Tuesday, July 17, 2007

Immunotherapy for sarcoma - in the 19th century

Damn Interesting is one of my favorite blogs, and this week's post is of particular interest to physicians (note the UK spelling of "tumor") ... 

Damn Interesting » Coley’s Cancer-Killing Concoction

... The story so convinced Coley that he– perhaps cavalierly– contrived to contaminate his next ten suitable sarcoma cases with Streptococcus. His initial approach was to inject a solution of live bacteria deep into the tumour mass on a repeated basis over several months. The first patient to undergo this treatment was a bedridden man with inoperable sarcoma in the abdominal wall, bladder, and pelvis. Using this experimental method, the patient was cured spectacularly. He staged a full recovery, and survived another twenty-six years before dying from a heart attack. But subsequent results were mixed; sometimes it was difficult to get the infection to take hold, and in two cases the cancer responded well to treatment but the patients died from the Streptococcus infection.

Coley’s discovery, as it turns out, was actually a re-discovery. The idea of a link between acute infection and the resolution of tumours was not new, and the phenomenon of infection-related "spontaneous regression" of cancer has been documented throughout history. A 13th century Italian saint was reputed to have his tumour-afflicted leg miraculously healed shortly after the malignant growth burst through the skin and became infected. Crude cancer immunotherapies working along similar lines to Coley’s early experiments were known in the 18th and 19th centuries, and may extend back to the time of the pharaohs. Ancient writings suggest that the renowned Egyptian physician Imhotep may have used a similar infect-and-incise method to treat tumours....

I've been fond of medical history ever since I enjoyed a thinly attended history of medicine course at McGill in the 80s. I don't recall ever hearing about Dr. Coley or his early use of immunotherapy for sarcoma -- a cancer that's often incurable even now. The article implies that the treatment has been long forgotten, which is not quite true, the work of Coley is periodically revisited.

Dr. Coley deserves a Wikipedia page, but as of 7/17/07 none exists.  Perhaps a scholar somewhere will insert one based on this article (A review of DI could be the source of several new topic pages really.)

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