An unorthodox but growing treatment in a 9-year-old's battle against cancer
By Barbara Williams
ACKENSACK, N.J. (MCT) When repeated chemotherapy and radiation treatments failed to stop the cancerous tumors from growing in their 9-year-old son's lungs and chest, a Ridgewood, N.J., couple took a desperate chance on a bunch of mice.
They paid a laboratory $25,000 to inject pieces of their son's tumors into the rodents and then test different drugs on the mice. The lab offered no guarantees, but the hope was to find a treatment that would shrink the boy's particular tumors and possibly cure him of Ewing's sarcoma.
Months passed as the tumors grew in the mice and standard treatments failed on Michael Feeney. Then the lab discovered a three-drug cocktail that began to heal the mice, destroying the cancer cells.
And now, Michael's tumors are also shrinking thanks to those drugs.
"If someone had asked me what the chances were of this working, I would have said one or less than one in 10," said Michael's doctor, Dr. Leonard Wexler, a pediatric oncologist from Memorial Sloan-Kettering Cancer Center in New York. "But I am delighted, joyful, and just praying with his family that it will be a long recovery."
Michael's treatment may seem unorthodox but, increasingly, researchers believe the key to effectively fighting cancer is by tailoring treatment to the genetic makeup of a patient. By growing the human tumors in mice, researchers can test different treatments on the rodents rather than trying drug after drug on sick patients.
Using mice avatars is now quite common in medical research, especially in the fight against cancer. Studies are being done with the rodents for breast and prostate cancers, as well as diabetes and digestive problems.
Though most of the research on these treatments is done at academic institutions, the Feeney family used one of the few companies that will work with the general public, taking tumors from patients who are not in a clinical trial. The lab they used, Champions Oncology, has a corporate office in Hackensack and implantation centers in London, Singapore and Tel Aviv and at the Johns Hopkins Hospital in Baltimore. Treatments are tested on the mice at Johns Hopkins, said Dr. Ronnie Morris, an internist and president of Champions.
"Normally, the way cancer is treated is by trial and error," Morris said. "There is no way of knowing if the drug is working and the patient could be suffering severe side effects. With this, we have the ability, for the first time, to test 10 different drugs on any patient's tumor at the same time."
That process was a relief to Michael's mother, Jill Feeney. "The great thing about this is Michael didn't have to be a guinea pig with all the drugs," she said. "And we found out one of the drugs that they could have used on his cancer made the tumors grow in the mice three times as fast as doing nothing. What if he had been given that drug? He wouldn't be here today."
The medications that Michael is taking are all approved for treating cancer, so insurance covers those costs. But the fees for the mice trials are not yet covered, so the Feeneys had to pay for them.
Those fees are decreasing, however, as scientists refine the process, and are now down to about $10,000 per patient, said Dr. David Sidransky, one of the founders of Champions and the director of the head and neck cancer research division at Johns Hopkins University. "Insurance companies are talking to us and are interested."
Jill Feeney said her family was fortunate that it could pay the lab, but believes insurance companies could ultimately save money by not having to cover a drug that is ineffective on a patient.
"We figured we didn't have anything to lose but our rainy-day fund and it was pouring," Feeney said. "But people who can't afford this shouldn't be excluded because of money."
Michael has been battling cancer since he was 6. Diagnosed with Ewing's sarcoma, a very rare, aggressive and often fatal bone cancer that typically develops in children and young adults, Michael has managed to maintain a somewhat normal life while undergoing a slew of medical procedures, including a surgery to replace his shoulder blade.
In the fall of 2009, he was complaining of pain in his shoulder that would lessen but never completely go away. By December, doctors not only found that a tumor was causing the pain but also that there were nodules in his lungs nodules that were later discovered to be cancerous.
Michael began treatment immediately and has had precious few spells without some type of surgery, chemo or radiation. Though he has lost his hair several times from the potent drugs, he has maintained his weight and otherwise looks healthy. He was home-schooled for only a short time and does well academically in his fourth-grade class.
