"I Wasn't Going to Curl Up and Die"

By Richard Lacayo

Sue Strauss has seen much worse than this. All the same, it's a needle again, another IV, so she braces herself a little. The attending nurse inserts it into her arm, and tens of millions of specially designed cells begin finding their way, she hopes, to the very core of the thing she has struggled with for years. Strauss, 76, is a retired preschool teacher from Chapel Hill, N.C., just down the road from Duke. For five years she has battled breast and liver cancer. Chemotherapy gave her two years in remission. The new breast-cancer treatment tamoxifen provided two more. Another year was gained from another antiestrogen drug. Then doctors ran out of approved medications.

That was the point at which some people might have resigned themselves to the thought that it would only be a matter of time. Then last spring one of Strauss's doctors, Kim Lyerly, offered her an experimental therapy being developed at Duke's Gene and Cellular Therapeutics Center, where Lyerly is the clinical director.

People generally think of a vaccine as something that fends off an illness before it gets started. But this one mobilizes the immune system against already established tumors. Lyerly and his colleagues aim to enhance the ability of dendritic cells, an alarm conveyor in the immune system, to target the cancerous cells and make it easier for the body's killer T cells to recognize and destroy them. If it works, this approach promises a more effective and much less toxic alternative to the carpet bombing that is chemotherapy. After decades in which immune therapies have failed to live up to expectations, the field is advancing again, in part because of improved understanding of how the immune system works.

At Stanford last year a small trial using the dendritic-cell approach cleared two patients of lymphoma and reduced tumor size in two others. Trials elsewhere have produced mixed but still promising results. Researchers have found a way to increase massively the number of dendritic cells ordinarily found in the body, in the hope of amplifying the therapeutic effect. Lyerly and his colleagues achieve their results by infusing patients with their own dendritic cells--after the cells have been encouraged to grow and have been altered in a way that enables them to stimulate a more aggressive immune response. To do that, the cells now carry a protein on their surface that stimulates a specialized subtype of T cells to attack the tumors.

Lyerly's work has been furthered by one of the many infusions of corporate money that the medical center has been aggressively pursuing in recent years. Last fall Duke opened a new 10,000-sq.-ft. laboratory, a set of "clean rooms" where cell cultures can be cultivated in sterile surroundings. The $1.5 million facility was paid for by the pharmaceutical giant Rhone-Poulenc Rorer, based in Collegeville, Pa. But this particular deal is unusual in that the company has no commercial claim on any products developed through the use of the new lab. Sue Strauss is one of 18 Duke patients in Lyerly's trial, one of several vaccine tests approved by the Food and Drug Administration.

Strauss settles back in the Piedmont sunshine. In a chair nearby, her husband sits silently. "I knew I wasn't going to curl up and die," she says. When she first learned she had cancer, her son, who is a physician, was worried that his mother would not live to see her first grandchild, not yet born at the time.

"Well, I saw that beautiful little girl, who is now four, and a boy, who is almost two," she says. "I'd love to see them grow up."

--By Richard Lacayo