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Defiant woman inspires researchers

A woman's refusal to undergo chemotherapy more than 10 years ago has resulted in cutting edge discoveries into a rare cancer by National Taiwan University (NTU).

The woman had high-grade lymphoma of mucosa-associated lymphoid tissue, or high grade MALToma for short. Chemotherapy was the standard therapy and doctors said there was an 80 percent chance she would survive five more years.

The woman decided against chemotherapy and flew back to Taiwan from the US, where she had been living, when her doctors there insisted that chemotherapy was her only option.

"She was adamant that she would not undergo chemotherapy even though we also told her she would be risking her life," said Cheng Ann-lii (鄭安理), director of medical oncology at NTU Hospital.

"In the end, we tried antibiotic therapy, and were surprised to find that she responded positively to it," Cheng said.

Antibiotic therapy has been reported as an effective treatment against low-grade MALTomas, but not high-grade ones.

Subsequent medical trials have found the antibiotic therapy effective for most high-grade MALToma patients, and the team's findings have been published in several international journals such as the Journal of the National Cancer Institute, the Journal of Clinical Oncology and Blood.

"With out her, we might have never started on this line of research," Cheng said.

He said the antibiotics do not act on the cancer itself but on a bacteria called Helicobacter pylori, a common bacteria present in the gastric systems of 50 to 70 percent of the population. The bacteria only causes high-grade MALTomas in a very small percentage of people, roughly 100 to 150 in Taiwan annually, he said.

He said it was unclear why it's important to remove the bacteria after the cancer has formed.

"We cannot answer even this basic question fully. The cancer cells seems to need stimulation to continue growing and multiplying," he said. "Perhaps the immune signal triggered by the presence of the bacteria also stimulates the growth of the cancer."

As for the defiant woman, she is now 49 and in good health.

"We doctors are most concerned about the survival of the patients. But sometimes they [the patients] insist most forcefully that their quality of life is important as well," Cheng said.
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