New therapies against cancer: hope for many patients thanks to state-of-the-art medicine

Prof. Peter Bartenstein (LMU) and Prof. Wolfgang Weber (TU) © Marcus Schlaf

Cancer will probably remain a shock diagnosis for a long time to come. But modern medicine is constantly developing new effective treatments and drugs for cancer. Many patients today live long lives despite and with the diagnosis of cancer and have a good quality of life.

Munich scientists at the university hospitals, united in the Cancer Center CCC, have developed some groundbreaking therapies that are attracting great interest from science and patients worldwide. In our major report, top experts from the Munich University Hospital, LMU and the Klinikum rechts der Isar (TUM) present new therapies against cancer. For example, the so-called theranostics, which combines diagnosis and therapy and destroys metastases with radioactivity directly in the body. At the end of 2022, an international pharmaceutical giant applied for global approval for this novel prostate cancer therapy, which has been significantly developed at the Munich University Hospitals. We explain six new weapons against cancer and how they work:

Theranostics as a novel prostate cancer therapy

Theranostics – this term stands for a combination of diagnosis and therapy in which tumors in the body are marked and destroyed. Here, the nuclear medicine specialists at the two Munich university hospitals have done pioneering work that has attracted worldwide attention. The scientists have identified molecules that can be found in particularly high concentrations on tumors. These are illuminated on PET/CT images. PET stands for Position Emission Tomography and CT for Computed Tomography. A hybrid device combines the two methods. The CT analyzes the structure, the PET the function. The metastases glow because a surface molecule marked by radioactivity is injected, which binds to the one on the tumors. You can get to them by irradiating them directly in the body. And it does so with millimeter precision with radioactively mixed substances, the radiation of which then hits the tumors directly in the body and destroys them. Sounds like science fiction. But it is precisely this treatment – called molecular radiotherapy – that has been developed in Germany. In Munich, for example, fundamental research was carried out on the surface molecule CXCL4, which can be found on lymphomas (malignant tumors of the lymphatic system), among other things. The same applies to the surface molecule PSMA, which can be found on prostate carcinomas. "The radiotherapy in this regard has been brought to product maturity and is already being used successfully on hundreds of patients," says Prof. Peter Bartenstein, Director of Nuclear Medicine at LMUKlinikum.

Success of nuclear therapy at the CCC Munich: Here you can see pictures of a prostate cancer patient whose skeleton is full of metastases that light up before therapy. After four cycles of nuclear therapy with lutetium PSMA, he was largely tumor-free. © LMU Munich

Theranostics will also be used to treat bone marrow cancer and kidney cell cancer

Such therapies are also currently being developed in Munich for diseases such as multiple myeloma (a form of cerebral cancer) and renal cell cancer. "We did pioneering work here in Munich, and today we have hundreds of patients from the USA who we treat here," says Prof. Wolfgang Weber, Director of Nuclear Medicine at the Klinikum rechts der Isar (TUM). The treatment has been so successful that pharmaceutical giant Novartis has applied for international approval for it, which took place in 2022. "We scientists are proud to have a treatment method here that has not been developed by a large corporation, but at German university hospitals," says Prof. Bartenstein.

Prof. Peter Bartenstein (LMU) and Prof. Wolfgang Weber (TU) © Marcus Schlaf

Sharpening immune cells

"Cell therapy
with so-called CAR-T cells is highly complex, expensive but highly effective in lymph node cancer, non-Hodgkin's lymphoma," says Prof. Michael von Bergwelt, oncologist, intensive care physician and director of the Medical Clinic and Polyclinic II of the LMU Hospital. For this immunotherapy, blood is taken from the patient and sent to the USA, as there are too few specialized laboratories in Germany so far. In the U.S., the immune cells are genetically reprogrammed in such a way that, back in the patient's body, they specifically attack the lymph node cancer cells that are constantly forming." Thanks to this novel therapy, many patients who would have died promptly in the past are still living for a long time. That's a real miracle," says Prof. von Bergwelt.

