William Coley

Overview
Dr. William Coley (1862–1936) was an American bone surgeon and cancer researcher, pioneer of cancer immunotherapy. He developed a treatment based on provoking an immune response to bacteria.

Overview
Dr. William Coley worked as a bone surgeon at New York Cancer Hospital (which later became part of the Memorial Sloan-Kettering Cancer Center). He looked into the success rates of cancer treatment in the past compared to his day. He found that surgery had been much more effective in the past, before the use of antiseptics when infection was a normal side effect of surgery. For example, one surgeon in the 1770s purportedly cured six out of every seven patients. Coley also learned of the case of a patient at his own hospital seven years earlier, who had throat and tonsil cancer. After surgery, there was not much hope for him. Then he came down with erysipelas, a bacterial infection caused by Streptococcus pyogenes. His cancer disappeared, and Coley found that he was still alive, seven years later.

He discovered that the human immune system could be stimulated through the administration of killed bacterial infusions. Once stimulated, he observed, the immune system would capable of tackling cancerous cells along with the infection. The cancerous cells would then slough off.

His clinical tests achieved a number of remissions, in patients with severe or terminal tumours. His work was however marginalised, by the advent of radiology and radiation treatment.

The infusions of killed bacteria are now known as Coley's Toxins. They are currently not generally available to patients suffering from cancer. One reformulation of Coley's Toxins persists under the name Coley Fluid.

Clinical trials
Coley developed the theory that it was the infections which had helped patients in the past to recover from their cancer. So he began to treat patients by injecting a brew of Streptococcus pyogenes directly into inoperable tumors. This met with much success, even after metastasis. The treatment was most effective when it provoked a fever and a full-blown infection. Later, Coley decided to use a mixture of dead Streptococcus pyogenes and dead Serratia marcescens bacteria. According to Stephen Hoption Cann of the University of British Columbia, "He had successes you simply couldn't hope for today, curing even extensive metastatic disease."

The first patient to receive Coley Vaccine was a sixteen-year-old boy with a massive abdominal tumor. Every few days, Coley injected his vaccine directly into the tumor mass and produced the symptoms of an infectious disease, but did not produce the disease itself. On each injection, there was a dramatic rise in body temperature and chills. The tumour gradually diminished in size. By May 1893, after four months of intensive treatment, the tumour was a fifth its original size. By August, the remains of the growth were barely perceptible.

The boy received no further anticancer treatment and remained in good health until he died of a heart attack 26 years later. Coley published his results and by the turn of the century 42 physicians from Europe and North America had reported cases of cancer that had been successfully treated with Coley Vaccine.

Radiation therapy vs. Coley vaccine
By 1901, the development of x-rays as a cancer treatment showed great promise. In particular, the therapy resulted in immediate tumor destruction and pain relief. Although Coley successfully treated hundreds of patients, his superiors decided to put the emphasis on the newly invented radiation therapy. At the time, it was thought that radiation therapy could be improved into an effective cure for cancer. But, as we now know, radiation is not successful after metastasis.

Coley arranged for a wealthy friend to provide funds to purchase two x-ray machines for his use. However, after several years of experience, Coley came to the conclusion that the effect of x-ray therapy was localized, temporary and not curative. Others disagreed and cited the dangerous and unpredictable effects, predominantly the fever caused by the bacteria, that the vaccine had upon individuals weakened by cancer. Furthermore the creation of the vaccine had to be made to a patient's exact needs, making the Coley Vaccine more labour intensive, time consuming and expensive.

Conclusions
Coley died in 1936, and his treatment method more or less died with him. There is only now a renewed interest in his ideas.

The historical results of Coley Vaccine therapy are difficult to compare with modern results.

There were, however, many different formulations of Coley Vaccine. These varied greatly in effectiveness, and there were many different treatment protocols that also varied greatly in effectiveness.