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Cancer treatment was for years dominated by just four techniques. But there is now a fifth category -- immunotherapy -- thanks to the revolutionary research of Jim Allison and Tasuku Honjo, who won the 2018 Nobel Prize in Medicine on Monday. Allison joins Nick Schifrin to discuss his research and his personal connection to fighting the disease.
It's Nobel Prize week.
And, today, the Nobel Committee announced its 2018 award in medicine.
Jim Allison, an American research scientist, and Tasuku Honjo from Japan, helped create a revolutionary cancer treatment that continues to save lives.
Nick Schifrin has that story.
For years, cancer treatment was dominated by four techniques, surgery, radiation, chemotherapy, and hormone treatments.
There is now a fifth category, because researchers overcame a fundamental challenge. In the past, they couldn't recruit the body's own immune system to fight cancer. But, today, they can. And that is thanks to the research of Jim Allison, today's Nobel Prize winner and chairman of immunology at the University of Texas MD Anderson Cancer Center, who joins me now from New York.
Jim Allison, thank you so much. Congratulations on the award.
How do you feel? And how did you find out?
I feel stunned, actually. This is something I suppose every scientist must dream of. And it's happened, and I'm still absorbing it.
The way I found out about it was actually this morning that my son called me. He was watching television. Somehow, the committee didn't have my cell number and so didn't know how to contact me.
And so I got the message from my son, who was watching, and called and said, "Hey, dad, you know, you won the Nobel Prize."
And what a great way to get the news — get the message anyway.
You effectively learned how to manipulate the immune system to go after cancer cells, not only by turning on the gas, so to speak, of the immune system, but by turning off the immune system's brakes.
How's that work?
Well, we were — I have been studying T cells for 30 years now, just trying to learn their…
T cells, basically the immune system's soldiers, so to speak.
Yes, the soldiers that — you start with a few, you got to build an army, and then they go out and take care of whatever the problem it is, virus infection, or bacteria, or, in this case, cancer.
And it's a very tightly controlled process. And we learned that there's an antigen receptor, which is kind of like the ignition switch in a car, that has to be flipped when something is recognized, saying, OK, we got to go. But that's not enough.
There's another molecule that's needed, a second signal that we showed in the late '80s was a molecule called CD28. But it turns out there's still a third molecule called CTLA-4 that actually serves as the brakes, because, once you start that process, you have got to stop it to keep the immune system from hurting normal cells.
And so I had the idea that, if we just block this break, disable the brakes temporarily, we could let T cells keep going until they had time to actually eliminate the entire tumor.
And that reference, elimination, because you're using the immune system, this is not only about suppressing cancer. You're actually curing these patients, right?
Well, I use that cautiously. But, in the case of melanoma, about 22 percent of people — and this is a study of thousands of patients of whom — for whom there's 10 years follow-up — about 22 percent of patients with late-stage melanoma, for which the prognosis, the survival was about 11 months after diagnosis when we started this work, about 22 percent, again, after a single dose are alive 10 years later.
Jim Allison, I want to talk about one of those patients.
Take me back to 2006. You get a call from a colleague about one of his patients who had advanced melanoma and was being treated with drugs based on your research. Tell me about Sharon Belvin.
Yes, Sharon, I found out subsequently, she was 22. She had just finished school, was engaged to be married, when she was tired, and had some exhaustion.
She went to see her doctor. And she had metastatic melanoma. And she had, as I recall, 31 tumors in her lungs and a small brain metastasis and some on her skin. And she was — had failed everything.
So she was in really bad shape. And so Jedd Wolchok, a clinical colleague at Sloan Kettering, put her on this trial. And her tumors completely went away. And when she came in and was told she was tumor-free, Dr. Wolchok said, the guy that invented this is here. You want to meet him?
And so she did. And she — Jedd called me and said, "Come down. I want you to meet somebody."
And I — and — anyway, I went down to the outpatient care and walked in the room. And we all started hugging and crying. Before then, it had all just been numbers to me. She was the first patient that I met.
And we became friends. And several years later, she sent me a photo of her first baby and, then a few years after that, her second baby. And she's now about 14 years out from the treatment and has a lovely family. We still stay in touch. She actually came to my 70th birthday party.
Was it always numbers for you? Tell us about — tell us about how you first got into this. Tell us about your mother.
Well, my mother passed away when I was about 10 of lymphoma and was treated with radiation. And I was with her when she passed away.
And she had two brothers, my uncles. Two of them died when I was very young, one of melanoma, the other of lung cancer. And the one that was lung cancer was treated with chemotherapy. And I got to see the ravaging effects of chemotherapy up close.
I did have in the back of my head this notion that the immune system offered the possibility of really specifically and selectively killing tumor cells, with the hope of not causing any adverse events.
Quickly, Jim Allison, in the time we have left, there are serious side effects to this. There have been. It's very expensive.
Are you going to continue work on this therapy and on this research?
There are serious side effects in some patients, not in all, but in some. But they're typically manageable. The algorithms have been developed as physicians have experience with it where these can be really minimized in the vast majority of patients.
But we know now that this drug works against many types of cancer. And PD-1 and the combination work against many kinds of cancer, including not just melanoma, but lung cancer, and Hodgkin's lymphoma, kidney cancer, bladder cancer, the head and neck. The list goes on and on.
What we're working on now is trying to understand why it works sometimes and doesn't, in order to design combinations of drugs, both immunotherapy drugs and more conventional ones, which can be put together in a way that makes sense to maximize the therapeutic effect and try to increase that number of patients that benefit from this new type of therapy.
Jim Allison, Nobel Prize winner, thank you very much.
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