Assault on cancer

Belarusian oncologists have developed sensational projects — a cancer vaccine, 3D modelling of the most complex operations, and an ultra-modern method for treating leukaemia and lymphomas

Our country is starting to organise large-scale production of Elenagen anti-cancer vaccine. During clinical trials, the drug showed the world’s best results in the treatment of high-grade ovarian tumours with metastases. It is possible that it will be effective against other types of neoplasms. Learn more about the history of the vaccine, as well as other projects that are designed to be breakthrough in the treatment of cancer, in a conversation with Academician of the National Academy of Sciences, Professor, Deputy Director for Research at the Alexandrov National Cancer Centre Sergei Krasny.

Photo by BELTA

Set of circumstances

— Elenagen was conceived in the USA, but implemented in Belarus. How did this become possible?
— In part, we can say ‘thank you’ to the pandemic, a certain set of circumstances, but foremost, of course, to our team of highly qualified specialists. This vaccine is the development of the outstanding American molecular biologist Alex Schneider. Of course, before the creation of Elenagen, there were long-term fundamental studies on the examination of tumour growth, carcinogenesis and the search for solutions where the action of the drug could be applied. Chronic inflammation was chosen as such a target, since it is used by the tumour as a defence — this is how cancer creates a barrier around itself, like a purulent focus, where cells of the immune system and various chemicals cannot penetrate. It is for this reason that chemotherapy is ineffective, and after some time the disease is fatal.
When the fundamental research of the vaccine ended, the question arose of where to conduct clinical studies. In America, it is too expensive, we are talking about millions of dollars, so Schneider looked for venues with more reasonable prices. We suggested Belarus. I must say that at first, Alex was sceptical about this idea — he knew almost nothing about our country. However, he agreed to come and study the issue on the spot. Well, he was impressed. Our specialists were required to write a programme of clinical trials, and only after that, their conduct was approved. Moreover, the United States, Brazil and Israel wanted to join the studies, which were scheduled to begin in 2020 — this indicates a high degree of confidence in our programme. Then a pandemic broke out, which practically paralysed the oncological services of these countries, all the forces of doctors there were devoted to the fight against COVID-19. Belarus did not introduce a lockdown, medical and scientific institutions worked as usual. Considering that all stocks of Elenagen remained with us, clinical studies were conducted here. Therefore, the project turned out to be American-Belarusian.

Second chance at life

— What results did the vaccine show?
— I will say without exaggeration — just grandiose, there are no such places anywhere else in the world. The vaccine was administered to patients with chemotherapy-resistant ovarian cancer. Thanks to this, the time to progression of the disease increased by 2.5 times, and 40 percent of women had a long (up to three years) period without tumour progression. At the same time, in every cancer patient from the group where this drug was not taken, the disease developed progressively within a year after the start of treatment.
Therapy with Elenagen can improve the effectiveness of chemotherapy. In addition, the vaccine, unlike most toxic cancer drugs, is very gentle on the body, causing virtually no adverse reactions.
The effectiveness of the drug was studied on patients in several centres: in the Republican Scientific and Practical Centre of Oncology, in the Minsk Oncological Centre, patients from oncological dispensaries of several regions were involved. Currently, studies of the drug in prostate and breast cancer are ongoing. There are already positive results.
— How much Elenagen is produced today?
— While the release was limited: up to 40 bottles per week. Currently, there is no vaccine produced anywhere in the world. American partners promised to help set up the production of Elenagen at Belarusian enterprises. There are plans to increase production to 1000 doses per week and even more. However, I cannot predict how long this will take. Let me remind you that this is done for the first time in the world.

Raising aggression in the cell

— Another subject of special pride of our oncologists is an ultra-modern method for the treatment of leukaemia and lymphomas.
— This method is called CAR-T and has shown amazing results. It is being developed in many countries, but it has a crazy cost there — from 500,000 to a million US dollars per patient. We are, of course, much cheaper.
The essence of the method is that in a person with a resistant form of leukaemia or lymphoma, when all other methods of treatment are no longer effective, T-lymphocytes are taken from the blood and modified at the gene level. Simply put, they make aggressive towards this type of tumour. After that, they are propagated outside the body, and at this time the remaining T-lymphocytes are destroyed in the patient so that a void is formed — a chamber, a box. Then modified ones are introduced into the body — the same CAR-T. They rush to the tumour and begin to attack it, while multiplying intensively. We have had eight patients with refractory lymphoma undergo this method, three of them are still on treatment, but there are already great successes, and four of them have a complete regression of the tumour! You can imagine — these young people were at death’s door, they had very little time to live, but now the tumour has completely disappeared, and there has been no recurrence of the disease for a year and a half. Of course, CAR-T is one of the most promising areas in oncology.

Accurate to the cubic millimetre

— Lung cancer is one of the most common oncological diseases both in Belarus and around the world. Today, the main method of its treatment is surgical. How do patients manage to preserve this most important organ?
— When lung cancer spreads to large bronchi or vessels, the entire organ is removed. In this case, the patient becomes disabled person of group II or III, which, of course, affects the overall quality of life. Today, thanks to the use of reconstructive 3D modelling technologies, part of the lung can be saved.

The Alexandrov National Cancer Centre
Photo by BELTA

This is done as follows: data on the preoperative examination of the patient are taken, loaded into a computer. According to the developed algorithm, a 3D model of the lung, bronchi, blood vessels and tumour is built. On the model, a calculation is made where the line of intersection of each structure should pass, and a reconstruction plan is developed. We calculate to the millimetre the volume of the lung, the size of the vessels and, if necessary, the structures of the heart that will be removed. The portability of the operation is assessed. Then the surgical intervention is carried out strictly according to the plan developed by the algorithm. After the operation, a 3D model of the reconstructed lung is also built and the slightest deviations are monitored, as well as the dynamics of changes every three months. This makes it possible to take the necessary measures in a timely manner.
Such operations can only be performed by surgeons of the highest qualification. In our centre, this is primarily the leading researcher of the laboratory of thoracic oncopathology of the centre, Candidate of Medical Sciences Sergey Eskov, who is actively developing this technology under my leadership. To date, more than 50 operations have been successfully performed. In the future, of course, we plan a larger-scale implementation of this method in oncosurgery.

The vaccine had no choice

— Why choose Elenagen? Perhaps, in honour of a cured patient?
— Actually, the vaccine has a very difficult name for perception — ‘a plasmid, which is a circular supercoiled DNA molecule encoding the P62 gene’. It is clear that I had to choose a simplified version. Nevertheless, the patients have nothing to do with it. It is just that Alex Schneider’s wife’s name is Elena, and my wife has the same name. Thus, half-jokingly, the vaccine had no choice in terms of name.

Interviewed by Lyudmila Konopelko