“Cancer Drug Shows Promise Against Multiple Sclerosis.”
Many of you have read this headline and wondered if this is the right medicine for you.
I received multiple phone calls at our Comprehensive Multiple Sclerosis & Migraine Center at the University of Florida & Shands Jacksonville. There were questions from the media, public relations and Wall Street analysts, besides the many questions from patients.
So what is this “cancer drug” and what is new about it?
Alemtuzumab is a monoclonal antibody directed against the cell marker CD52 which sits on white blood cells (T cells and to a lesser degree B cells and monocytes).
[Side note: I love that people with MS are so educated that I can say things like B cells etc., and most of you know what I mean. If you don’t, then please email email@example.com and I will write a blog about it.]
We have known for some time that alemtuzumab suppresses the lymphocytes (white blood cells) and thereby resets the immune system and stops the body from attacking itself. The group at Cambridge has been using alemtuzumab (“Campath”) for some time, and hence the name “Cambridge Pathology.” The Phase II study showed that alemtuzumab was over 70% more effective than high dose high frequency beta interferon. This is exciting because this is a whole quantum leap forward – it is not simply better than placebo (fake medicine), but better than one of the standard medicines.
Alemtuzumab is a monoclonal antibody, which means that it all binds to the same target. This target is the white blood cells which cause inflammation and damage in MS. These white blood cells are important, though, for other aspects of normal immune regulation. This is why alemtuzumab also has the risk of causing autoimmune thyroid disease and other autoimmune diseases, such as idiopathic thrombocytopenic purpura (ITP). ITP is a condition where the body attacks its own thrombocytes (platelets), which are responsible for normal blood clotting, like when we get a cut. If the platelets are attacked, then our bodies cannot form clots and stop excessive bleeding. Before they realized that ITP was a risk in those treated with alemtuzumab, one person unfortunately died from bleeding into his brain.
So is this risk worth it?
Some people say that trading one autoimmune disease (MS) for other, more treatable ones is worth it. This will depend on individual scenarios. If a person has a high risk for worsening due to MS, it may be worth it. But if the MS looks like it will stay under good control with standard medicines, then it may not be worth the risk. This is a difficult decision because we do not yet have a blood test to know who it at risk and who is not.
So what can you do now?
You should talk to your neurologist about your own personal risk-benefit ratio and decide if being in a clinical trial of this medicine is right for you.