He also spends time with friends and plays on soccer, lacrosse and basketball teams. Upbeat by nature, he appears to take a that's-the-way-it-is attitude about the large part of his life that revolves around chemotherapy, scans and blood tests.
"The worst part of it all is the chemo because it makes me woozy and tired and sometimes I have a headache the next day," Michael said. But if he met someone who was diagnosed with the same disease, he said he would tell them, "Stay strong. It will get better."
Instead of complaining, Michael, a huge Giants and Yankees fan, regales listeners with tales of school or the time he was able to attend a Giants practice when the team ran a "secret play. And they threw all the reporters and everyone out but just let me and my family stay to see it," he reported, wide-eyed and fast-talking.
Though no one can predict Michael's future, his oncologist said the three-drug combination the boy is taking appears to be addressing the two distinct areas necessary to treat his cancer. Two chemotherapy drugs, gemcitabine and docetaxel, target the cancer cells while Avastin blocks the tumor from forming blood vessels that are needed to feed the cancer.
"It's difficult to speculate on how complete and long the recovery will be," Wexler said. "But he's been on this for over three months and the response has been excellent. Everything has gotten smaller and large amounts of the tumors are dead and dying."
It's been the only protocol that has significantly shrunk Michael's tumors. But it has come with some side effects. The skin on his feet became inflamed, red, itchy and burning, forcing him to use a wheelchair for a week. Then his hands suffered the same reaction, though not as severe. A tweaking of his medication seems to have alleviated the problem.
Wexler readily admits he doesn't know if he would have tried the three drugs on Michael if the medications had not been successful on the mice.
"We've used Avastin before and there was no evidence that showed it worked more effectively combined with the chemo drugs," Wexler said. "I wasn't shocked, but it was an intriguing result."
It is precisely for those types of surprising results that more scientists are using the mice avatars to study diseases and treatments.
At the Mayo Clinic in Minnesota, researchers are conducting a breast cancer study, known as the BEAUTY Project. They are collecting tumors from 200 women before, during and after chemotherapy and then are implanting them in mice to test different treatments.
"Because of the complexity of cancer and the many different drugs that are up and coming, this is a way to test the effects of these drugs in mice without giving patients all the side effects," said Dr. Matthew Goetz, one of the principal investigators on the project.
Another study at the Mayo Clinic, the PROMOTE project, involves men with advanced prostate cancer. In other research centers, scientists are using mice to study treatments for diabetes and digestive problems.
"Eventually, for all cancer care, we'd like to be able to biopsy a tumor, see exactly what the genomic makeup is and then know precisely how to treat it," said Dr. Judy Boughey, the other chief investigator of the BEAUTY project.
But using mice avatars has its disadvantages. It takes months for the tumors to grow in the mice, and patients can die before the cancer grows or a treatment can be found. In addition, drugs that will work in mice do not always produce the same results in humans, and mice typically don't suffer the same side effects as humans, so there's no way of knowing what the patient will actually experience as a result of the drugs.
"There's so much individuality between patients, and many times the differences don't translate from mice to humans," said Dr. Andre Goy, director of lymphoma at the John Theurer Cancer Center at Hackensack University Medical Center. "You're never really sure what you're growing in mice."
Sidransky, from Champions, acknowledges those problems. "In order for this to work we need fresh tissue, which means we have to capture the patient at the right time to biopsy the tumor," he said. "And in general, it takes two to four months for the tumors to grow in the mice, so patients do die. But we need to break cancer down into an individualized disease and the predictability of this is almost perfect."
Though Champions so far has about a 13 percent success rate with around 90 patients out of 700 responding to treatment Sidransky said that number should increase to about 250 by the end of the year.
Feeney said her family knew the chance of success was slim. "But," she said. "I've been saying we're the luckiest unlucky people I know and I'm just so grateful that it worked."
Every weekday JewishWorldReview.com publishes what many in Washington and in the media consider "must reading." Sign up for the daily JWR update. It's free. Just click here.
© 2013, The Record (Hackensack, N.J.) Distributed by MCT Information Services