Alternatives to traditional cancer treatment
- Ufrieda Ho
Opinions around cancer treatment options can be highly divisive, but many patients don’t have the luxury of choice.
The harm versus benefit argument around cancer treatment is complex and not easily resolved. But more harmful than any drug is not getting a diagnosis, or one early enough, to give more people the luxury of choice.
Razeeya Khan, Lecturer in the Department of Pharmacy whose special interest is oncology pharmacy, says we cannot argue harm or benefit without acknowledging the lack of cancer awareness and patient education in the country, or the shortage of oncology specialists.
“The problem is about more than who can access hospital treatment. It’s also empowering people to recognise the signs and symptoms of cancer and getting them to go for check-ups or a referral, coupled with seamless care through the health system,” she says.
“We are not talking just about availability and access to care, but also the need for better patient advocacy and initiatives to close the gap between private and public sector healthcare.”
Treatment inequality
There are also divides between access to new therapies and advances in cancer treatment in developed countries versus availability and affordability in less-resourced countries like South Africa. Research and development imbalances result in skewed resources, with less funding and fewer opportunities in the Global South.
And yet Africa is facing an increased cancer burden. The World Health Organization (WHO) in February 2023 reported that an estimated 1.1 million new cases of cancer are reported in Africa each year, resulting in about 700 000 deaths annually. The WHO estimates that by 2030, this number will be closer to one million.
In developed countries, Khan says, cancer treatments are moving toward precision medicine; using targeted therapies to manage some cancers as chronic illnesses. These therapies target the proteins that control how cancer cells grow, divide, and spread. Khan says: “The aim is to reduce the size of the tumour to stop it from spreading. The cancer is kept in check by targeting specific cycles of its cell growth. There are also immunotherapies that enhance the patient’s immune system to fight the cancer.”
In South Africa we are far from being able to offer these therapies, but scientists and researchers are nonetheless pushing ahead.
An alternative 3-step treatment
PhD student Alisha Badal in the School of Molecular and Cell Biology has made advances with her award-winning research which hones in on the treatment of triple negative breast cancer through a three-step method using advanced gene editing to manipulate a tumour suppressor gene.
Triple negative refers to cancer cells without oestrogen, progesterone or HER2 (human epidermal growth factor receptor2) receptors, making them more complex to treat.
“This is the most difficult type of breast cancer to treat because it is associated with higher proliferation and recurrence rates compared to other types, but for now treatment options are limited mainly to chemotherapy, which has adverse side effects and can, over time, become less effective as cancer cells become resistant,” Badal says.
“We have devised an alternative three-step treatment. Firstly, we aim to increase the expression of the GAS5 gene using advanced molecular CRISPR-CAS9 technology. In healthy cells, GAS5 is produced in sufficient quantities to identify defective or damaged cells, triggering programmed cell death. In cancer cells, GAS5 is produced in very small quantities, allowing cancer to grow and form tumours,” Badal says.
These altered cancer cells are then exposed to two drugs that are both inexpensive and highly efficient. One is UJ3 and the other is a US Food and Drug Administration approved PARP inhibitor. UJ3 has shown to be 10 times more effective than the conventional chemotherapeutic drug Cisplatin while the PARP inhibitor works to stop the process of cell repair and renewal, causing cancer cells to die. PARP, poly-ADP ribose polymerasea, is a protein (enzyme) found in our cells, which helps damaged cells to repair themselves.
“It is the first time using this approach. Advancements in immunology and endocrine therapy for treating cancer are important because in Africa we are at a major disadvantage. Many drugs are unavailable, and screening resources and awareness programmes are limited, so many cancers are detected late resulting in limited treatment options,” she says.
Homegrown treatment
Leveraging locally available and appropriate science may be part of the answer. For Associate Professor in Anatomical Sciences, Tanya Augustine, one area of opportunity for cancer management lies in compounds derived from cannabis. The region is ideally suited to growing cannabis and its decriminalisation for personal use for adults in 2018 opened the door for more research.
Although research is in its very early stages, cannabis has long been used by cancer sufferers and those undergoing chemotherapy to relieve pain and nausea and to stimulate appetite.
Augustine’s research looks at how cancer subverts the immune and coagulation system to procreate.
“We need to do more research to understand cannabis’s utility better so that it doesn’t remain forever in the realm of complementary medicine,” Augustine says.
She adds: “One of the biggest effects of cannabis on the endocannabinoid system is in helping pain reduction. Some of the receptors for these phytocannabinoids are concentrated in the central nervous system, that’s why they work so well in relieving pain.
Cannabinoids bind to the receptors, preventing the release of certain neurotransmitters associated with pain. Very early in vitro studies are showing that some of the compounds in cannabis may enhance the effects of one of breast cancer’s gold standard drugs.”
Augustine adds: “There are still a lot of unknowns about how cannabis works in cancer treatment – such as what it’s doing to immune cells, if it’s anti- or pro-inflammatory and how the interactions might switch certain transmitters and receptors on or off. We need more legislative reform so we can do more research. For every question, there are five more, it’s like a rabbit hole,” she says.
It’s a rabbit hole that researchers want to explore for an opportunity to change the landscape of cancer cure and care – and not a moment too soon.
- Ufrieda Ho is a freelance writer.
- This article first appeared in?Curiosity,?a research magazine produced by?Wits Communications?and the?Research Office.
- Read more in the 16th issue, themed: #Drugs, where we highlight the diversity, scope, and multi-dimensional nature of drug-related research at Wits University.