A vaccine containing the avian flu virus. As far as surgeon Casper van Eijck is concerned, this will be the future treatment of pancreatic cancer. Within a year he raised €1.5 million for an initial study.

Chemotherapy, radiotherapy and perhaps some surgery – for years, these were patients’ only options. Van Eijck (white lab coat, frown, bushy eyebrows) is seated in his study on the eighth floor of the former Dijkzigt Hospital. Above his head is the string of pennant flags hung up by his colleagues on the occasion of his sixtieth birthday, two weeks ago now. A photo of his two golden retrievers (now dead) hangs on the wall behind him.

Casper van Eijck in actie 0115-007

In his Cowboys in Science series, Geert Maarse interviews academics who take things just a little bit farther. Casper van Eijck is a Professor of Surgery who specialises in disorders of the pancreas. Through his “Support Casper” campaign he is focusing on new and innovative treatments of hard-to-eradicate forms of cancer, such as pancreatic cancer. In addition, Van Eijck spends every Sunday on the bench at the Kuip Stadium, being FC Feyenoord’s regular sports medicine doctor.

Much has changed in the 25+ years he has been treating patients with pancreatic cancer at Erasmus MC. He became a Professor of Surgery (the only one in the Netherlands specialising in disorders of the pancreas) and also became an absolute leader in his field. His patients think the world of him: they fly in from places as far away as India and the USA to be treated by him. But even though spectacular breakthroughs have been reported in the treatment of other types of cancer, Casper van Eijck remains empty-handed. Nearly all of his patients end up dying, often within half a year.

It must be weird to be a specialist in a disease whose patients are almost certain to die.

“It is. We recently published an article showing that the number of people who die of pancreatic cancer each year exceeds the number of people who have been officially diagnosed with the disease. We are talking about 3,500 people a year, i.e., nearly ten a day. And this number is rising. In a few years, pancreatic cancer will probably be the second-most deadly form of cancer in absolute terms, after lung cancer. You can either drop your head and give up, or alternatively you can say: we will fight this thing.”

You are working on a new and innovative therapy. How does it work?

“The campaign was established by the next of kin of two former patients of mine. As a doctor treating pancreatic cancer, you will inevitably turn into a counsellor at some point. During such conversations new therapies are sometimes brought up, even when they have not yet proved effective or when it is hard to get the research funded. So they said: let’s make sure Van Eijck raises the amount of money needed to test such a new method. Within a year we had raised a million and a half.”

Is it true that the idea was partially derived from another patient, who started injecting himself with the avian flu virus at one point?

“That is correct. He was a veterinarian who started experimenting on his own at one point. These people are often desperate. They know they are doomed. It is known that countries like Cambodia, Taiwan and China are working with oncolytic viruses: viruses that kill tumour cells on the one hand and cause the immune system – which is deactivated by cancer – to be reactivated on the other hand. There is no scientific evidence that it works, but even so this man lived for another six years, despite having been proved to have pancreatic cancer. These are results that – how am I going to put this? – would be described in other countries, at the very least.”

What do you mean, “How am I going to put this?”

“I mean this treatment has not yet been demonstrated to be effective. Much research is needed and the virus must be manipulated to obtain the desirable effects. In addition, it should be kept in mind that technically, the treatment this man administered to himself constitutes an offence under Dutch law. You can’t just inject yourself with viruses.”

Did you know he was doing it?

“No. He did not tell me until later.”

Would you describe it as an alternative therapy?

“I think it is important to distinguish between experimental and alternative therapies.”

Do explain.

“An experimental therapy is a new therapy which is subject to scientific evaluation, including a complete description of what you are doing and what kind of results you are obtaining. Alternative therapies are often not subject to such reporting. Although these things do change. Look at turmeric, for instance. Turmeric root is often used as an anti-cancer agent in Southeast Asia. Much positive literature has been published on the subject, so people are now jumping on the bandwagon here too. One should realise, though, that this literature is about studies involving Petri dishes and mice. It has never been proved effective in humans. Unlike many of my colleagues, I am open-minded when it comes to new methods. However, I do want them to be subjected to proper scientific research. As for the viruses… Thankfully, we have some excellent virologists here – Ron Fouchier, Bernadette van den Hoogen – who told me they wanted to look into this in a properly scientific way.”

You must have spoken to people who said: Van Eijck, what the hell do you think you’re doing?

“Of course I have. What we do definitely goes against the established order. You see, normally it is pharmaceutical companies who determine what follow-up studies are to be carried out. But we feel this should be up to the doctors. What makes our study so good is that we have gathered a team representing a wide range of specialists – immunologists, virologists, neurosurgeons, urologists, medical oncologists – who really want to get this project up and running. This is not a one-man project. There are many advantages to doing it all ourselves. For instance, our data will remain public property. Furthermore, we will retain intellectual ownership, meaning that the medications will be affordable. There is a reason why the health insurance company is now saying: we will pay for these medications. Brilliant.”

You are one of the most renowned pancreatic cancer specialists in the world. Why do you have to raise funds to ensure that this study gets funded?”

“It is a great pity, that is for sure. But then again, it is understandable. We are doing something revolutionary. Many well-known funds wish to wait and see from which way the wind blows.”

How long until this therapy will be able to be used in practice?

“If everything goes according to plan, we will be able to start treating people with virotherapy in about three years. The main concern is safety. We cannot create a situation where the virus we administer against cancer will pose a threat to other people, or to animals.”

Is there any chance that a few years from now, you will be forced to conclude that your therapy is useless?

“Everyone can tell that this is the future. Major pharmaceutical companies are buying these types of viruses. That says it all. Look, as far as I’m concerned, it is obvious that we are not going to cure pancreatic cancer this way. We are merely trying to get the disease under control. At present we do so by administering chemotherapy, but 30 to 80 percent of our patients do not respond to this. Moreover, chemotherapy is incredibly toxic. Over the last thirty years we have caused people to feel really sick with experiments from which they hardly benefited. This being the case, it is understandable that patients are increasingly reluctant to undergo chemotherapy. We hope to be able to control tumour growth through viro-immunotherapy, without all the nasty side effects. And I am absolutely convinced we will.”

Casper van Eijck in actie 0115-023

Erasmus MC has quite a reputation in the field of virus manipulation. Does this mean the Minister for Health is monitoring your every action?

“The minister embraces this sort of innovative approach. We recently received a subsidy of half a million euros to ensure safety when working with viruses. And the researchers are not evaluated by the hospital’s Medical Ethics Review Committee, but rather by the national Central Committee on Research Involving Human Subjects (CCMO).”

There are many scientists and doctors who are afraid to veer off the beaten track or to collaborate with researchers from other disciplines. What advice would you give to these persons?

“My drive was born out of my concern for my patients. Whenever I look at them and feel what they are giving me, I realise I have to try and do something. It should be said, though, that there is much to be gained in the field of translational research, where doctors and academics collaborate in the field of patient care. For example, we have the knowhow to be able to evaluate the use of chemotherapy in such a way that a few years from now, we will know whether someone is more likely to benefit from the red bottle or from the yellow bottle. At present we often do not know whether it is any use prescribing chemotherapy in accordance with the guideline. This costs a lot of money, all of which ends up in the pharmaceutical companies’ coffers. I suggest the Minister claim 10 percent of these companies’ profits and earmark it for ongoing research.”