PROTEIN TRANSDUCTION: - Moores Cancer Center

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VACCINES TAKE A SHOT AT CANCER ONE OF THE MAJOR ACCOMPLISHMENTS OF THE LAST HALF-CENTURY has been the development of vaccines to prevent such diseases as polio, measles, diphtheria and influenza. But now scientists at the Moores UCSD Cancer Center and other major institutions across the nation and around the world are working on vaccines for cancer. Unlike their predecessors, which prevent illness, cancer vaccines are designed to prevent a recurrence in those who already have the disease. These therapeutic vaccines work by teaching the patient’s own immune system to recognize and eradicate cancer cells. Researchers at the Cancer Center are conducting two clinical trials now to test the effectiveness of a patientspecific, or customized, vaccine against non-Hodgkin’s lymphoma (NHL). The vaccine is made from a protein found on the surface of lymphoma cells taken from the patient’s lymph nodes. This protein, called an idiotype (Id), is unique to the lymphoma cells of a particular patient. The Id is then mixed in the laboratory with a substance called keyhole limpet hemocyanin (KLH), which is derived from sea snails. The body recognizes KLH as an invader and launches an immune response. “When the Id-KLH cocktail is injected, the immune system not only attacks the KLH but also recognizes its own cancerous cells and destroys them as well,” said the Cancer Center’s Peter Holman, M.D., assistant professor of medicine and principal investigator of the two clinical trials. In one study, the vaccine is injected following an autologous stem cell transplant. In this type of transplant, the patient’s stem cells are removed before high-dose chemotherapy is administered, and then given back afterward to replenish the body’s supply of blood cells. So far four participants have completed this protocol at UCSD and three have mounted an immune response. The first patient on the study received his final vaccination in May 2002 and remains in remission with no further treatment (see sidebar). “While it is early in the process, the strength of the immune response results gives us hope that we may see prolonged remissions,” said Dr. Holman. To be eligible for the study, patients Peter Holman, M.D. must be diagnosed with low-grade or mantle cell non- Hodgkin’s lymphoma (NHL). Also eligible are patients whose low-grade NHL has transformed to high-grade NHL. This study is designed to test whether or not post-transplant patients would develop an immune response to the vaccine, and, if so, would this keep patients in remission longer than would be expected following a transplant alone. Dr. Holman is also conducting a non-transplant clinical trial in which patients receive the monoclonal antibody Rituxan before receiving the vaccine regimen. Non-Hodgkin’s lymphoma is one of three cancers that have been increasing in incidence over the past 20 years; the others are lung cancer in women, and melanoma. There has been an 81 percent increase in NHL overall since 1973. The reasons for this increase are not well understood, although environmental agents have been implicated, along with hepatitis C and HIV. There were 54,000 new cases of NHL in the U.S. in 2002, representing 4 percent of all cancers. For further information about these and other cancer clinical trials available at UCSD, please call the Cancer Center’s Clinical Trials Office, 858-657-7020, or visit the Center’s website: www.cancer.ucsd.edu. Cancer Center News 6
Jerry Hermesch: REGAINING HIS FUTURE For the last eight years, since being diagnosed with Stage IV non-Hodgkin’s lymphoma, Galen “Jerry” Hermesch has been living one day at a time. Before enrolling in a therapeutic vaccine study at UCSD, he had gone through numerous treatment approaches and had relapsed three times. The 56 year old from Rancho Mirage is hoping that the third time will prove to be the charm. “Until now, my longest time in remission was eight months,” Hermesch said. “It’s been 19 months since my autologous stem cell transplant, and almost a year since my last vaccination and there are no indications of any recurrence.” While Hermesch knows that the vaccine is experimental and that he may have a recurrence of his disease, he is for the first time in nearly a decade thinking about the future. “Without this treatment, I know the disease would have been a continuing issue until it took my life,” he said. “While there’s no way to say for certain that it’s the ultimate answer, it offers the most positive thing that I have experienced in the last eight years. All of a sudden, it seems, I have a future again.” Calculating Your BREAST CANCER RISK A new Web site, www.breastcancerprevention.com, offers women a simple tool to estimate their individual breast cancer risk and provides information about the STAR study, a clinical trial to prevent the disease. The Web site is sponsored by the National Surgical Adjuvant Breast and Bowel Project (NSABP), a non-profit cancer research group funded by the National Cancer Institute (NCI). Researchers from the NCI and the NSABP have developed a computerized formula, known as the Gail model, that allows a woman to estimate her risk of developing breast cancer in the next five years and in her lifetime. The model uses factors such as age, family history of breast cancer, and other personal factors to determine these estimates. Most importantly, the Gail model has been scientifically analyzed and found to be reliable. “In my practice, I find that women tend to overestimate their breast cancer risk leading to increased anxiety about developing the disease,” said Anne Wallace, M.D., director of the Cancer Center’s Breast Care Unit. “Information my patients get about their individual breast cancer risk from the Web site allows me to have a personal conversation with them and to map a strategy for good breast care.” A decade ago, women at increased risk for breast cancer had no option other than vigilant screening designed to detect the disease in its earliest stage. That no longer is the case. In 1998, research showed that tamoxifen — a drug used for over 20 years to treat breast cancer — could prevent the disease from occurring in almost half the women at increased risk for it. Armed with this finding, the NSABP and the NCI began a follow-up study, called STAR (Study of Tamoxifen and Raloxifene), to compare the proven benefits of tamoxifen to the promising effects of raloxifene, an osteoporosis drug that has shown potential for reducing a woman’s risk of breast cancer. STAR participants take either tamoxifen or raloxifene daily for five years and receive close follow-up examinations. The drugs are provided at no cost to study participants. Postmenopausal women at increased risk for breast cancer can call 858-657-7083 for more information about STAR. 7 Cancer Center News
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PROTEIN TRANSDUCTION: - Moores Cancer Center

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