October 8, 1999 update from Dennis McKenna
This is a brief update on Terence from Dennis. Please feel free to forward to anyone who needs to know; if I've missed anyone on this list, well, hopefully you will see this and then get on the next one.
Terence has decided to proceed with the p53 gene therapy protocol, which is an experimental protocol in Phase I clinical trials here at the UCSF Med Center.
It involves using a genetically engineered adenovirus to deliver a gene, p53, to the tumor, which codes for a tumor suppressor protein. P53 is mutated or damaged in cancerous cells, which is one reason they are cancerous in the first place. The virus is used to replace the defective gene with an active, wild-type gene; if the cells take it up, and the gene is functional, it should program the cells to stop growing, and to die. Its a great idea, and the closest thing to a magic bullet that high-tech medicine has come up with so far. Its also highly experimental and unproven; Terence is the fourth, or fifth person in the world to ever receive this therapy. The other patients were all treated recently so there is no data on whether it has worked for them or not. It *has* worked rather spectacularly in animal models, which is one reason we felt it was worth a shot.
He's now in recovery, having completed the first and easiest step of what is a two stage process. First, he was given a biopsy to determine that the tumor was still alive, and active, and to collect tissue for later uses. Then, a catheter was implanted into the tumor bed, and the virus cocktail was administered over about 10 minutes.
Now he has to remain in the hospital for three days, with the catheter implanted. He can get up and move around, and does not seem to be set back much from this first procedure (he was conscious and under very light anesthesia during this phase). So he is staying in the hospital over the next few days so they can monitor him and also to minimize the risk of infections. On Monday, he will receive the "big op," which is a craniotomy in which they will remove the bulk of the tumor, and will administer additional adenovirus/p53 to the tissue that remains following surgery. This first procedure, other than getting a biopsy, is not therapeutic, it is part of the protocol, to determine if the cells do in fact take up the gene and express it. It's important for the research that this be known, but does not directly benefit Terence (but it will afford an idea if the therapy is likely to work). The second part of the operation, in which he will get the craniotomy and more adenovirus, is designed to be therapeutic. He will in any case get the craniotomy, which is being done by one of the world's best neurosurgeons, Dr. Mitch Berger. He will also get an additional dose of the p53 gene, which, if it is taken up into the tumor cells and expressed, will definitely be therapeutic if it works. If it does not work, Terence will still benefit from the craniotomy; and, the gene therapy does not preclude him from receiving additional treatments down the line, which was one reason we decided to go for it; it did not require that we "burn any bridges," as the doctor put it.
So far, so good. We are keeping our fingers crossed and hopes up for a similarly successful outcome on Monday. Keep your good vibrations coming our way, and look for an additional update to come your way by the middle of next week. You may also find additional bulletins, etc. encluding this one if Dan posts it, at www.levity.com/eschaton
This is Dennis, sending love to all