Nieuwe horizonten in de behandeling van hoofd-hals kankerpatiënten: Kan bliksem kanker verslaan?
Kanker - what’s in a name
Wereldwijd sterven meer dan tien miljoen mensen jaarlijks aan kanker. Naar schatting zou dat cijfer tegen 2030 nog eens toenemen met 20%. Wetenschappers strijden dagelijks om kankerpatiënten hun leven terug te geven, maar ondanks aanzienlijke verbeteringen blijft die ziekte ons te slim af. Ontdek in dit artikel wat vandaag de dag mogelijk is, specifiek voor hoofd-hals kanker!
Op de zesde plaats van meest voorkomende kankertypes wereldwijd staat hoofd-hals kanker, een diverse groep aan tumoren die zich ontwikkelen in verschillende delen van het hoofd en de hals, zoals de tong, neus en keelholte. Aangezien deze tumoren zich in gebieden bevinden die essentiële functies als spreken, slikken en ademen beïnvloeden, ervaren patiënten vaak ernstige belemmeringen in hun dagelijks leven. De voornaamste boosdoeners gelinkt aan het ontstaan van hoofd-hals kanker zijn het overmatig gebruik van tabak of alcohol. Deze schadelijke stoffen staan namelijk in rechtstreeks contact met de slijmvliezen van de mond- en keelholte waardoor irritatie gemakkelijk optreedt en dit kanker kan veroorzaken. Verder stijgt het risico drastisch indien roken gecombineerd wordt met alcohol. Daarnaast is een besmetting met het humaan papillomavirus (HPV) ook een welgekende risicofactor.
Als preventie wordt de bevolking meer en meer aangesproken door een uitgebreid pakket aan infosessies en campagnes tegen tabak/alcohol. Ook worden HPV-vaccinaties verplicht gegeven op school. Deze inspanningen schieten helaas te kort, want jaarlijks wordt bij steeds meer personen de verschrikkelijke diagnose van hoofd-hals kanker gesteld.
Innovatie in kankerbehandelingen blijft essentieel in de overwinning
Een vroege detectie van kanker is een doorslaggevende factor in de tumorbehandeling en de prognose voor de patiënt. Jammer genoeg wordt bij het merendeel van de hoofd-hals kankerpatiënten de diagnose pas gesteld wanneer de tumor al uitgezaaid is over het lichaam, wat de behandeling nog moeilijker maakt.
Oorspronkelijk werden de patiënten met deze ernstige vorm geholpen met chemotherapie. Helaas bood dit weinig hulp en hadden deze verzwakte mensen last van gekende neveneffecten zoals vermoeidheid, misselijkheid en haaruitval. Een zeer grote doorbraak in de behandeling van (hoofd-hals) kanker was de introductie van immunotherapie: dit is een nieuwe techniek die het immuunsysteem van de patiënt versterkt zodat kankercellen beter gedood kunnen worden. Bovendien werken deze middelen meer gericht op de tumor, en is het minder schadelijk waardoor patiënten minder bijwerkingen ervaren. Doch blijkt dit niet dé oplossing te zijn tegen kanker: de hoofd-hals kankercellen zijn vaak nog te slim en kunnen deze behandeling omzeilen. Vandaar moet men blijvend onderzoek uitvoeren naar nieuwe behandelingsstrategieën om slimmer te worden dan kanker!
Het immuunsysteem: een sterke bondgenoot in de strijd tegen kanker
Het immuunsysteem functioneert als een beschermende barrière tegen schadelijke zaken zoals ziekteverwekkende bacteriën of virussen. Wat minder gekend is, is dat ons lichaam ook een mechanisme heeft ingebouwd om ons te beschermen tegen kanker, de zogenaamde ‘kanker-immuniteitscyclus’. Dit proces helpt ons lichaam om kankercellen te herkennen en te vernietigen door specifieke immuun cellen aan te sturen. Echter, bij kankerpatiënten is deze cyclus verstoord waardoor kankercellen buiten schot vallen van het immuunsysteem en zich ongeremd kunnen vermenigvuldigen.
