A smile of courage

TRACEY Lyons sits perched on the edge of a hospital bed, joking with the nurses and flashing her bright, confident smile.

Without the sobering backdrop of the cancer ward at the Royal South Hants Hospital, you could easily imagine she doesn't have a care in the world if you.

The reality is that the Southampton mother-of-two is being treated for lymphoma - a cancer of the lymphatic system, which is almost impossible to cure.

But Tracey feels lucky. She has been selected to take part in the world's first DNA cancer vaccine trial.

Scientists at Southampton General Hospital have spent the best part of ten years developing the techniques to turn the vaccine dream into a reality.

Now the first stage of the trial has been successfully completed and Tracey is part of the second group of patients to receive the treatment at a higher dosage.

The researchers have warned her that they won't really know if the vaccine works for another five years or so.

If the trial patients are still alive, with no sign of the cancer returning, the scientists will have proved the value of the vaccine - even if it only delays the return of the disease.

But Tracey's outlook on life is positive, particularly compared to the moment her illness was diagnosed in 1998.

Tracey, of Weston, said: "The doctor said it was lymphoma - a cancerous growth.

"I remember leaving his office and just standing in a hospital corridor with tears streaming down my face.

"I didn't know what to do. I didn't want to go home. How do you go home to break that kind of news to your family?"

Tracey has two sons, Craig, 15, and Shane, 17, and works as a home carer for Southampton City Council.

She said: "My husband, Gary, was totally devastated - he can't even bring himself to come to the hospital.

"It took a while for it to sink in. I only broke the news to my youngest son a week ago.

"I would never have told him unless I thought there was a good chance that this vaccine was going to work."

Tracey had an operation in June 1999 to remove a tumour in her groin, followed by six months of chemotherapy in tablet form.

"During my treatment I read about the trial that was happening in Southampton and the lady from Poole who had the first injection, then I saw it on Tomorrow's World.

"I told my doctor that I would be interested in taking part in the trial. They tested me and told me I was suitable."

Meanwhile, the medics at the General who developed the vaccine are preparing a series of test tube studies to take place in the new year which will give them a good indication of whether the treatment will work.

Supported by the Leukaemia Research Fund, Tenovus and the Cancer Research Campaign the scientists have created the vaccines by fusing together genetic material from a cancer cell with that of a harmless toxin.

The team, led by Professor Freda Stevenson, believe the body's immune system will be alerted by the presence of the toxin and start to seek and destroy it, killing all the cancer cells in the process.

If everything continues to progress as planned, an effective treatment for certain types of lymphoma may be ready for widespread use in three or four years' time.

Dr Christian Ottensmeier said: "Treatments for the kind of lymphoma that Tracey has are only very rarely curative - in about two per cent of cases.

"Scientists are becoming more effective at engaging the immune system thanks to research that has taken place across the world.

"The immune system has a fault, in that it doesn't respond to cancer. We are trying to re-awaken it to the presence of cancer."

The researchers have to create tailor-made vaccines to match the individual identities of the cancer cells in the patients' bodies.

"We're not sure how much of the vaccine we have to give so we will have five groups of volunteers who will receive increasingly higher doses of the vaccine.

"Tracey is the first patient at the second dose level.

"Our prediction that this would be safe has been true so far. The only side-effects have been tiredness - we hope that reflects the activation of the immune system.

"We are trying to measure in test tubes the immune response to the tetanus toxin and against the cancer cells.

"We are mimicking the body's reaction in a test tube. We will take the patient's cancer cells, which were frozen at the time of the operation, and see if the vaccine kills them."

Dr Ottensmeier joined the Southampton team five years ago, having studied in Germany and Boston, and is fully aware that fate has given him the chance to make history.

"I think the whole thing is fantastic. We haven't seen any toxicities - it looks very promising.

"It will take another year to get the number of patients we need. Then we will decide whether we need to expand this trial or whether we need a national or international multi-centre trial.

"If this vaccine works, the same principle could be applied to other cancers. We would probably look at breast cancer and colorectal cancer first."

Although everything is proceeding to plan so far, the Southampton team are acutely aware that they are involved in a scientific three-horse race to publish the first results and take their place in the pantheon of great medical advances.

Two teams in the United States are trying to achieve the same results, but using a different process.

"It's a very competitive field, but Southampton is a particularly attractive place to work at this point in time.

"A lot of cancer experts have moved here, we have the new cancer sciences building being constructed and the appointment of Professor Peter Johnson has also been an important factor."

Tracey will now receive eight vaccines over the next three months. She knows the results are far from guaranteed, but she has no fear about taking part in the trial.

"One of the big advantages is that I will be watched very closely. I will have regular tests - bone marrow, biopsies, X-rays, blood tests.

"If this vaccine works there is a possibility it might cure the lymphoma. I've got nothing to lose - I would go for anything that offered me any sort of hope."