INNOVATIVE DENDRITIC CELL TREATMENT IN GERMANY – interview with Prof Dr med Frank Gansauge

26.01.2024 | from Booking Health GmbH | Press

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Prof. Dr. med. Frank Gansauge is a surgeon and oncologist who specializes in immunotherapy for cancer and actively practices its innovative type, dendritic cell vaccination, for the advanced stages of cancer. Dr. Gansauge is one of the most respected experts in the field of dendritic cell therapy worldwide.

Thanks to his unique scientific and practical work, Prof. Gansauge is a Visiting Professor at Liaoning University of Technology in China, the Faculty of Medicine at the University of Belgrade in Serbia, and Shanxi Medical University in China. He has repeatedly won prestigious awards, including the Fred Stephans Award and the Merckle Research Award, and his scientific publications are estimated in the hundreds.

Prof. Frank Gansauge sees patients at the LDG Laboratories Dr. Gansauge Berg. He is the Head of the Department of Oncology and Dendritic Cell Therapy. The department has its own laboratory for the production of dendritic cell vaccines, certified in accordance with EU-GMP requirements. In the interview, the professor tells us about LANEX-DC® dendritic cell immunotherapy and the successes of German medicine in this area.

Good afternoon, Prof. Gansauge! Thank you very much for agreeing to the interview!

We are very happy to meet you!

My name is Frank Gansauge. I studied surgery at university, but my true calling is immunology, and I am particularly interested in immunotherapy. We have been working on dendritic cell immunotherapy for over 22 years. It is this type of therapy that we mainly practice, and the key focus of our work is dendritic cell therapy for cancer.

Your clinic is very popular. Could you please reveal the secret of your success?

I am pleased to hear that my clinic is popular. We strive to provide treatment in a comfortable atmosphere, and we do not have any standard algorithms. We combine classical methods that are highly effective and are included in clinical guidelines with new types of therapy that have also proven themselves as suitable additional measures to standard treatment methods.

It is the patient who is the center of the therapeutic process. This means, as stated in our clinic's slogan, that we strive to restore not only a person's physical health but also his mental well-being.

Prof. Gansauge, could you please tell us about the discovery and development of dendritic cell therapy?

Dendritic cell therapy was discovered by Ralph Steinman in Canada, who later received the Nobel Prize for this. Simultaneously with Steinman, the German Prof. Hinrich Peters from the University of Göttingen was actively involved in the study of this therapy. Today, he advises us during tumor boards at the LDG Laboratories Cancer Clinic. The idea was that dendritic cells, which I call the "officers" of the immune system, are specially "trained" to trigger an immune response against, for example, malignant cells.

This therapeutic method has existed for almost 25 years, which is quite a bit for medicine. I remember well the time when, in my youth, I defended my Ph.D. thesis on antibody therapy, and this method of treatment has become available only now.

How did you start practicing dendritic cell therapy?

Immunology has always been one of our scientific interests. Even more than 10 years before dendritic cell therapy was discovered, we saw immunodeficiencies in cancer patients that needed to be addressed. And then the first scientific paper on dendritic cell therapy appeared in Canada, which, of course, immediately attracted our interest. In 2001, we became one of the first private laboratories that could perform dendritic cell therapy.

Prof. Gansauge, could you please explain in a simple form to our patients how dendritic cells work?

When a person is infected with a virus or bacterium, doctors first need to determine what kind of virus or bacterium it is. The antigens of these viruses and bacteria are then identified, and dendritic cells are the mediators of this process. This means that dendritic cells absorb antigens, present them in a small amount on their surface, and then "train" effector cells, which are specific lymphocytes that subsequently take concrete actions against the virus or bacterium.

I like to call these effector cells "soldiers" and dendritic cells "officers", who recognize pathological cells, understand what they are dealing with, and then pass this information on to cells that perform their task, which is to destroy tumor cells, bacteria, or viruses. This is cellular immunity, and I would not like to go into details now about humoral immunity, which is provided by antibodies, because this will already be too complicated information to understand.

