After more than a decade of research, testing and Africa’s only clinical trial of its kind, a cancer treatment that could improve the effectiveness of standard oncology care in South Africa’s public health system is poised for rollout, reports the Sunday Times.
The work is the brainchild of South Africa’s Dr Carrie Minnaar, a specialist in oncologic hyperthermia who has built her career in an unusual niche: using controlled heat to make cancerous tumours more responsive to standard cancer treatments.
Her doctoral research focused on improving outcomes for women with locally advanced cervical cancer in African settings, finding ways to achieve better results within the limits of public healthcare resources.
Remarkably, the clinical trial found that the disease-free survival rate five years after treatment more than doubled, from 14% to 32%, and Minnaar has since published several peer-reviewed papers in a number of respected scientific journals.
She now plans to install six modulated electro-hyperthermia (mEHT) devices across three South African public hospitals over the next three years, aimed at improving survival rates and slashing treatment costs. The project requires about R57m, and fundraising is under way, she said.
Minnaar, who led the first hyperthermia trial conducted in Africa and the first anywhere in the world to include HIV-positive participants, said hyperthermia, or “heat therapy”, is not a new concept. What has changed is the understanding of how it can be used as a complementary therapy alongside radiation or chemotherapy.
Earlier attempts at hyperthermia involved heating tumours to temperatures above 43°C to permanently damage the proteins in the cells and kill cancer cells. But this often damaged surrounding healthy tissue.
Minnaar said maintaining the temperature between 39°C and 42°C, while combining heat therapy with radiation or chemotherapy, made the treatment safer and more effective – as has already been demonstrated in international clinical trials involving several tumour types.
The heat is delivered using a mEHT device, first introduced in Europe in 2006. In 2009, Minnaar, who has a background in radiation biology, began specialising in oncologic hyperthermia and training in the technique in Germany.
She returned to South Africa and, in 2014, launched a clinical trial at Charlotte Maxeke Hospital and Wits University involving women with cervical cancer.
“I wanted to bring this into the public system to use alongside the treatments already available, despite all the other resource issues and challenges in that setting,” she said. A total of 210 women were enrolled and randomly divided into two groups – one receiving standard treatment and the other receiving standard treatment plus hyperthermia.
Treatment lasts about an hour, is painless and can be administered by a nurse. Patients then proceed to their radiation treatment.
“We followed the participants for two years after treatment, and the results were so good we continued for another three years. After five years the disease-free survival rate had more than doubled, from 14% to 32%, which was statistically significant,” she said.
The trial also found that, over three years, patients in the hyperthermia group cost less to treat because they required fewer additional interventions and fewer hospital admissions than those receiving standard treatment alone.
Minnaar said the study produced five important findings: improved disease control; significantly better disease-free survival; evidence of an immune-mediated response; proof that the treatment is safe for HIV-positive patients; and the potential to reduce costs in the public healthcare system.
Some women in the study had localised cancer while others had cancer that had spread beyond the cervix, which had not been detected during initial staging. The researchers found that patients receiving hyperthermia alongside radiation often had these tumours die off as well as the tumour in the cervix.
This unexpected finding suggested an immune response in which the patient’s own immune system helps fight the cancer.
To take the work further, Minnaar – who runs a practice in Randburg, Johannesburg – clinical oncologist Dr Thanushree Naidoo and specialist radiation oncologist Dr Prinitha Pillay established the HEAT (Hyperthermia Equitable Accessible Treatment) Foundation, a registered NPO that aims to equip three public hospitals with six mEHT devices by 2027.
“One device in each hospital will treat 180 women with cervical cancer each year, doubling their survival rates. The second machine will be for research and clinical trials,” Minnaar said.
The next phase of research will focus on aggressive brain tumours in adults and aggressive childhood cancers.
TimesLIVE article – Turning up the heat on cancer (Restricted access)
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