As many readers of this blog will know, I have cancer. I’ve had many operations over the last fifteen years, but a few years ago we decided that the spread was now wide enough that further surgery was not very pointful; we should instead wait for particular lesions to start causing problems, and only then treat them. (I have metastases in my lungs, liver, remaining kidney, leg, pleura and other places.)
Historically, chemotherapy hasn’t been an option for me. Broad spectrum chemotherapies work by killing anything growing fast; but my rather unusual cancer doesn’t grow fast (which is why I’ve lived as long as I have so far) and so they would kill me as quickly as they would kill it. And there are no targetted drugs for Adenoid Cystic Carcinoma, the rare salivary gland cancer I have.
However, recently my oncologist referred me to The Christie hospital in Manchester, which is doing some interesting research on cancer genetics. With them, I’m trying a few things, but the most immediate is that yesterday I entered a Phase 1 trial called AToM, which is trialling a couple of drugs in combination which may be able to help me.
The two drugs are an existing drug called olaparib, and a new one known only as AZD0156. Each of these drugs inhibits a different one of the seven or so mechanisms cells use to repair DNA after it’s been damaged. (Olaparib inhibits the PARP pathway; AZD0156 the ATM pathway.) Cells which realise they can’t repair themselves commit “cell suicide” (apoptosis). The theory is that these repair mechanisms are shakier in cancer cells than normal cells, and so cancer cells should be disproportionately affected (and so commit suicide more) if the mechanisms are inhibited.
As this is a Phase 1 trial, the goal is more about making sure the drug doesn’t kill people than about whether it works well, although the doses now being used are in the clinical range, and another patient with my cancer has seen some improvement. The trial document listed all sorts of possible side-effects, but the doctors say other patients are tolerating the combination well. Only experience will tell how it affects me. I’ll be on the drugs as long as I am seeing benefit (defined as “my cancer is not growing”). And, of course, hopefully there will be benefit to people in the future when and if this drug is approved for use.
In practical terms, the first three weeks of the trial are quite intensive in terms of the amount of hospital visits required (and I live 2 hours drive from Manchester), and the following six weeks moderately intensive, so I may be less responsive to email than normal. I also won’t be doing any international travel.