In what areas of medicine are dendritic cells used?

Dendritic cell therapy is mainly used in oncology. It is in this area of medicine that dendritic cells are most often used today. It is worth noting that there are many scientific publications by reputable scientific groups from universities around the world that testify to the effectiveness of dendritic cell therapy. As for the future applications of dendritic cells, they will certainly be widely used in the fields of allergy treatment and anti-aging medicine.

In what areas of medicine are dendritic cells most effective?

First of all, dendritic cells are used in oncology as palliative care. This happens when there is no possibility to completely remove the tumor with surgery or destroy it with radiation. The primary task in such cases is prolonging the patient's life, which is ensured through palliative care. Promising publications on almost all types of cancer are now available. Certainly, very good results are achieved in the treatment of widespread types of cancer, such as prostate cancer in men, breast cancer in women, colon cancer, stomach cancer, pancreatic cancer, and more recently, glioblastoma.

At this point, it is impossible to say for which cancers dendritic cell therapy is most effective, but it is known for which cancers its use has been best studied. And, of course, first of all, the effectiveness of dendritic cell therapy is being studied for common types of cancer and then for rare types of oncology.

Prof. Gansauge, could you please tell us about the effectiveness of dendritic cells in cancer treatment?

There are many very good clinical trials showing a significant increase in life expectancy for melanoma, prostate cancer, and many other cancers that may require palliative care. Such trials were also carried out at our clinic. We mainly conducted clinical trials on the effectiveness of dendritic cells for gastrointestinal tumors, such as stomach cancer, pancreatic cancer, and colon cancer. We have demonstrated a case that required palliative care, and we achieved a significant increase in patient life expectancy with minimal side effects. At the same time, in this case, we managed to provide the patient with curative care. It is about relapse prevention. We have demonstrated, for example, that in the case of colon cancer, the recurrence rate can be significantly reduced, which means that dendritic cell therapy can not only increase life expectancy but also completely cure the patient.

Can dendritic cell therapy be combined with other treatment methods, such as chemotherapy or radiation therapy?

Dendritic cell therapy is an innovative type of treatment, so it would be very bold of me to say that we should put aside well-established standard methods and use only this new type of treatment. If you read our publications, you will see that almost all patients received standard treatment before starting dendritic cell therapy. Thus, we chose an additive therapy model.

Dendritic cells are differentiated cells. This means that, due to the absence of the division process, they are not exposed to radiation therapy and chemotherapy. So, in answer to your question, yes, we combine dendritic cell therapy with radiation therapy or chemotherapy whenever possible.

Prof. Gansauge, is chemotherapy necessary after vaccination? How high are the chances of stopping chemotherapy after receiving dendritic cell treatment?

As a reputable doctor, I cannot make such predictions unreasonably. The data currently available on dendritic cell therapy is rather scarce to suggest that we can offer a new type of therapy and simply abandon proven standard therapies. In this regard, we also recommend standard treatment for patients. Dendritic cell therapy is recommended in addition to standard treatment according to the guidelines that exist in every country and are actually the same throughout the world.

Of course, there are situations when the patient tolerates chemotherapy so badly that it is impossible to continue it, or radiation therapy is not possible due to other factors. But in general, standard treatment is always used, and it is complemented by dendritic cell therapy.

What is the effectiveness of dendritic cell therapy for oncological diseases when compared with classical treatment methods? How efficient are dendritic cells? Could you please estimate this in percentage terms?

In the field of oncology, the answer to this question is unequivocal: already after three months, a doctor can see whether the patient's condition has improved or not. This can be clearly determined using diagnostic tests such as magnetic resonance imaging or computed tomography. Differentiation is then made between the complete disappearance of the tumor, which happens quite rarely, tumor shrinkage, no change in the size of the tumor, or an increase in its size.

