A Bermudian surgeon is playing a key role in a revolutionary new cancer research that might mean the end of cancer treatment as we know it.

Cardiothoracic surgeon Dr Malcolm Brock, Director of Clinical and Translational Research in Thoracic Surgery at Johns Hopkins Medicine in Baltimore, Maryland, was in Bermuda recently, along with a team from Johns Hopkins.

The team gave medical lectures and also met with former heart patients at a special dinner.

Dr Brock’s expertise lies in cancers in the chest cavity such as lung cancer, or esophageal cancer. Lung cancer claims more lives worldwide than any other cancer.

“We have been talking a lot about research in lung cancer this trip,” Dr Brock said. “One of the big new things in lung cancer is the use of immunotherapy.”

Immunotherapy aims to switch on the patients’ own immune system to fight cancer. For years, scientists have been puzzled as to why the immune system recognises certain types of cancers, but not others.

“The majority of cancers are non immunogenic, meaning that the immune system can’t see them,” said Dr Brock. “What we have learned here, recently, is that cancer cells use a certain technique to hide themselves from the immune system.”

The process works in a profoundly different way from traditional chemotherapy. First, the patient receives very low-dose chemo that primes the cancer cells for killing by making them more sensitive to treatment. The low-dose chemo ever so slightly transforms the tumours to behave more like normal cells. Once the tumour cells are weakened and prepped for killing, a second-line of treatment is administered to eradicate them. In addition, the immune system begins to recognise the weakened cancer cells as abnormal and marks them for killing.

“We are doing that in clinical trials,” said Dr Brock. “It seems like it is working pretty well. Once the immune system is awakened, and can start to fight cancer, especially the non immunogenic cancers, like lung cancer. Then you are starting to talk about long term, durable survival. Once the immune system recognises something and starts to get rid of it, it will always get rid of it. We have a couple of patients who have been treated and responded to this therapy and have not died from cancer. We are seeing certain metastasis to the liver go away and never come back.”

Dr Brock wants to get people from Bermuda involved in clinical trials at Johns Hopkins, but it’s complicated. To take part in clinical trials, you have to have a certain eligibility.

“One eligibility is that you have to fail the first round of chemotherapy,” he said. “In the United States they have so many regulations. Anything experimental has to happen after the standard therapy. Once that happens then, to fit the criteria for the trial, there is an enrolment period. You have to be a certain age. Your liver, kidney and immune system numbers have to be correct. If they were damaged by the chemo, then it sets up this other therapy to fail. There are all these little steps that have to be met to enrol in a trial.”

The participant also has to be willing to spend a large amount of time in the United States, sometimes living out of a hotel or apartment for several months.

Dr Brock said once you are enrolled in a clinical trial anything normally covered by insurance, will be covered. Anything that is outside the normal standard of care is covered by the trial.

“For example, the trial would pay for extra computed tomography (CT) scans, or positron emission tomography (PET) scans, administering the drug, the costs of the nurses to do that, the cost of preparing the drug, and so on.”

But, he said insurance companies, particularly insurance companies outside of the United States, were sometimes reluctant to give the nod for their patients to participate in clinical trials.

Sometimes, especially when we are outside of the US, and even in the US, the insurance companies often won’t approve of people who go into clinical trials for a lot of reasons,” said Dr Brock. “The concern is what happens if the trial goes wrong. “We have to try and educate the insurance companies about how things will get paid for if something goes wrong.”

He said clinical trials like the immunotherapy research were important because it brought people hope, often in their darkest hour.

“They give patients choices,” he said. “If your doctor says there is nothing he can do; we would never say that, because we have clinical trials. Some of these clinical trials go on to be very good. If text book prescribed treatment fails, it doesn’t have to be the end of the road. You can try something else and something else. With all the information on the internet now, patients are becoming quite sophisticated and educated about that.”