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The process behind Ms. Sonnleitner’s case is called “translation”. This refers to the rapid transfer of medical research into real-life clinical treatments. The gene fusion seen in the type of bronchial cancer Ms. Sonnleitner suffers from was discovered only a few years ago – and yet a targeted treatment is already available. Of course, you would be forgiven for thinking that the latest findings from research would normally reach patients as quickly as possible. But unfortunately this is rarely the case.

The primary reason behind this is that these days, drug development is really only carried out by large corporations. Conversely, the links between these processes and core research, which is vitally important, are often missing. One group is conducting research into the biochemical foundations of life, while another entirely is manufacturing products for a specific market. And all this is happening in individual ‘bubbles’, each separated from the other in terms of both staff and space. The result is that a whole host of potentially life-saving research never even reaches the patients that need it or, when it does, it’s already too late.

Now the Dr. Margarete Fischer-Bosch Institute for Clinical Pharmacology (IKP) at the Robert Bosch Hospital wants to change this, ensuring that medical innovations help as many people as possible as quickly as possible. And it’s just walking distance from the oncology department.

“We have seen incredible progress in cancer treatments in recent years, especially in the field of pharmacogenomics, or cancer treatments that are specific to an individual’s germline or the tumor’s genome,” explains Prof. Dr. Matthias Schwab, the Institute’s director since 2007 and the chair of Clinical Pharmacology at the University of Tübingen.

“Theoretically speaking, many cancers can now be cured or converted into a chronic disease. It’s truly terrible when sufferers live with a chance of being cured but also the knowledge that time is running out.” The way Prof. Dr. Schwab sees it, doctors and researchers have a moral obligation to ensure that findings are translated into results quickly.

One example of the IKP’s pioneering work is in the treatment of breast cancer, the single most common cancer to affect women. For a long time, breast cancer was also treated using cytostatics. But this treatment, which, broadly speaking, inhibits the growth of all cells in the body, is enormously taxing, with hair loss, nausea, and severe pain all common side effects.

As early as the 1960s, researchers had already discovered a different mechanism for combating breast cancer: the substance tamoxifen, which interferes with the patient’s estrogen balance and can lead to the tumor disappearing entirely. It was a truly groundbreaking drug – but sadly not for all patients. “My predecessor here at the IKP, Prof. Dr. Michel Eichelbaum, discovered the CYP2D6 polymorphism back in 1975,” explains Schwab.

This variation means that between ten and twenty percent of women are genetically missing the enzyme which first metabolizes tamoxifen into an effective substance in the body. As such, the drug is of little use to them, and the tumor can still grow. What can help these women, however, is instead administering the metabolite to them directly – an option that has been on the market for several years now.

Researchers at the IKP are fighting cancer on a whole range of levels. “You need to work with models to really understand the metabolism of tumors, for example how they respond to drugs,” says Dr. Thomas Mürdter, the Institute’s deputy director. For a long time, tumor tissue was cultivated in Petri dishes for this reason. The problem is that tumors are incredibly complex structures where the tumor cells are interacting with the surrounding tissue, including blood vessels, fibroblasts and immune cells. A 2-D model in a dish just isn’t capable of replicating this level of complexity. Instead, the team, led by Dr. Mürdter, is working with what are known as organoids: artificial mini-tumors grown, for instance, in a gel extracted from mouse tumors. “Tumor avatars” is Dr. Mürdter’s name for them.

But there’s another factor behind the fact that translation is practiced so purposefully at the IKP, namely the Institute’s close links to the Robert Bosch Hospital’s Oncology Center. Tumor samples are delivered straight from the operating theater several times a week before being cut into 0.3-millimeter slices and sent for further processing, for example into organoids. As we speak, research is in full swing into breast, intestinal, and ovarian tumors above all.

But the team is also very often busy with lung cancer, whose high number of variants and mutations makes for particularly interesting core oncological research. “It’s a question of give and take between treatment and research,” says Mürdter. “We get the patients’ tumor material, and, in return, we strive to ensure the latest research findings are incorporated back into their treatment as quickly as possible.”

This may well have been how Ms. Sonnleitner’s tumor samples ended up in the IKP’s underground labs. In her words, the fact she’s still here to talk about her illness in person is a miracle: “I didn’t want a prognosis, I asked the doctors not to give me a life expectancy,” she says, “but I didn’t feel I had long left: the pain, the cough, the depression – I just couldn’t take it anymore.”

But after taking this new drug, the inhibitor selpercatinib, she woke up the next morning with a remarkable improvement: “I wouldn’t say I was symptom-free, but I was only in a quarter as much pain as I had been. My husband got a bit of a shock when he walked in and saw me sitting up in bed, not lying down.” The improvements stabilized and even the metastases are receding. “I’m still not well,” says Ms. Sonnleitner, “and I might never win my battle with cancer. But being able to live a relatively pain-free life, most of all without that nagging cough, is the greatest gift of all right now.”

Professor Dr. Kopp, too, is very pleased: “We saw a tiny chance, and we jumped on it. Now we have to see how things play out. Some inhibitors only work in the short term before the tumor develops resistance strategies that we need to counteract. Research into this is currently in full swing,” he adds. 

Melanie Sonnleitner has complete faith in the team at the Robert Bosch Hospital. “I had a lot of respect for hospitals before I got sick,” she says. Going into hospital literally gave her heart palpitations.

Once she was diagnosed with cancer, it became clear to her that “I only stand a chance if I give everything to the treatment. But the team here makes it easy for me. Not only are they incredibly well-informed, they also welcomed me with open arms. I have never felt alone with my illness.” Perhaps that is exactly what translation is all about: ensuring no one is left alone with their illness, that everything works together with the goal of healing.