These are four possible results by which the dynamics of tumor changes are assessed. The effectiveness of dendritic cell therapy varies within 50-65%, both according to our observations and according to the observations of other doctors involved in this type of therapy. But for me, it is not indications in percentage terms that are decisive, but the survival rate of patients and the achievement of palliative care goals. We published the results of our observations, for example, in colon or pancreatic cancer, confirming a significant increase in the average life expectancy of patients with these oncological diseases.

Prof. Gansauge, were there any cases of complete recovery after dendritic cell treatment in your practice?

Yes, we had such cases in our practice. These are patients who achieved a complete response to therapy, although at this point it is necessary to understand what a complete response to therapy is. This concept implies the absence of any signs of a malignant process after conducting follow-up examinations at a certain interval of time. So, if I understand your question correctly, you are asking about people in whom we managed to achieve a complete recovery from cancer, after which there was no cancer recurrence. That is, we are talking about a group of patients who, based on their diagnostic results, had no tumor recurrence after 5 years. Yes, we had such cases in our practice.

Why do many clinics offer several courses of dendritic cell therapy, but you achieve the same stable effect after only one vaccination?

There are two reasons for this. One reason is that we know that dendritic cells have a certain lifespan. We inject "fresh" dendritic cells, which means that we do not freeze them, so dendritic cells are injected into the patient's body immediately after they have been processed in the laboratory. This means that we are able to eliminate a certain decrease in the quality of the drug that is always associated with cell freezing and storage. We inject dendritic cells without prior freezing. In addition, it is worth considering that one dendritic cell can "train" a certain number of lymphocytes per day, so the limiting factor is not the number of dendritic cells but the number of cells that need to be "trained". That is why, when conducting dendritic cell therapy, it does not always happen that when culturing twice as many cells, the effect of therapy will be twice as good because lymphocytes are the limiting factor.

How is dendritic cell therapy performed?

I always say that the dendritic cell therapy procedure is absolutely unremarkable. Patients provide basic information in advance: information about their disease, its stage, and their previous treatments. Laboratory tests are required to clarify if dendritic cell therapy can be performed. If, for example, the required amount of blood cannot be obtained or the patient has low red blood cell levels, but we take 200 ml of blood, the procedure will not give the desired result. There are also certain work regulations, which we, of course, strictly observe. It goes without saying that if laboratory tests have already been carried out and the patient has the necessary clinical data available, he does not have to undergo them again at our clinic. Depending on the patient's body mass, we take 150-200 ml of blood, after which the biological material is immediately sent to the laboratory, where the dendritic cell-based vaccine is created.

Of course, our laboratory operates under the control of certain organizations and institutions. In addition to the European Medicines Evaluation Agency (EMEA) and the Paul Ehrlich Institute, we also abide by the local regional councils in Germany. It is the regional councils that supervise our work on the spot. Dendritic cell therapy is supplemented by the intake of high doses of vitamin D and water-soluble vitamins. It takes 1 week to culture the cells, after which the patient returns to the clinic and receives a subcutaneous injection of a dendritic cell-based vaccine. After the injection, an intravenous vitamin infusion is repeated, so the duration of the course of treatment is actually only 1 week.

Getting back to your question about why our clinic only performs one vaccination procedure but not several, I can say that we can simultaneously cultivate a huge number of dendritic cells, which is enough to vaccinate a patient for several years. But in cases where the patient needs palliative care, tumor cells tend to change. Our approach therefore provides a course of therapy with dendritic cells against exactly those tumor cells that are currently present in the patient's body.

So, when I repeat the course of therapy, for example, after 3-6 months, I will need to repeat the process of obtaining dendritic cells again because the patient will have new antigens and, over time, the tumor will also change.

Like any innovative treatment, dendritic cell-based vaccination often causes fears and doubts in patients. Could you please help us dispel the myths about complications and side effects of this therapy?

