What the Dog Saw [51]
4.
Pike’s proposed solution is a class of drugs known as GnRHAs, which has been around for many years. GnRHAs disrupt the signals that the pituitary gland sends when it is attempting to order the manufacture of sex hormones. It’s a circuit breaker. “We’ve got substantial experience with this drug,” Pike says. Men suffering from prostate cancer are sometimes given a GnRHA to temporarily halt the production of testosterone, which can exacerbate their tumors. Girls suffering from what’s called precocious puberty — puberty at seven or eight, or even younger — are sometimes given the drug to forestall sexual maturity. If you give GnRHA to women of childbearing age, it stops their ovaries from producing estrogen and progestin. If the conventional Pill works by convincing the body that it is, well, a little bit pregnant, Pike’s pill would work by convincing the body that it was menopausal.
In the form Pike wants to use it, GnRHA will come in a clear glass bottle the size of a saltshaker, with a white plastic mister on top. It will be inhaled nasally. It breaks down in the body very quickly. A morning dose simply makes a woman menopausal for a while. Menopause, of course, has its risks. Women need estrogen to keep their hearts and bones strong. They also need progestin to keep the uterus healthy. So Pike intends to add back just enough of each hormone to solve these problems, but much less than women now receive on the Pill. Ideally, Pike says, the estrogen dose would be adjustable: women would try various levels until they found one that suited them. The progestin would come in four twelve-day stretches a year. When someone on Pike’s regimen stopped the progestin, she would have one of four annual menses.
Pike and an oncologist named Darcy Spicer have joined forces with another oncologist, John Daniels, in a startup called Balance Pharmaceuticals. The firm operates out of a small white industrial strip mall next to the freeway in Santa Monica. One of the tenants is a paint store, another looks like some sort of export company. Balance’s offices are housed in an oversized garage with a big overhead door and concrete floors. There is a tiny reception area, a little coffee table and a couch, and a warren of desks, bookshelves, filing cabinets, and computers. Balance is testing its formulation on a small group of women at high risk for breast cancer, and if the results continue to be encouraging, it will one day file for FDA approval.
“When I met Darcy Spicer a couple of years ago,” Pike said recently, as he sat at a conference table deep in the Balance garage, “he said, ‘Why don’t we just try it out? By taking mammograms, we should be able to see changes in the breasts of women on this drug, even if we add back a little estrogen to avoid side effects.’ So we did a study, and we found that there were huge changes.” Pike pulled out a paper he and Spicer had published in the Journal of the National Cancer Institute, showing breast X-rays of three young women. “These are the mammograms of the women before they start,” he said. Amid the grainy black outlines of the breast were large white fibrous clumps — clumps that Pike and Spicer believe are indicators of the kind of relentless cell division that increases breast-cancer risk. Next to those X-rays were three mammograms of the same women taken after a year on the GnRHA regimen. The clumps were almost entirely gone. “This to us represents that we have actually stopped the activity inside the breasts,” Pike went on. “White is a proxy for cell proliferation. We’re slowing down the breast.”
Pike stood up from the table and turned to a sketch pad