Man's recurring tumors may change cancer care

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(AP) It's a medical nightmare: a 24-year-old man endures 350 surgeries since childhood to remove growths that keep coming back 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 coup that holds promise for millions of cancer patients.

The strange case is the first use in a patient of how to keep ordinary and cancerous cells alive indefinitely in the lab.

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The discovery allows doctors to grow "mini tumors" from each patient's cancer in a lab dish, then test various drugs or combinations on them to see which works best. It takes only a few cells from a biopsy and less than two weeks to do, with materials and methods common in most hospitals.

Although the approach needs much more testing against many different cancers, researchers think it could offer a cheap way to personalize treatment without having to analyze each patient's genes.

"We see a lot of potential for it," said one study leader, Dr. Richard Schlegel, pathology chief at Georgetown Lombardi Comprehensive Cancer Center in Washington. "Almost everyone could do it easily."

For infections, it's routine to grow bacteria from a patient in lab dishes to see which antibiotics work best, Dr. George Q. Daley, director of the stem cell transplantation program at Children's Hospital in Boston, said in an email. "But this has never been possible with cancer cells because they don't easily grow in culture," he said.

The new technique may reveal in advance whether a person would be helped by a specific chemotherapy, without risking side effects and lost time if the drug 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's not a drug that doctors would have thought to try, because the man technically does not have cancer. But his lung tumor shrank after a few months of treatment, and he has been stable for more than a year. He still has to have operations to remove throat growths that keep coming back, but only about once every five months.

The man, an IT specialist in suburban Washington who asked to remain anonymous, has recurrent respiratory papillomatosis, or RRP. It's usually due to infection at birth with certain types of a virus, HPV, that causes genital warts.

The condition causes wartlike growths in the throat, usually around the voice box. These growths usually are noncancerous but can turn malignant, and even benign ones can prove fatal if they spread to the lungs. The main treatment is surgery, usually with lasers to vaporize the growths and keep them from choking off the airway or making it hard to talk.

About 10,000 or more people in the U.S. have the disease, said Jennifer Woo, president of the RRP Foundation. Woo, 29, is a medical student at Georgetown and one of the researchers on the study. She also has the condition but said it is confined to her throat and has required only 20 surgeries so far.

The man in the new study has a much more serious case.

"I was diagnosed when I was 3 or 4. At first, I had to have surgery every 7 to 10 days," the man said in a phone interview. "I get short of breath and my voice will get more hoarse."

Two years ago, the growths to his lungs became extensive and life-threatening, and his physician, Dr. Scott Myers, described the condition at a meeting of Georgetown hospital specialists. "It's crushing the airway," Myers said.

Doctors suggested that the new lab method pioneered by Schlegel and others might help. It borrows an idea from stem cell researchers: adding mouse cells for nourishment, plus a chemical that prevents cell death to an ordinary lab culture medium. That enabled healthy and cancerous cells to keep growing indefinitely.

Researchers grew "mini tumors" from the man's lung mass and from healthy tissue and screened various drugs against them. One proved ineffective. Another worked against the tumor but at too high a dose to be safe. The third did the trick.

A similar approach could let doctors screen drugs for cancer patients.

"What could be more personalized than taking this person's cell, growing it in culture, finding a drug to treat them and then treat them?" said Doug Melton, co-director of the Harvard Stem Cell Institute. The Georgetown method gives an answer quickly enough that it could save lives, he said.

Tyler Jacks, a cancer researcher at the Massachusetts Institute of Technology and former president of the American Association for Cancer Research, said the next step is to show that this could work for many different cancers 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.

The National Institutes of Health paid for much of this work and has already sent research teams to Georgetown to learn the method. About a dozen 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.

[ToolMangler1]

In the 'olden days' man was known to live 800 to nearly 1000 years. Check out Noah, Methuselah and others in the 'Pentateuch'. Maybe someday we can get back the 'lost years'..

[charbmoore]

As usual, the most elegantly simple experiment is the best. Scientist know this since it is taught in class from the begining of your training, but I love to see it in action.

[Atlanticum]

I miss your point Henri. This is a good use of tax dollars for research.

