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Unusual tumor case may lead to custom cancer care

NEW YORK — It’s a medical nightmare: a 24-year-old man endures 350 surgeries since childhood to remove growths that keep coming back in his throat and have spread to his lungs, threatening his life. Now doctors have found a way to help him, through a scientific coup that holds promise for millions of cancer patients.

The case is the first use in a patient of a new discovery: how to keep ordinary and cancerous cells alive indefinitely in the lab.

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The discovery allows doctors to grow ‘‘mini tumors’’ from each patient’s cancer in a lab dish, then test various drugs on them to see which works best. It takes only a few cells from a biopsy and less than two weeks to do, with materials and methods common in most hospitals.

Although the approach needs more testing against many different types of cancer, researchers think it could offer a cheap, simple way to personalize treatment without having to analyze each patient’s genes.

‘‘We see a lot of potential for it,’’ said one study leader, Dr. Richard Schlegel, pathology chief at Georgetown Lombardi Comprehensive Cancer Center in Washington.

An independent specialist agreed.

For infections, it’s routine to grow bacteria from a patient in lab dishes to see which antibiotics work best, said Dr. George Q. Daley of Boston Children’s Hospital and the Harvard Stem Cell Institute . ‘‘But this has never been possible with cancer cells because they don’t easily grow in culture.’’

The new technique may reveal in advance whether a person would be helped by a specific chemotherapy, without risking side effects and lost time if the drug doesn’t work.

In the case of the 24-year-old, described in Thursday’s New England Journal of Medicine, lab tests suggested that a drug used to treat a type of blood cancer and some unrelated conditions might help.

It’s not a drug that doctors would have thought to try, because the man technically does not have cancer. But his lung tumor shrank after a few months of treatment, and he has been stable for more than a year. He still has to have operations to remove throat growths that recur but only about once every five months.

The man, an information technology specialist in suburban Washington who asked to remain anonymous to protect his privacy, has recurrent respiratory papillomatosis, or RRP.

About 10,000 or more people in the United States have the disease, said Jennifer Woo, president of the RRP Foundation. Woo, 29, is a medical student at Georgetown and one of the researchers on the study. She also has the condition but said it is confined to her throat and has required only about 20 surgeries so far.

The man in the study has a much more serious case.

‘‘I was diagnosed when I was 3 or 4. At first, I had to have surgery every seven to 10 days,’’ the man said. ‘‘I get short of breath and my voice will get more hoarse.’’

Two years ago, the growths to his lungs became extensive and life-threatening, and his physician, Dr. Scott Myers, described the condition at a meeting of Georgetown hospital specialists. ‘‘It’s crushing the airway,’’ Myers said.

Doctors suggested that the new lab method pioneered by Schlegel and others might help. It borrows an idea from stem cell researchers: adding mouse cells for nourishment, plus a chemical that prevents cell death, to an ordinary lab culture medium. That enabled healthy and cancerous cells to keep growing indefinitely.

Researchers grew ‘‘mini tumors’’ from the man’s lung mass and from healthy tissue and screened various drugs against them. One proved ineffective. Another worked against the tumor but at too high a dose to be safe. The third did the trick.

A similar approach could let doctors screen drugs for cancer patients.

‘‘What could be more personalized than taking this person’s cell, growing it in culture, finding a drug to treat them, and then treat them?’’ said Doug Melton, codirector of the Harvard Stem Cell Institute. The Georgetown method gives an answer quickly enough that it could save lives, he said.

Tyler Jacks, a cancer researcher at MIT and former president of the American Association for Cancer Research, said the next step is to show that this could work for different cancers and that it leads to better outcomes in patients.

‘‘It seems to have worked in this one instance, but other tumors might prove to be more challenging,’’ he said.

The National Institutes of Health paid for much of this work and has already sent research teams to Georgetown to learn the method. About a dozen other universities have done the same, Schlegel said.

SOURCE: Associated Press
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