In 1890, William Coley, a surgeon at New York Cancer Hospital, now called Memorial Sloan Kettering, was visited by a 17-year-old patient named Elizabeth Dashiell.
She had had a sore and swollen hand for days after she was trapped between two seats on a train.
After several tests without conclusive results, a biopsy determined that the symptoms had nothing to do with the accident: the girl had developed a sarcoma – a type of aggressive tumor – and not even the amputation of part of the arm managed to prevent her death for a few months then. Obsessed with the case, Coley searched the medical literature for a more effective procedure. What he found is now considered the starting point for immunotherapy.
Years earlier, another sarcoma of a patient diagnosed as incurable had diminished until it disappeared after having suffered an infection by a bacterium of the genus Streptococcus. Coley thought that her immune system had reacted not only against infection, but also against cancer, and to prove it, she infected one of her own patients with the same type of bacteria. In a few weeks he recovered.
Excited, Coley infected numerous more patients over the next few years, trying different combinations. Although he continued to be successful, the procedure only worked sometimes and it was unknown what his success or failure depended on. Also, it did not seem as effective in other tumors. Radiotherapy and chemotherapy, much more docile and susceptible to a pre-established protocol, were imposed as the weapons to be used against cancer.
The results of several clinical trials have brought the therapies that fight cancer through the immune system back to the window
But the idea of him was never completely abandoned. In recent decades, different ways of attacking cancer through the immune system have been tried: with specific antibodies, cytokines – molecules released during the defense reaction – or therapeutic vaccines against the tumor. However, except for certain antibodies, few relevant results have been achieved and there is only one approved vaccine, with limited efficacy, against prostate cancer.
This has been the case until 2013, when the results of several clinical trials with a new type of drug have returned immunotherapy to the showcase, so much so that the American journal Science has chosen it as the scientific breakthrough of the year.
The biggest milestone in science in 2013
“Are we taking risks by choosing and promoting works whose final impact is still unknown? Were we irresponsible in calling a strategy that has only been tested in a few patients and has only helped some of them as a breakthrough? This is the question expressed in the editorial that Science dedicates to immunotherapy against cancer. And it was surely that question that made her competition, the British publication Nature, not include her on its list, although it did dedicate an extensive monograph in compensation.
“Ultimately, our conclusion is that cancer immunotherapy passes the test,” they say in Science. And it does so because this year various clinical trials have consolidated its potential and persuaded even the skeptics ”.
The editors of the prestigious journal refer to trials with so-called “immune checkpoint inhibitors.” These drugs remove the tumor from the hiding place where it manages to take refuge from the defense system.