As I said at the beginning, this type of therapy has only been used for about 25 years. From a medical point of view, it is considered innovative. Let me explain why: when a new type of therapy appears, it is, of course, necessary to comply with safety standards, that is, certain procedures must be carried out to approve the therapy and confirm the possibility of its use in clinical practice. This requires that various scientific groups publish many scientific papers that confirm the effectiveness of therapy. At the same time, side effects must be as acceptable as possible, and the frequency of their development must be minimal. Certainly, the protection of patients is also at the forefront, and, of course, there will always be black sheep for whom the idea of developing dendritic cell therapy will not be beneficial.

To date, it is known that dendritic cell therapy causes practically no side effects. Periodically, there were publications in the press saying that this technique was ineffective, but German case law helped us figure everything out. The Higher Regional Court of Frankfurt-am-Main clearly ruled in a court case last year that dendritic cell therapy is a new treatment option. The court ruling was also taken into account at the state level. According to the court decision, dendritic cell therapy was classified as a new treatment method, and research on it is still ongoing. If this technique was ineffective, then we would not be able to obtain permission from the Federal Republic of Germany to manufacture a dendritic cell-based vaccine.

The permission to manufacture the vaccine, which we received, is associated with the observance of a huge number of strict conditions. At the beginning of our work, it was sometimes quite difficult to comply with all the requirements, but today they provide excellent safety for us and our patients. Patients know that they are receiving a product whose proper manufacture is controlled by the state. And even if a patient consults with us but is considering another clinic for dendritic cell therapy, I always say that the first thing to do is to find out if this clinic has permission to manufacture a vaccine.

Thus, the patient will be able to "separate the wheat from the chaff" relatively quickly.

Prof. Gansauge, I would like to thank you that, despite your very tight schedule, you always meet our needs, due to which Booking Health patients can get an appointment at your clinic as soon as possible. And how long is it necessary to wait for those who contact the clinic directly?

Our task is to provide medical care to patients with advanced cancer, so we always strive to arrange an appointment within a maximum of 2-3 weeks after the patient contacts us. We simply do not have the right to tell a patient with advanced cancer that he has to wait another 3 months. Therefore, during the design of the laboratory facilities and resources of our clinic, we took into account the fact that the patient can begin treatment within the next 2-3 weeks after seeking help.

Recently, the pharmaceutical market has been actively promoting the DCVax-L vaccine. Besides the fact that its price is many times higher than the price of dendritic cell-based vaccination, what is the other difference? Why is dendritic cell-based vaccination more reliable and effective?

It is impossible to judge if dendritic cell-based vaccination using our LANEX-DC® product is more reliable or effective than DCVax® dendritic cell-based vaccine. Of course, in the field of dendritic cell therapy, including for glioblastomas, the use of this vaccine plays an important role because studies have proven its effectiveness. Immunotherapy involves the use of DCVax® preparations and, for example, the Sipuleucel-T vaccine produced by the American company Dendreon. There are some very interesting scientific papers that show that many medical facilities use different vaccines to achieve their goals, but the results of using all these vaccines are identical. Thus, DCVax® is a good drug, which in general has contributed to the development of dendritic cell therapy and, of course, boosted recognition of this therapy.

Prof. Gansauge, what information should the patient provide to you for you to determine whether this type of therapy may be indicated for them or not?

A standard procedure includes the following: a patient contacts us, and we request a certain package of documents. It is usually sufficient to have the latest medical record from the attending physician since it contains all the diagnoses. We then need the recent results of laboratory tests, after studying which we decide on the indications for dendritic cell therapy. The next step is to plan the upcoming treatment on specific dates.

As most patients come from abroad and the treatment process is planned in advance, it is worth understanding that dendritic cell therapy is not a miracle cure that always helps patients. Therefore, unfortunately, we also tell many patients that this type of treatment is not indicated for them, or we recommend that they receive some other type of treatment that is more advisable in their particular case.

