Lung cancer: behind the smoke screen

Scientists are closer than ever to finding an effective treatment for lung cancer. But their work is mired in controversy as tobacco giants muscle in on the act, writes Clare Rudebeck
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In 1986, Ernest Jones coughed up blood and went to his doctor. A week later, he was diagnosed with lung cancer and given 12 months to live. It wasn't a surprising discovery – Jones had smoked since he first tried one of his father's Woodbines at the age of 13. What is remarkable is that more than five years later, the grandfather from Croydon is still alive. More Britons die from lung cancer than any other form of the disease, and it is almost untreatable. The average rate of survival, five years after diagnosis, is five per cent. "I'm still here," he says. "No one is more surprised than me."

Each year, more than 40,000 British people are diagnosed with lung cancer, 90 per cent of whom are current or former smokers. But a vaccine for this deadly disease could be just around the corner. That could mean thousands of lives may be saved or prolonged and – for the company that patents it – millions of pounds in profits. Years of research and trials are beginning to show results and a vaccine could be on the market by 2005.

That research, however, has been mired in controversy. It was revealed last week that Japan Tobacco, the world's third largest tobacco company, is funding some of the leading teams of scientists. In return, the tobacco giant gets marketing rights to the vaccines when they are developed.

The American pharmaceutical company Cell Genesys struck a multi-million dollar deal with Japan Tobacco in 1998. Earlier this year, it completed a trial on 22 patients with advanced lung cancer, most of whom had not responded to chemotherapy or radiation therapy.

In three of the patients, the tumours disappeared completely. In five of them, the disease stabilised. The company is now expanding its manufacturing capabilities and expects to launch the product on to the market in 2004 or 2005.

The vaccine works by boosting the body's immune system so that it can fight the cancer itself. "What you're aiming to do is boost the body's natural immune response," says Mary Berrington, a spokeswoman for the Cancer Research Campaign. "This happens naturally when you get an infection. For cancer, you are aiming to hook on to something in the cancer cell that's abnormal – they have molecules on their surfaces that you don't find in normal cells. From that, you try to develop a vaccine to alert the body's killer cells to go and wipe out the cancer."

This method of treatment is already working well for other cancers such as melanomas and kidney and cervical cancer. It has a clear advantage over chemotherapy and radiation therapy because it works with the body's natural defence systems, thereby having fewer side effects.

Visions of future generations of smokers freed from the spectre of lung cancer should be dispelled immediately, however. The drugs that are currently in the development phase will never be a cure. "I don't think these vaccines will be used to prevent cancers," says Poulem Patel, of the Imperial Cancer Research Fund. "They will be used to stop them recurring. Even then, they will only be part of the armoury."

It is this fear of raising false hope that Clive Bates, director of Action on Smoking and Health (ASH), says is really worrying. "Smokers will latch on to these vaccines as a reason for not quitting. We may find people who may never have got lung cancer, who get it because they think treatments are in the pipeline."

The drug companies developing the drugs strongly defend their contracts with Japan Tobacco saying that they are dealing with the pharmaceutical arm of the company and maintain that they only have the patients' interests at heart. "This deal [with Japan Tobacco] was done back in 1998," says Jennifer Williams, a spokeswoman for Cell Genesys. "We would not need to do the deal financially now, but we did need to then. Our goal is to develop a product for cancer patients."

The pharmaceutical company, Corixa, also has a multi-million dollar deal with Japan Tobacco. Its research has been marred by criticism of its attempts to patent human gene sequences. Its vaccines rely on gene sequences from lung cancer patients which the company now wants to patent for its exclusive use.

"The patents would stop any other research teams using these gene sequences for 20 years – and Corixa may be able to control them for much longer than that," says Dr Helen Wallace of GeneWatch UK. "We are opposed to patenting genes because they're not inventions – which is what is normally patented – they are something that exists in nature." Doctor Wallace adds that "the monopoly on this information could delay the discovery of a vaccine for years, but the company insists it is only thinking of patients' interests. Giving a tobacco company exclusive rights to lung cancer vaccines is like putting Dracula in charge of a bloodbank".

"Our sole purpose is to develop a treatment as rapidly as possible for the many patients suffering from this disease," says Jim De Nike, a Corixa spokesman. A company press release, issued when the deal with Japan Tobacco was struck in 1999, states: "This new partnership means products that may result from our lung cancer antigen discovery efforts could be available on a worldwide basis." Roy Tsuji, general manager of the media and investor relations division at Japan Tobacco, says that the company was diversifying because of the limited prospects for growth in the tobacco sector. "The vast majority of people welcome efforts that help find drugs for various diseases.

But for Clive Bates of Ash the attempt to integrate smoking and sickness marks "a new frontier in cynicism and greed". "While they are frantically promoting the image of a carefree smoking lifestyle, they are planning to cash in on a dreadful illness." Critics say parallels can be drawn with the development and promotion of treatment for people with HIV. Pharmaceutical companies have profited from the sale of much-needed antiviral drugs and this has led to controversy. Last year, a drug company took the South African Government to court in an attempt to stop it selling much cheaper copies of its antiviral products. After fierce public protests and international condemnation, the pharmaceutical company pulled out.

Responding to the criticism, Japan Tobacco claims it is protecting smokers' interests as well as those of cancer sufferers. "Tobacco is a known controversial product," says Roy Tsuji. "Yet many adults choose to enjoy it as a legal product, knowing the health risk associated with smoking. Based on the belief that our mission is to supply the best products and services, responding to our customers' needs in the respective business areas, we will do our best in the future."

In response, ASH's Clive Bates described this statement as "nauseating cant". After years of campaigns dedicated to getting people to quit smoking, however, most smokers must be aware of the deadly consequences of their habit. Can blame really be laid squarely at the door of Japan Tobacco?

Ernest Jones, who has survived the disease so far, only blames himself for the habit that almost killed him. "You can't blame the tobacco companies," he says. "You buy the cigarettes, you smoke them – it's your fault." Yet he denounces the new deals between Japan Tobacco and Cell Genesys: "I think it's taking advantage of people who have this disease. The only way to cure lung cancer is to stop people smoking, I can't see any other way."

It is a conviction echoed by Mary Berrington of the Cancer Research Campaign. "It's a crazy world when tobacco companies plan to profit from the suffering their product causes in this way. The big thing here is prevention – lung cancer is largely preventable."

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