29 januari 2018: 

Klik op de titel van de studie voor het volledige studierapport, een reviewstudie over het werk en de resultaten van Dr. Coley, de arts die nog altijd aan de basis staat van de huidige vormen van immuuntherapie met gemoduleerde virussen en bacteriën. Ik heb de introductie vertaald met google translation en daaronder een samenvatting van de conclusies. Maar klik dus voor het volledige studierapport inclusief een referentielijst (staat ook onderaan dit artikel, op de titel die onder de grafiek staat van behandelde patiënten met het Coley vaccin):

TABLE 1

Patients With Inoperable Cancer Treated With Mixed Bacterial Vaccine Alone Before 1940a

Type of CancerTotalPatients With Complete Tumor Remission Follow-up
No Tumor Response
> 20 y10-20 y5-10 y< 5 yb
Soft tissue sarcomas 84 17 12 11 12 32
Lymphosarcomas (lymphomas) 33 8 7 4 4 10
Osteosarcoma 3 0 0 0 1 2
Ewing's tumor/reticulum cell sarcoma 1 1 0 0 0 0
Ovarian carcinoma 4 1 0 0 2 1
Cervical carcinoma 2 1 0 0 1 0
Testicular tumor 14 1 2 3 3 5
Renal tumor 8 1 1 1 1 4
Multiple myeloma 1 0 0 1 0 0
Colorectal carcinoma 1 0 0 0 0 1
Breast carcinoma 13 0 0 2 6 5
Melanoma 6 0 1 0 3 2
aValues indicate number of patients with or without tumor response, duration of follow-up with no indication of relapse.17
bOr relapse within 5 years.

Bron: Glob Adv Health Med. 2012 Mar; 1(1): 92–100.

Published online 2012 Mar 1. doi:  10.7453/gahmj.2012.1.1.016

Fever in Cancer Treatment: Coley's Therapy and Epidemiologic Observations

In de herfst van 1890 ging een atletisch, zelfbewust en bedachtzaam 17-jarig meisje, dat net was teruggekeerd van een avontuurlijke reis naar Alaska, waar ze tijdens een triviaal ongeluk haar hand had bezeerd, naar een jonge, innovatieve chirurg in zijn nieuwe praktijk in New York City. Nauwelijks aan de medische faculteit in Harvard, was hij een rijzende ster in de chirurgische kringen in New York, en de jonge vrouw vroeg hem om hulp bij haar slecht genezende, gezwollen en zeurende pijnlijk letsel. Dit bezoek had een verreikend effect op kankeronderzoek, Amerikaanse filantropie en de carrière van de jonge man, William Coley, MD (1862-1936, figuur 1). De patiënt, Elisabeth Dashiell, vertrouweling en goede vriend van John D. Rockefeller, Jr, werd gediagnosticeerd door Coley met een zeer agressief rondcelsarcoom, en ondanks radicale chirurgie en ondanks Coley's ongetwijfeld fijne chirurgische vaardigheden en intensieve zorg, een snelle progressie van de kanker, het immense lijden en de dood van Elisabeth een paar maanden later kon niet worden voorkomen.

Figure 1William Coley, circa 1888, at the start of his medical career.

De ervaring van het snelle, fatale verloop en de ontoereikendheid van operaties in zelfs het beste en modernste Amerikaanse ziekenhuis zorgde ervoor dat Coley diep geschokt was en vastbesloten een behandeling voor deze vreselijke ziekte te vinden. Het was ook het startpunt van Coley's levenslange vriendschap met Rockefeller, wiens filantropische werk werd geïnspireerd door de dood van Elisabeth, die leidde tot de oprichting van de Rockefeller University.1

Coley ontwikkelde vervolgens de eerste immunologische kankerbehandeling, probeerde kanker met koorts te genezen en richtte daarmee het veld van tumorimmunologie. Hij begon met een onderzoek naar alle casuïstiek van sarcomen in het New York Cancer Hospital (later Memorial Sloan-Kettering). Hij struikelde over het record van de 31-jarige Fred K. Stein, die leed aan een rondcelsarcoom in de nek dat vijf keer was teruggekeerd na chirurgische verwijdering totdat het als onbruikbaar werd beschouwd; de zaak was hopeloos verklaard toen de man een ernstige erysipelas-infectie opliep (veroorzaakt door Streptococcus pyogenes) die zich snel over de nek en het gezicht verspreidde en gepaard ging met een woedende koorts. Een tweede aanval volgde 2 weken later. In de loop van deze aanvallen verdween het sarcoom volledig. Zeven jaar later volgde Coley Stein op de Lower East Side, waar hij nog steeds een uitstekende gezondheid genoot en slechts een litteken onder zijn oor had om te laten zien waar het "niet-operabele" sarcoom was geweest.

CONCLUSION

Altogether, the responses to fever therapy, spontaneous remissions in the course of infectious diseases, and the observation of the inverse correlation of acute febrile infections and incidence of cancer are remarkable. Still, deciphering the optimal tuning of host response and immune surveillance is far from being solved. A systemic concept is probably needed to understand the orchestrated cytokine and cellular storm resulting in the cures; otherwise, we might forever be left perplexed by the multitude of different kinds of cellular and molecular interactions.132-134

What is remarkable is that Coley developed the treatment not as we are used to—via “research and development” by the laboratories of biotech industry—but quite differently: through careful clinical observation of hundreds of patients and thorough knowledge of medical and scientific literature combined with critical reflection. Coley was the epitome of a clinician scientist, one of those pioneering individual physicians who made the seminal discoveries, especially in the golden age between 1930 and 1965 that irrevocably changed medicine by bringing us, for instance, sulphonamides, penicillin, cephalosporins, neuroleptics, antidepressants, and steroids.135,136 Since then, clinical drug research has moved into the laboratories and the pharmaceutical industry and is presently experiencing an insufficiency crisis.137-139 The strengths of those clinical champions are today remembered and called for again, and so are their virtues. Like Coley, they were proficient in their clinical work, guided by practical scientific thinking, open to the unexpected, and driven by the desire to cure patients.135,136,140,141

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