could be removing these checkpoint receptors that we know turn the immune cells off and instead replacing them with the receptors that allow they will allow the immune cells to go after in target cancer one person who's already benefited from these is Emily Whitehead she was diagnosed with leukemia at the age of five tried a bunch of different types of chemotherapy none of them worked but then she got card t-cells in 2012 and amazingly they eliminated her leukemia and have allowed her to live a healthy life since then now card P cells are an FDA approved yet but they've been tried in hundreds of patients in clinical trials and in Leukemia and Lymphoma they've worked on about four out of every five patients which is an absolutely incredible success rate so hopefully I expect to the next couple years we'll start to see some of these become FDA approved and then hopefully more patients can benefit just like Emily has another way that another type of personalized immunotherapy are vaccines now normally when we think of a vaccine we think of something that helps prevent a disease not treat something we already have and while we may eventually be able to develop a vaccine that helps us prevent cancer right now we're focused on using vaccines to help treat people that already have cancer so there's there's many different types of vaccines but above all their job is to educate the immune system about what the cancer looks like tell it what the cancers markers are and now the reason that these are considered personalized is because every tumor has its own unique mutations so what you tell one patient's immune system won't work for another because the two tumors look different so once you get this information to the immune system again it'll be able to coordinate that that overall response and develop those customized cells that are targeted specifically to that tumor and we still don't know the best way to make a vaccine we don't know what makes the best vaccine either we're still figuring out what's the best information to deliver as well as what's the best way to deliver it but we are making great progress and we're also starting to figure out ways that we can rapidly figure out what mutations a patient has and then convert that into a vaccine quickly and for hopefully the most success and I would these are a bit longer term but I would think within the next decade we'll really start to see some of these succeed as well unfortunately both the vaccines and cartee cells and the checkpoints by themselves they'll never work for every patient and because we can we can tell the immune system what to look for and we can give it powerful cells but that's useless unless the immune cells can actually get into the tumor which isn't always possible because some recruit cells that act as bouncers and they literally block the immune cells from being able to get in there so these other cells that cancer recruits to support it are a whole another level of complexity to the whole issue and unfortunately we want to have time to talk about them today I also won't have time to talk about the hundred trillion bacterial cells that live on our skin and in our guts that influence cancer as well as our ability to treat it and not only there not only affect cancers of the gut and of the skin but they actually influence our immune system over our entire body so bacteria in your stomach can actually influence cancer anywhere else in your body and tumor the cancer cells and the immune cells also compete so for instance they fight over precious resources in the tumor and if the tumor cells win over the immune cells the immune cells starve and they actually can't do anything else about it so my slides earlier made it seem fairly simple for us to use the immune system to fight cancer but but the environments that tumors create around themselves are extremely complex and there's many factors that control it and those factors also vary from patient to patient so what we need isn't a magic bullet in fact the magic bullets probably doesn't exist different patient different tumors and different patients always need different strategies so rather than a single magic bullet what we need are just several great bullets some of which are the immunotherapies i've already been talking about and more importantly we need to know which one's work best against which types of tumors so by designing the treatments specifically for patients based on the characteristics of their individual tumors we can tell the immune system exactly what it we can give the immune system exactly what it needs to be able to go after the cancer we're also making other advances besides the treatments themselves that will benefit patients as I said earlier if the earlier read attacked cancer the better the better the likelihood that we can get rid of it and we're developing remarkable ways that we can detect cancer earlier so soon you might even be able to get tested for cancer just by a simple blood draw or even a saliva sample we're also constantly learning more about the immune system which will help us refine and improve our strategies and allow it to really get after cancer unfortunately it's going to take a lot more work before we turn those possibilities into realities luckily a lot more people are starting to get on board and immunotherapies potential and invest in it in just the last year we've had several major groups launch that are focusing on immunotherapy including the parker institute for cancer immunotherapy the Bloomberg camel immunotherapy Institute at Johns Hopkins and the cancer moonshot which was launched by Delaware's own Vice President Biden so people always ask me if I think we'll be able to come up with a cure for cancer and honestly a couple years ago I didn't think we would I thought that cancers complexity would be too much for us to tame but with the with how far immunotherapy has already come in addition to the amazing breakthroughs that I see happening every day I know we're on the right path and even though it may not be possible anytime soon to save every single person from cancer I have great I very strongly believe and more important have great reason to believe that eventually we will be able to conquer this deadly disease [Music] [Applause] you

Channel: TEDx Talks

Views: 73,628

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Keywords: TEDxTalks, English, United States, Health, Bacteria, Cancer, Cells, Creativity, Disease, Innovation, Invention

Id: BVLIXmcbfAA

Length: 15min 34sec (934 seconds)

Published: Wed Dec 21 2016