The “Ma Rabu Ma'asecha: Celebrating the Wonders of Hashem’s Creations” lecture series has been held at the boys campus of the Yeshiva of Greater Washington (YGW) in Silver Spring, Maryland, since November 2016. Each lecture begins with a scientist speaking on their area of expertise, coupled with a local rabbi or teacher giving Torah insights into the topic.
On March 11, Dr. Yehuda Strauss of the NIH gave a lecture on "The Human Immune System and Cancer Therapy," followed by comments from Rabbi Dovid Rosenbaum of Young Israel Shomrai Emunah.
Dr. Strauss opened with the “Yehi Ratzon” for taking medicine, which acknowledges Hashem’s role in refuah (healing): “May it be your will, Hashem, that this endeavor cure me, for you are a free Healer.” Dr. Strauss explained there are several interpretations about what it means to heal for free — some believe this refers to the fact only Hashem can heal without side effects.
To give the audience the necessary background for understanding cancer therapies, they were treated to a brief introduction to the main players of the human immune system: T cells, B cells, natural killer cells, and dendritic cells. These actors have many weapons up their sleeves.
T cells are produced in the bone marrow. Once matured, they have the special ability to recognize specific proteins on the surface of other cells and, in the presence of other go-signals and the absence of stop-signals, tell those cells to die. This maturation — T cell boot camp if you will — occurs in the thymus. Here, T cells that develop to recognize proteins that are self (or normal proteins that are in the body) are destroyed, and only T cells that recognize foreign proteins (or sometimes, malformed self-proteins from cancer cells) survive.
Cancer therapies are targeting these T cells in a series of ways: by targeting proteins that inhibit go-signals; by targeting proteins that act as stop-signals; by producing modified viruses that make cancer-cell proteins on their surface, are injected into the body (vaccination), gobbled up by dendritic cells, and presented to maturing T cells to alert them to the presence of this cancer-cell protein somewhere in the body; and finally, by producing engineered T cells that are designed outside of the body to react to specific cancer cell proteins — useful if T cell boot camp doesn’t produce these naturally.
B cells produce antibodies, and can be used clinically to produce specific antibodies to specific proteins. This can be hijacked also: Natural killer cells (not much of a mystery what they do) make cells commit suicide when those cells are covered in antibodies. Create an antibody to malformed cancer cell proteins, introduce many copies to the body, and they will latch onto the cancer cells. The body’s natural killer cells will then come along and destroy the cells.
Dr. Strauss was keen to stress that these therapies are typically used in people who have exhausted other treatment options, and that they are not 100 percent guaranteed cures. In fact, he explained that with cancer, we talk about remission, as cancer cells may lie dormant, and the patient look “cured” only for cells to start growing again. However, even with that caveat, remission rates in a particular form of skin cancer with no other treatment bar targeting one specific T cell off-signal are 20 percent. When used in combination with another treatment that targets a different T cell signal, remission rates went up to 60 percent.
Dr. Strauss ended on a note of great hope for the future of cancer immunotherapy by mentioning that currently there are thousands of ongoing clinical trials with some sort of combination of the therapies mentioned here, as well as others not covered in the lecture. These, along with preventative cancer vaccinations, he said, are likely to be staple forms of cancer treatment and prevention in the future.
In his comments, Rabbi Rosenbaum focused on the paradox of universalism and particularism with respect to cancer and these treatments. In one sense, being diagnosed as very sick is the great equalizer, yet we are all individuals and respond differently to different treatments.
While it is terribly difficult to understand struggle in the human condition, such as a cancer diagnosis, said Rabbi Rosenbaum, it can also be an opportunity to reflect on our relationship with G-d, He who heals for free.
By Dr. Mallory Bogen
Dr. Mallory Bogen is a Silver Spring, Maryland, resident with a medical background who enjoys writing about related subjects.