EXPERIMENTAL CANCER TREATMENT CURBS 'RELENTLESS DISEASE' IN TEST
By HAROLD M. SCHMECK Jr., Special to the New York Times
Published: February 5, 1987
NEW HAVEN, Feb. 4— An experimental treatment in which a drug activated by ultraviolet light kills cancer cells in the blood produced major improvements in some patients whose disease had resisted all conventional treatments, scientists reported today.
Although employed so far against only a single form of cancer, the novel treatment might prove valuable in the future against other ills, including some cases of leukemia, rheumatoid arthritis and threatened rejection of transplanted organs, leaders of the research project said at a news conference at Yale University's medical school.
The treatment might be applicable to any of several diseases in which the objective would be to eliminate diseased cells that circulate in the blood. It is being tested as a means of killing viruses, including the AIDS virus, in donated blood, the researchers said.
An international research team has tested the experimental treatment in 37 patients suffering from advanced cases of a major cancer of the immune defense system, cutaneous T-cell lymphoma. At least 10,000 new cases of the disease are estimated to occur every year in the United States, and it is usually fatal if it proceeds to an advanced stage. #27 of 37 Improve Conventional treatment, chemotherapy or radiation, had been unsuccessful in all of the 37 patients. The new treatment produced improvements in 27 of the patients, two of whom have remained free of symptoms for about two years since the treatments were stopped. The experimental treatment failed in six patients. Four others, still being treated, were judged to be unchanged after at least 24 weeks of the treatment.
Dr. Richard L. Edelson, the chairman of the department of dermatology of the Yale School of Medicine, explained that cutaneous T-cell lymphoma usually begins with a skin rash that spreads gradually over much of the body. He said it can often be arrested if caught early, but in the patients who volunteered for the experimental treatment, the disease had damaged vital internal organs such as the liver. On the average, patients survive only about 30 months after the disease reaches this advanced stage.
The first detailed report of patients' response to the novel treatment was published Thursday in The New England Journal of Medicine. F.D.A. Approval Sought
''Considering the early state of this technique, it is particularly encouraging that such results can be obtained in the apparent absence of limiting side effects,'' the report said. The scientists noted, however, that these results are only a preliminary step in the development of a new form of treatment based on the use of drugs that are activated by ultraviolet light.
The treatment, approved last August by an advisory committee to the Food and Drug Administration, is being considered for approval by the agency.
The drug used in the studies is methoxsalen, a substance found in trace amounts in figs, limes and some other fruits and vegetables. It is inert in the dark but is activated by low energy ultraviolet light in sunlight, a fact that has been known for centuries. In its active form it damages DNA and therefore can kill or inactivate cells. It has been widely used to treat the skin disease psoriasis. When hit by the appropriate untraviolet light, the drug is activated in a millionth of a second.
The targets of the new anti-cancer treatment are clones of cancerous T-cells. Normal T-cells, a type of white blood cell, are crucial components of the immune defense system. In the experimental treatment, the drug apparently inactivated more than 80 percent of the T-cells exposed to it. Once back in the body, the dead or damaged T-cells seem to have evoked an immune reaction that attacked many more of the patient's malignant cells. The exact mechanism of this reaction is unknown, but is the subject of continuing study, Dr. Edelson said.
In research over the past several years, Dr. Edelson and his colleagues, with engineers of Therakos Inc., a subsidiary of Johnson & Johnson, have developed the treatment technique. The Blood Is Treated
The patient is fed a dose of the inactive methoxsalen. Later, blood is removed and separated into red cell, white cell and serum components. The red blood cells are infused back into the patient immediately. The white cells and the serum containing the inactive drug are exposed to ultraviolet light while flowing through tubes of disposable plastic units. Then the treated cells are put back into the patient.
In addition to Dr. Edelson, leaders in the research included Drs. Francis Gasparro and Peter Heald of Yale, Dr. Carole Berger of Columbia, and Drs. Brian Jegasothy and Bruce Wintroub of the University of Pennsylvania. The research studies were also conducted at the Universities of Vienna and Dusseldorf in Europe. The equipment was demonstrated today by Glynis McKiernan and Inger Christiansen, Yale nurses who are co-authors of the report.