Nieuw in de strijd zijn innovatieve therapieën die deze kanker-immuniteitscyclus kunnen stimuleren door immuun cellen specifiek te trainen. Een aantrekkelijke strategie hierin is kankercellen vernietigen op wijze dat ze een ‘immunogene dood’ ondergaan, waarbij stervende kankercellen alarmsignalen vrijgeven zoals “eet mij”! Deze alarmsignalen kunnen opgepikt worden door de boodschappers van ons immuunsysteem, de ‘dendritische cellen’, zodat deze de tumorcellen beter zullen herkennen en opruimen. Hierna zal deze missie doorgegeven worden aan gespecialiseerde vechter cellen van het immuunsysteem, de T-cellen, die in het lichaam circuleren, zoekend naar resterende kankercellen om ze vervolgens te vernietigen.
Hoe gaat deze bal aan het rollen? Verschillende kankerbehandelingen hebben reeds aangetoond immunogene celdood te veroorzaken, zoals klassieke chemotherapie. Daarnaast worden nieuwe strategieën intensief onderzocht of ze deze immunogene celdood kunnen opwekken. Een voorbeeld hiervan is niet-thermisch plasma, een reactief gas waarvan de actieve deeltjes zeer selectief kunnen inwerken op kankercellen – vergelijkbaar met de specifieke inslag en ontlading van bliksem. Zonder het te weten komen wij dagelijks in aanraking met zo’n soorten plasma: een computerchip is hier bijvoorbeeld mee gemaakt. Recentelijk heeft plasma ook zijn intrede gedaan in de medische wereld. Jullie denken waarschijnlijk: hoe kan bliksem nu kankerpatiënten redden? Door het teweegbrengen van extreme stress in de tumorcellen zullen deze sneller immunogeen sterven en komen er meer alarmsignalen vrij om de immuun cellen te stimuleren en resterende delen van de tumor aan te vallen. Bliksem blijkt dus enorm aantrekkelijk te zijn, en wat als we het combineren met bestaande kankertherapieën?
Is één plus één drie?
De vraag die wij ons stelden voor deze scriptie luidde ‘zou niet-thermisch plasma de huidige behandeling van hoofd-hals kanker kunnen verbeteren?’. De eerste stappen zijn weldegelijk gezet om hierop volmondig ‘ja’ te antwoorden. Ons onderzoek heeft namelijk aangetoond dat kankercellen meer alarmsignalen vrijgaven indien ze behandeld waren met plasma én de huidige behandeling voor hoofd-hals kankerpatiënten samen. Meer nog, we hebben bevestigd dat kankercellen hierdoor beter zichtbaar worden voor het immuunsysteem en effectiever opgeruimd worden. Dit zou dus kunnen betekenen dat onze nieuwe combinatietherapie met niet-thermisch plasma het immuunsysteem van hoofd-hals kankerpatiënten beter kan trainen in het aanvallen van de tumor. Al klinkt dit veelbelovend, er is nog werk aan de winkel! Om deze combinatietherapie van de aparte cellen in het laboratorium naar de kliniek te krijgen, zal deze strategie verder getest moeten worden op proefdieren, meer gelijkend op de mens.
Zowel het gebruik van plasma alleen als zijn combinatie met huidige therapieën is veelbelovend om het toenemende (hoofd-hals) kankercijfer in te dijken. Onze onderzoeksgroepen aan de Universiteit van Antwerpen, CORE en PLASMANT, werken nauw samen met chirurgen van het Universitair ziekenhuis Antwerpen om expertise te delen en een efficiënte wisselwerking tussen laboratorium en kliniek te creëren.
Wij streven naar een verbeterde en minder belastende behandeling voor hoofd-hals kankerpatiënten en met onze combinatietherapie hebben wij een belangrijke stap gezet richting meer hoop. Met oog op een mooiere toekomst voor alle kankerpatiënten: welke deuren zouden er geopend zijn voor andere kankertypes?
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