A direct dose
Injecting drugs into lung tumors could improve treatment
By Czerne M. Reid
Despite advances in lung cancer treatment, more than 1 million people a year worldwide still die from the disease. Some available drugs can’t safely be given in doses high enough to be effective because they are so poisonous.
To minimize drug toxicity complications, Eugene Goldberg, Ph.D., a professor in the colleges of Medicine and Engineering, and international clinical research colleagues are pioneering a new lung cancer treatment technique that changes the way cancer drugs are administered.
Called endobronchial intratumoral chemotherapy, it involves injecting drugs directly into lung tumors via a flexible tubular instrument called a bronchoscope, which is inserted through the mouth and into the airways. The procedure uniquely delivers extremely high drug doses to tumors with the goal of decreasing damage to healthy cells.
Early clinical results are promising, and Goldberg, an adjunct professor of pharmacology and therapeutics in the College of Medicine and a professor of biomedical engineering in the College of Engineering, hopes the technique will eventually be adopted for general clinical use.
“It’s primarily a question of conducting additional clinical studies and making the procedure more widely known,” said Goldberg, who also serves as the Genzyme professor of biomaterials, materials science and engineering.
Direct tumor injection is applicable to most solid tumors, especially breast, colorectal and prostate cancers. For now, the researchers are focusing on lung cancer, the leading cause of cancer deaths. Lung cancer kills more women each year than breast cancer, and more than 80 percent of patients die within five years of being diagnosed, according to the National Cancer Institute. Additionally, lung cancer claims more lives than the next three cancer killers combined.
In collaborative clinical studies of this new treatment with Firuz Celikoglu, M.D., and Seyhan Celikoglu, M.D., in Turkey, and Wolfgang Hohenforst- Schmidt, M.D., in Germany, the procedure rapidly destroyed tumor cells. Tumor-clogged airways were opened to allow easier breathing and re-inflation of collapsed lungs. And surgery was made possible in many cases thought to be inoperable. Results for the more than 500 patients treated to date in Germany, China, Switzerland and Turkey indicate significantly prolonged survival and greatly improved quality of life.
“The preliminary results are very good, the potential is there, but we need to see more data,” said David Feller-Kopman, M.D., director of bronchoscopy and interventional pulmonology, and an associate professor of pulmonary and critical care medicine at the Johns Hopkins University. “It’s definitely worth looking at from a clinical trial standpoint.”
As Goldberg and colleagues plan additional clinical trials, they are publishing papers on the procedure — including one this year in the Journal of Pharmacy and Pharmacology — and making presentations at international meetings such as the PacifiChem2010 conference in Honolulu in December.
Goldberg is also investigating a gene therapy approach to cancer treatment, using tiny particles called nano-microspheres that can encapsulate drugs and disperse them throughout a tumor upon injection. In this work he is partnering with Nasreen Najmunnisa, Ph.D., in the division of pulmonary, critical care and sleep medicine. Najmunnisa has been instrumental in developing gene therapy concepts to better treat mesothelioma and non-small cell lung cancer. Animal studies are in progress, in which the nano-microspheres are loaded with genetically engineered hormone-like molecules that can be injected into tumors to stop their growth.