[alphaa10000]

MEDICAL CARE AND MEDICAL INFLATION

Henri_Rochard said, "Now I'm not saying this gentleman shouldn't receive treatment; I'm not on a death panel, but if we want to provide care in cases like these, it's gonna be expensive..."
--------

Researchers find privately-delivered health care is excessively costly, and the leading source of inflation in our country.

But competent medical research is not the cause. Research delivers improved recovery prospects to patients through better diagnostics and more effective treatment, bringing the cost of treatment down and the number of treatment options up-- hardly a grim prognosis for patient care efficacy per dollar spent.

Soaring medical cost comes, instead, from simple greed. Researchers studying the problem of "medical inflation" found it linked not to more research, but to the opposite end of America's health care system-- an unrelenting, even fraudulent rush to huge profits by both health care providers and medical insurers.

Inevitably, the rush to profit occurs at patient expense, as well as to taxpayers. According to the National Academy of Medicine, "... each year more people die from medical errors than from motor vehicle accidents (43,458), breast cancer ( 42,297), or AIDS (16,516). The number of deaths caused by malpractice also exceeds the number of deaths in the U.S. caused by accidental falls, drowning, and aviation accidents combined. The scary reality is that malpractice has become one of the top 10 leading causes of death in the United States."

Life Extension Magazine (March, 2004) reports, "2.2 million people per year have adverse reactions to drugs within hospitals. The number of unnecessary antibiotics prescribed annually for viral infections is 20 million per year. The number of unnecessary medical and surgical procedures performed annually is 7.5 million per year. The number of people exposed to unnecessary hospitalization annually is 8.9 million per year... the most shocking statistic is that the total number of deaths caused by conventional medicine is an astounding 783,926 per year!!" (http://www.chiro.org/LINKS/Iatrogenic_Page.shtml)

Figures from the World Health Organization (WHO) show the United States spent $7,146 per capita on health care-- 15 percent of the 2008 US Gross Domestic Product, more than any other nation.

Yet, each year, fewer than 2,000 physicians (less than one-third of one percent of all physicians) are disciplined by state boards for any reason.

Equally puzzling, hospitals continue to double or even triple-bill treatment and even procedures completely unwarranted (not medically indicated)-- apparently to gather more money. All too frequently, the over-charges are passed along to Medicare, and the taxpayer.

Columbia Hospital Corporation (HCA) paid the largest court judgment in history for its fraudulent practices-- in settlements reached in 2000 and 2002, Columbia/HCA pled guilty to 14 felonies and agreed to a fine over $600 million. Columbia/HCA also admitted systematic overcharges-- claiming marketing costs as reimbursable, concealing illegal deals with home healthcare agencies, and submitting fraudulent claims about its overhead. HCA also admitted fraudulent charges to Medicare by exaggerating the seriousness of diagnoses and giving doctors partnerships in company hospitals as a kickback for the doctors referring patients to HCA.

HCA filed false cost reports, including charges for home health care workers, and paid kickbacks in the sale of home health agencies and to doctors to refer patients. In addition, HCA gave doctors "loans" (never to be repaid), as well as free rent, office furniture, and drugs from hospital pharmacies.

Florida governor Rick Scott was CEO of HCA during the years in question, and after a federal investigation turned up alarming evidence, was persuaded to resign by nervous HCA corporate officials in 1997.

In late 2002, HCA agreed to pay the U.S. government $631 million, plus interest, and pay $17.5 million to state Medicaid agencies, in addition to $250 million paid to resolve outstanding Medicare expense claims. In all, civil law suits cost HCA more than $2 billion, the largest fraud settlement in US history. (Wikipedia, "Rick Scott")

Federal researchers laying groundwork for reforms found the syndrome of overpriced, underperforming private health care delivery could be remedied by much closer scrutiny of medical billing practices. They wrote these reforms into the Affordable Health Care Act for America-- also known popularly as "Obamacare".

[Henri_Rochard]

If any of y'all are wondering why health care is so expensive, this is exhibit 'A'.

Now I'm not saying this gentleman shouldn't receive treatment; I'm not on a death panel, but if we want to provide care in cases like these, it's gonna be expensive. Let's face it, in the olden days this man would've been dead and buried a long time ago.