Einar Stefán Björnsson, professor at the Faculty of Medicine
A staggering proportion of people in Iceland struggle with cancer – almost one in three Icelanders will be diagnosed with cancer during their lifetime. There is a lot to gain, therefore, by finding a cure, with 1,500 new cases of cancer diagnosed each year. The search for new drugs to fight this malignant force is never ending, but the matter is complicated by the fact that cancer is not a single disease but rather an umbrella term for over 200 different diseases, most of which require specialised treatment.
Many scientists dream about discovering 'the one true drug' that will cure all cancer, but it is doubtful that such a drug will ever be found. Progress is nevertheless continuous and new drugs are always entering the market, improving the chances of recovery for many people. But as is frequently the case with drugs, they bring various new side effects that must be thoroughly researched.
"My research is based on mapping and investigating the risk of patients suffering liver injury induced by certain cancer drugs, in particular new drugs that affect the immune system." So says Einar Stefán Björnsson, professor at the University of Iceland, who has attracted considerable international attention for his research into the side effects of drugs; for example, an article from his research team that was published in Gastroenterology in 2013 has been cited around 400 times according to Google scholar, as of June 2019.
"The older cancer drugs have been in use for many decades," says Einar Stefán, "but there are now considerably more options with the arrival of monoclonal antibodies and a new generation of drugs that affect the immune system."
Known across the world for his research into drug-induced liver injury
Einar Stefán's research into liver disease has, among other subjects, focused on identifying risk factors for bad patient prognosis and describing the natural progression for patients with drug-induced liver injury. Einar Stefán says that Iceland is a very good place for so-called population-based studies of cancer-drug-induced liver injury. The size of the population is practical, there are few institutions providing cancer drug treatment, and records of cancer drugs and other drugs are good.
"Forward-thinking research into the frequency of cancer-drug-induced liver injury was conducted here in Iceland between 2010 and 2012, uncovering the highest rate of liver injury that had ever been published," says Einar Stefán, who has a rather unique academic background. His path, therefore, differs somewhat from many of his medical colleagues. Einar Stefán studied psychology for one year and philosophy for two years at the University of Iceland before enrolling at the Faculty of Medicine. Einar Stefán went to Sweden after completing his degree in medicine, and completed his doctorate from the University of Gothenburg in 1994. He has also completed a specialist diploma in gastroenterology and hepatology from Sahlgrenska University Hospital.
"My research is based on mapping and investigating the risk of patients suffering liver injury caused by certain cancer drugs, in particular new drugs that affect the immune system," says Einar Stefán Björnsson, professor of medicine at the University of Iceland.
Cancer is a complex phenomenon – as is the treatment
Although cancer is a word in common parlance, many people are not actually sure what it is. In a healthy body, cells are arranged in an organised manner and function as part of tissue or organs. The common factor in all cancers is that they are caused by damage to cell DNA, which leads to uncontrolled cell proliferation and abnormal cell behaviour. Cancerous cells behave differently to normal cells and damage the body.
It depends on the nature of the cancer how malignant the cancerous cells become. Ninety percent of cancers begin in the epithelial lining of organs such as the lungs and breasts. Initially, the cancerous cells form a localised tumour within these organs. If the cancer is left to grow, there is a high chance that the cells will spread to the surrounding membrane and enter the lymphatic or circulatory system. The cancerous cells can then form metastases in other organs.
It has emerged that cancerous cells have a different metabolism to healthy cells. New drugs work to take advantage of these metabolic differences, with some also affecting the immune system in the fight against the cancerous cells. It is very important to monitor all drugs closely, not least these new cancer drugs, and research their impact on long-term patient prognosis.
"Incidents have been reported abroad of patients suffering liver injury, for example jaundice, caused by cancer drug treatment. There have been no systematic studies into how common this is, nor which patients are most at risk and whether this side effect has an impact on patient prognosis."
Findings will show which drugs cause the most damage
Einar Stefán says that the findings of his research will indicate which cancer drugs are most likely to cause liver injury, and what the prognosis for patients is. "This means it may become possible to identify risk factors for this side effect. Our research team possesses a great deal of expertise in the subject area and many papers have been published in foreign peer-reviewed professional journals. In many ways, the situation in Iceland is ideal for researching the number of people who take drugs and suffer side effects. The Directorate of Health's Prescription Medicines Register plays an important role here, since all drug prescriptions outside hospital are recorded. The small population size makes it easily manageable and attempts to conduct this kind of research in other places have not been successful to the same extent. No other research team has identified a similar proportion of patients suffering liver injury induced by certain drugs, and therefore the number of patients who need to be treated with a drug before one experiences this side effect. The chances are that it will be possible to use the findings of this research to calculate these figures for certain cancer drugs," says Einar Stefán, adding that this is part of the doctoral thesis of Helgi Kristinn Björnsson, a junior doctor at Landspítali University Hospital. Einar Stefán says that research such as he is currently conducting creates new knowledge, which is crucial for progress that improves patient outcomes.