For example, if a woman with breast cancer contacts us, which happens quite often in our practice, and says that she is interested in dendritic cell therapy instead of surgery, then, of course, we recommend surgery because this type of treatment will make it possible to achieve better results, or this approach to treatment will provide a higher chance of recovery than using dendritic cell therapy alone.

How often and why do you have to refuse patients?

One of the reasons to say that a patient is not a candidate for this therapy is his unsatisfactory general condition. For the same reason, surgery, chemotherapy, or radiation therapy may also be impossible. The second reason we refuse patients is when another conventional type of therapy is preferred.

For example, in cases of breast cancer or colon cancer, when the patient can be operated on, we prefer classical treatment methods. We use such an approach because we strive to find the optimal individual solution for each patient who contacts us for help. In this case, the course of treatment may include not only dendritic cell therapy but also other methods.

We often hear rave reviews from patients about the results of cancer treatment with dendritic cells. Could you please tell us if this therapy is also applicable for other diseases for which conservative medicine fails?

There are many interesting areas where dendritic cell therapy may also be effective, such as the treatment of chronic bacterial and viral infections. Let me explain why: we have antigens against which we can immunize. In the future, this method can also be used to treat various types of allergies.

Dendritic cell therapy is potentially promising in the field of anti-aging medicine, as we noted that patients who received dendritic cell therapy annually experienced a slowdown in the aging process, which ultimately can be easily explained because we know the factors that cause aging.

Anyone who wants to stay young for a long time must understand what causes aging. These are external factors that we cannot influence, such as radiation, exposure to solar ultraviolet, and so on. However, the aging process may also occur due to chronic infections, which dendritic cell therapy should easily deal with. I have to say that I would never have believed it, but I did after patients told me about it, and what is more, not only my patients but also those who had their dendritic cell therapy at other clinics. After the completion of the course of treatment, they looked younger.

I then decided to try dendritic cell therapy myself. My working hypothesis was that it was a waste of time. One should never have empty hopes. However, after the therapeutic procedure, all the people around me told me that I looked younger and fresher, and perhaps even something changed in my character. I am convinced that dendritic cell therapy will soon become an integral part of anti-aging medicine.

Prof. Gansauge, could you please tell us about dendritic cells in anti-aging therapy? What results should we expect?

I cannot tell you what results can be achieved because, as I mentioned earlier, the therapy has only been around for 25 years, and in anti-aging medicine, it has only been used for about 5-6 years. This is a too short period of time to draw any conclusions. It will be possible to talk about the results and effectiveness of the method 30 years later, since very little time has passed.

In theory, dendritic cell therapy should be effective. To understand why, one needs to know what triggers the aging process. Aging occurs under the influence of external factors that we cannot influence, including toxic substances that, in any case, enter the human body, background radiation, and solar radiation. The presence of chronic infections in the human body also accelerates aging. This is the basis for dendritic cell therapy: the suppression of chronic infections, not prevention, but the slowing down of the aging process against this background.

What advice would you give to those patients who are still hesitant about their decision to undergo dendritic cell therapy?

We live in a modern world, and in our enlightened times, of course, there are many opinions on every issue. If you read what they write on the forums today, you will see that patients who have a certain disease describe their experience of treatment. However, in cases where they manage to successfully overcome the disease, they no longer write about it on the forum, but only in those situations when they are dissatisfied with the results of the treatment.

The modern world, however, provides enough opportunities for ordinary people to gain knowledge on the Internet and find out the results of research. Most of the research data is published in English, but today there are advanced translation programs that can translate this data into the desired language so that a person can form their own opinion based on the information studied. I always recommend starting by reading about the topic of interest and skipping the advertising pages on the websites. If, for example, you enter into a search engine: "dendritic cell therapy for breast cancer and research", you will find scientific papers that you can quickly translate using special programs and form your own opinion about this therapy. Today, the patient has to form his own opinion based on the available information.

Prof. Gansauge, thank you very much for the informative interview!

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