It was in 2005: the young oncologist surgeon had just had his right eye removed because of ocular melanoma, a rare cancer that affects six out of a million people on average in the United States.
Prior to this procedure, her doctors were confident in her ability to make a full recovery and have the surgery again.
“But my reality, with the loss of my eye, was that my perception of depth had been destabilized,” he told AFP. “I knew I could no longer operate.”
At the time, he was 33 years old and had just spent thirteen training and practicing cancer surgery, a specialty he chose before he even knew he would suffer from cancer himself. He was also interested in research on this disease.
But after his eye was removed, he didn’t feel out of place anywhere.
“I was a surgeon who could not operate and I was interested in oncology, but I was not a doctor of internal medicine,” recalls Hinrichs, who therefore returned to school for four years to acquire these skills.
A return to square one for this thirty-something, married and young father.
But with one goal in mind that has become a personal struggle: to find a way to beat cancer when surgery, chemotherapy and radiation therapy fail.
In the event of recurrence, “I would be in the group of incurable patients”, loose the 46-year-old doctor, specifying that his cancer would then be considered metastatic and therefore fatal.
Now a researcher at the National Cancer Institute, he is leading trials to eradicate cancers caused by the papillomavirus (HPV), a sexually transmitted virus that causes various cancers such as that of the cervix or throat.
Two women who participated in the first clinical trials of immunotherapy against cervical cancer are considered cured because they have not had any trace of the disease for at least five years.
These trials, conducted at the National Institutes of Health Clinical Center, the most prestigious establishment in the United States in terms of research, involve patients with advanced stage cancers who no longer respond to conventional treatments.
If the majority of them did not heal at the end of Dr. Hinrichs’ tests, some nevertheless saw their cancer disappear within a few months. The hope is to design new treatments one day accessible to the general public.
His colleagues describe him as straightforward, honest and blunt, “with a sense of urgency to advance his research” possibly linked to his own experience of the disease. An experience that also brings him closer to his patients.
Aricca Wallace, one of the two healed patients, describes her “scanxiety” – her anxiety with every monitoring MRI (“scan”) – which the doctor helps her overcome. According to her, they have more “a family relationship than doctor-patient”.
The oncologist stopped taking control scans (MRI and X-ray) about five years after his eye was removed. The risk of recurrence for this type of tumor is approximately 50%.
“The statistics are really of limited value” in this case, he explains.
The doctor does not see himself doing anything other than research, to find a cure for advanced cancers by practicing a single injection of billions of lymphocytes, taken from the patient and cultivated so that they multiply. An immune invasion against cancer.
“People with cancer don’t want researchers who focus on things that slow cancer down or have limited effects,” he says.
And to say: “What they really want is for their cancer to disappear”.
Cancer immunotherapy progresses
Sue Scott had already organized her funeral. It was the winter of 2013, she was 36 years old and her cervical cancer was metastasizing at top speed.
Chemotherapy, radiotherapy, operations … everything had failed. The tumors were now lodged in his liver and colon. But Sue got one last chance: an experimental trial at the clinical center of the National Institutes of Health.
At this publicly funded research hospital, doctors were trying to replace patients’ immune systems with lymphocytes (white blood cells) programmed to specifically attack cancers related to papillomavirus (HPV), a sexually transmitted and widespread virus.
A few months later … Sue’s tumors were completely gone. In March, she celebrated five years of complete remission. Doctors consider her to be cured.
“My greatest reward is being a source of hope for other people,” says the real estate agent in Washington, who also volunteers for cancer patients.
The clinical trial in which she participated is a breakthrough in the fight against cancer. This is the first time that researchers have shown that immunotherapy, already effective against blood and skin cancer, can also be used successfully against cancer of the cervix.
What’s more, Sue’s recovery led doctors to an unexpected discovery, which could kill other types of tumors. Doctor Christian Hinrichs, from the National Cancer Institute, told him the good news in February during a check-up.
“We got a certain genetic sequence from you, which we can put into anyone’s cells to attack cancer the same way,” Hinrichs explains. “We’re trying to see if it works clinically.”
A survivor doctor
Dr Hinrichs, 46, himself is a survivor of a particularly rare cancer, which affects six in a million people.
When he was in his twenties, the young surgeon learned he had melanoma in his right eye. But after each laser or radiotherapy treatment, the cancer would come back. He had to resolve to have his eye removed in 2005.
“I am influenced in my research by the fact of having known cancer myself and the fear that it will come back every time”, specifies the researcher to AFP. “I really wanted to find a treatment to prevent the cancer from coming back.”
The purpose of white blood cells is to attack intruders. But when the intruder is a tumor capable of mutating, hiding, or growing on such a scale that it overwhelms the immune system, lymphocytes often fail.
Immunotherapy is believed to solve this problem. It works well against cancers of the blood, like lymphoma or leukemia, because in these cases the cancers carry some kind of flag or signal on their surface (antigens of the tumor), which makes them easily spotted.
But most cancers don’t have this “flag”.
In Sue’s case, the cancer carried HPV antigens – a signal that the immune system can recognize.
“This cancer is very interesting because the virus is right in the middle,” says Miriam Merad, professor of oncology at Icahn School of Medicine in Mount Sinai, New York.
Dr. Hinrichs’ work, she says, is “absolutely crucial” to understanding why immunotherapy works in some people and not others … which remains a mystery. Still to develop new clinical trials to confirm the breakthrough.
For Sue, here’s how the doctors proceeded: They operated to remove one of her tumors, then they isolated the lymphocytes that were attacking her.
The researchers then “cultivated” these lymphocytes, and produced billions more, which they then reinjected into his blood … causing a real immune invasion.
This treatment was successful in another patient, a 41-year-old mother, Aricca Wallace, living in Kansas City. She too is considered cured after five years without a tumor.
But the trial failed in the sixteen other women who participated.
Looking at the data from the two recovered patients, Hinrichs found that two-thirds of the cells that eradicated Sue’s cancer attacked another signal or flag, the KK-LC-1 protein.
However, this protein is also expressed in cancers that affect half a million people around the world, in particular one of the most fatal breast cancers, as well as certain cancers of the stomach. Doctors had therefore found their new target.
“It was a hell of a surprise,” recalls the doctor. “It reminds us that science sometimes takes us in directions different from those we had anticipated.”
The next step is therefore to launch clinical trials to treat cancers where this famous KK-LC-1 protein is expressed, in about a year. International patients can apply to participate.
Nothing guarantees success, but the approach is “promising”, told AFP Ronald Gress, deputy director of the National Cancer Institute. “It is one of the most amazing options, but at the same time it is an option that could really help patients.”
Sue, for her part, cannot believe that her cells may one day be able to cure other patients.
“Are you telling me that I have something in me that can help others?” It’s pretty crazy, ”she rejoices.