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Prof. Michael von Bergwelt is an oncologist at the LMU Munich Hospital. © Clinic of the LMU Munich

Immune to skin cancer

Black skin cancer (malignant melanoma) is an aggressive, very malignant skin tumor that spreads very quickly and early to other organs, where metastases then form. "About ten years ago, the survival rate here was just over five percent. Now, more than 50 percent of patients survive for more than five years," says Professor Dr. Angela Krackhardt, an expert in immunotherapy at the Klinikum rechts der Isar (TUM). So-called checkpoint inhibitors release the blockages in the body's immune system and allow the body's own immune system to fight the cancer. But checkpoint inhibitors don't always work so well. Unfortunately, only 20 to 30 percent of patients with lung cancer or other cancers affecting the stomach or intestines currently respond to therapy.

Prof. Dr. Angela Krackhardt is an expert in immunotherapy at the Klinikum rechts der Isar of the Technical University of Munich. © Klinikum rechts der Isar (TUM)

See more thanks to Artificial Intelligence

Artificial intelligence (AI) can sometimes detect strange tiny tissue changes better than the human eye. For example, radiologists use AI in their analysis of images created by computed tomography, for example. "However, it is not artificial intelligence that makes the diagnosis, but rather points out abnormalities to the experts that might not otherwise have been seen," explains Prof. Marcus Makowski, Director of the Institute of Radiology at the Klinikum rechts der Isar (TUM). He sees a lot of potential here with a view to the future. There is a lot of hope for AI, especially for lung cancer screening, which is to be introduced from 2023/2024. It is intended for people who are at particular risk of developing a lung tumor.

Prof. Dr. Marcus R. Makowski, Director of the Institute for Diagnostic and Interventional Radiology at the Klinikum rechts der Isar of the Technical University of Munich, is enthusiastic about the new possibilities. © Klinikum rechts der Isar (TUM)

Decoding cancer DNA

Specifically slowing down the genetic material (DNA) of a cancer cell from implementing its program of uncontrolled growth – this works if you know the weak points of the individual tumor. "It is precisely these weak points that we then attack with drugs," explains Prof. Dr. Frederick Klauschen, Director of the Institute of Pathology at LMU. This is called precision oncology. In order to compare the thousands of mutations of the tumors and the effects of the drugs in hundreds of patients, the scientists use artificial intelligence (AI). In Munich, the universities are developing a large portal to track down lung cancer on the basis of millions of data records and to find out whether a patient is out of therapy or whether a recurrence, i.e. a recurrence of the tumor, is to be expected.

Prof. Dr. med. Frederick Klauschen is Director of the Institute of Pathology at LMU Munich LMU Hospital Munich ©

Bombarding mini-tumors

Today, radiation physicians have a good grip on mobile tumors, explains Prof. Stephanie Combs, Head of Radiation Therapy at the Klinikum rechts der Isar (TUM). For example, when the patient breathes, tumors in the body can change their position. Modern equipment makes it possible to irradiate only when the tumor is in focus. In addition, nuclear medicine can accurately mark metastases. For this reason, for example, in the case of metastases after prostate cancer, only the affected lymph nodes are irradiated – and no longer the entire pelvis on suspicion. Prof. Claus Belka, Head of Radiation Therapy at LMU Hospital: "Thanks to modern diagnostics, we can now see much more and can thus irradiate only the tumors with pinpoint accuracy."

Prof. Stephanie E. Combs at the MRI Gamma Knife during radiotherapy, Klinikum rechts der Isar of the Technical University of Munich. © Thomas EinbergerProf. Claus Belka from the LMU Hospital during radiotherapy at Elektra. © LMU-Klinikum

This article contains only general information on the respective health topic and is therefore not intended for self-diagnosis, treatment or medication. It is in no way a substitute for a visit to the doctor. Unfortunately, individual questions about clinical pictures may not be answered by our editors.