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William Coley

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Dr. William Coley (1862–1936) was an American bone surgeon and cancer researcher, pioneer of cancer immunotherapy. He developed a treatment based on provoking an immune response to bacteria. In 1975 a protein responsible for this process was identified and called tumor necrosis factor alpha[1].

Overview

Dr. William Coley began his career as a bone surgeon at New York Cancer Hospital (which later became part of the Memorial Sloan-Kettering Cancer Center); however, he became more interested in cancer treatment when one of his early patients died from bone cancer. While going through hospital records, Coley found a sarcoma case study of one patient named Fred Stein, whose tumor disappeared following a high fever from erysipelas infection, now known as Streptococcus pyogenes.[2] This sparked Coley’s interest and drove him to find what few examples of similar cancer treatment had been previously recorded. He discovered that other medical pioneers including Robert Koch, Louis Pasteur, and Emil von Behring, had recorded observations of erysipelas infection coinciding with cancer regression.

Coley’s first intentional erysipelas infection was performed on a patient named Mr. Zola on May 3, 1881, who had tonsil and throat cancer. Mr. Zola came down with erysipelas and his condition improved tremendously. Mr. Zola lived for another eight and a half years.[2][2]

Coley was convinced that he could effectively use bacteria to treat cancer and created a mixture of killed bacterial infusions called Coley’s Toxins. The infusion was administered by injection in increasing doses to induce a fever. Once stimulated, he observed, the immune system could be capable of tackling cancerous cells along with the infection. [2] The cancerous cells would then slough off.

His clinical tests achieved a number of remissions, in patients with severe or terminal tumors. His work was however marginalized, by the advent of radiology and radiation treatment.

The infusions of killed bacteria are now known as Coley's Toxins. They are currently not available to patients suffering from cancer. One reformulation of Coley's Toxins persists under the name Coley Fluid.[1]

Clinical trials

Coley developed the theory that it was the infections which had helped patients in the past to recover from their cancer. So he began to treat patients by injecting a brew of Streptococcus pyogenes directly into inoperable tumors. This met with much success, even after metastasis.[citation needed] The treatment was most effective when it provoked a fever and a full-blown infection. This observations coincided with similar observations in 1867 by the German physician W. Busch when his patient's tumor became smaller after a high fever.[3] Later, Coley decided to use a mixture of dead Streptococcus pyogenes and dead Serratia marcescens bacteria. According to Stephen Hoption Cann of the University of British Columbia, "He had successes you simply couldn't hope for today, curing even extensive metastatic disease."[4]

On January 24, 1893, the first patient to receive Coley Vaccine was John Ficken, a sixteen-year-old boy with a massive abdominal tumor. Every few days, Coley injected his vaccine directly into the tumor mass and produced the symptoms of an infectious disease, but did not produce the disease itself. On each injection, there was a dramatic rise in body temperature and chills. The tumour gradually diminished in size. By May 1893, after four months of intensive treatment, the tumour was a fifth its original size. By August, the remains of the growth were barely perceptible.[2]

The boy received no further anticancer treatment and remained in good health until he died of a heart attack 26 years later. Coley published his results and by the turn of the century 42 physicians from Europe and North America had reported cases of cancer that had been successfully treated with Coley Vaccine.

Radiation therapy vs. Coley vaccine

By 1901, the development of x-rays as a cancer treatment showed great promise. In particular, the therapy resulted in immediate tumor destruction and pain relief. Although Coley successfully treated hundreds of patients, his superiors decided to put the emphasis on the newly invented radiation therapy. At the time, it was thought that radiation therapy could be improved into an effective cure for cancer.

Coley arranged for a wealthy friend to provide funds to purchase two x-ray machines for his use. However, after several years of experience, Coley came to the conclusion that the effect of x-ray therapy was localized, temporary and not curative. Others disagreed and cited the dangerous and unpredictable effects, predominantly the fever caused by the bacteria, that the vaccine had upon individuals weakened by cancer. Furthermore the creation of the vaccine had to be made to a patient's exact needs, making the Coley Vaccine more labour intensive, time consuming and expensive.

Conclusions

Coley died in 1936, and his treatment method more or less died with him. There is only now a renewed interest in his ideas. MBVax manufactures MBVax Coley Fluid for clinical trials.[2][3] Drug makers including Pfizer and Sanofi-Aventis also have a renewed interest in modern versions of Coley's Toxins. [4]

The historical results of Coley Vaccine therapy are difficult to compare with modern results. Coley's studies were not well controlled and factors such as length of treatment and fever level were not adequately documented. Many of his patients had been pretreated with chemotherapy, radiation therapy, or both, which likely distorted what appeared to be an immune response to the Coley Vaccine.[5] The recently formed non-profit Global Cures Foundation[6] plans to fund research trials of Coley's Toxins in the near future.

There were, however, many different formulations of Coley Vaccine. These varied greatly in effectiveness, and there were many different treatment protocols that also varied greatly in effectiveness.

References

  1. ^ Terlikowski SJ.: Tumour necrosis factor and cancer treatment: a historical review and perspectives.
  2. ^ a b c d e Coley WB (1893). "The Treatment of Malignant Tumors by Repeated Innoculations of Erysipelas: With a Report of Ten Original Cases". American Journal of the Medical Sciences. 10: 487–511. Cite error: The named reference "Coley" was defined multiple times with different content (see the help page).
  3. ^ Busch W (1867). "Aus dersitzung der medicinichen". Berliner Klinische Wochenschrift. 5: 137.
  4. ^ Pain, Stephanie (2 November 2002). "Dr Coley's Famous Fever". New Scientist. {{cite web}}: Check date values in: |date= (help); Italic or bold markup not allowed in: |publisher= (help)
  5. ^ Hobohm, Uwe (January - February 2009). "Healing Heat: Harnessing Infection to Fight Cancer" American Scientist 97 (1): 34-41.
  6. ^ Global Cures Foundation - Promising Therapies

Further reading

  • Hall, Steven S. (1997) A Commotion in the Blood. New York, New York: Henry Holt and Company. ISBN 0-8050-5841-9
  • Hess, David J. (1997) Can Bacteria Cause Cancer? Politics and Evaluation of Alternative Medicine. New York, New York: NYU Press.
  • Hobohm, Uwe (January - February 2009). "Healing Heat: Harnessing Infection to Fight Cancer" American Scientist 97 (1): 34-41.[5]
  • Starnes, C. (1992) "Coley's Toxins in Perspective" Nature 357 :11-12.

See Also

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