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Cancer Immunotherapy: A Radical New Cancer Treatment That’s Saving Lives

Date: November 2, 2015      Publication: Health Insider      Source: Louis Weiner, MD, and  James P. Allison, PhD      Print:

It seems like every week there’s a promising new cancer treatment—that never happens. Too often we read about a new theoretical approach that saves lives in one or two studies…only to wait and wait for the treatment to materialize in the practice of cancer medicine.

This time is different.

“No chemotherapy drug works so well on so many patients,” says Louis Weiner, MD, director of the Lombardi Comprehensive Cancer Center at Georgetown University. “This is not theoretical or another case of overhyping, overpromising and underdelivering. These drugs are working.”

He’s talking about a new way to fight cancer by using the body’s own immune system to wage war on cancer cells. Many leading cancer experts believe this new approach, cancer immunotherapy, could revolutionize how we treat many forms of cancer. When it comes to certain cancers, the revolution has already begun. In fact, former President Jimmy Carter, 91, is now being treated with one of these drugs for the melanoma that has spread to his brain.

The new treatments aren’t about enhancing immunity in general. Instead, this is a new approach that can prevent cancerous tumors from hijacking our own immune defenses—and let our amazing immune system do its job.

6 THINGS YOU NEED TO KNOW ABOUT THE NEW CANCER IMMUNOTHERAPY

Here are the details on this latest form of cancer immunotherapy…

1. It treats the body’s immune system so the immune system can fight the cancer. T cells are the immune system’s main line of defense, but they’re not always effective against cancer cells. In the 1990s, cancer researchers identified a class of molecules in the body that are known as immune checkpoints. These molecules keep T cells from attacking normal cells, but cancer cells can hijack them for their own purposes. “Cancer cells employ immune checkpoints to turn off killer T cells that would otherwise recognize and destroy a cancer that was growing in somebody’s body,” Dr. Weiner says. Drugs that block these checkpoints so T cells can do their job are called immune checkpoint inhibitors, he explains. “They’re the game changers.”

2. It still has side effects, but early results suggest a less toxic experience. “All of us would love to see a day when very toxic chemotherapy agents that cause hair loss, low blood counts, fatigue, etc., are no longer the backbone of therapy for cancer,” Dr. Weiner says. “With checkpoint inhibitors, there will potentially be fewer side effects and certainly different ones.” So far, the most common side effects caused by checkpoint inhibitors already in use include fatigue, cough, nausea, skin rash and itching. But more serious side effects including severe diarrhea, colitis and intestinal inflammation (even perforation) have also been reported.

3. It can be very effective and long-lasting. Consider the effects of checkpoint inhibitors against end-stage Hodgkin’s disease, where patients have already received every imaginable therapy and were running out of hope. “More than 90% of these patients went into complete remission, and these remissions were durable,” Dr. Weiner says. When checkpoint inhibitors are combined against metastatic melanoma—the most deadly form of skin cancer—as many as half of those cancers are completely eliminated, with benefits that have lasted 10 years so far. He adds, “You’ve taken a disease that was destined to end somebody’s life very quickly, and you’ve completely changed it.”

4. It works against many forms of cancer. In a viewpoint recently published in JAMA, James Allison, PhD, who pioneered the use of immune checkpoint inhibitors against cancer, wrote: “The therapy does not target the tumor cell but rather engages a target on the patient’s immune system. Thus, there is no inherent reason that it would not be successful against a wide variety of tumors.” At this time, checkpoint inhibitors are FDA-approved only for treating certain types of melanoma and lung cancer. But studies show they also work against no fewer than 20 different cancers including certain forms of kidney cancer, triple negative breast cancer, stomach cancer, Hodgkin’s disease, bladder cancer and head and neck cancer.

5. It is very expensive. “It can cost tens of thousands of dollars or more to have a course of therapy with these drugs, especially if you start combining them with other expensive cancer therapies,” Dr. Weiner says.

6. It is still evolving. One promising innovation in cancer immunotherapy that’s currently being researched is chimeric antigen receptor (CAR) T-cell therapy. Here, a patient’s T cells are genetically engineered to produce antibodies against a specific type of cancer. When these T cells proliferate, they pass their cancer-killing modifications along. So far, says Dr. Weiner, this experimental treatment has had “stunning results” against a hard-to-treat and deadly form of leukemia called acute lymphocytic leukemia.

WHAT TO DO NOW

While many checkpoint inhibitors are in development, currently only three have been approved by the FDA…

• Opdivo (nivolumab) and Keytruda (pembrolizumab) are approved for advanced stage non-small cell lung cancer that has spread and that is not responding to conventional platinum-based chemotherapy, and for advanced melanoma.

• Yervoy (ipilimumab) is approved for melanoma that has spread within the body (metastatized) or that cannot be removed by surgery.

Until new drugs for different cancers make it through the FDA approval process—or the existing approved ones get future approvals for different cancers—these are the only three of this type of cancer treatment that insurance companies or Medicare are likely to pay for. If you have the financial wherewithal, you may be able to have your doctor prescribe the approved drugs off-label and pay for them yourself.

For everyone else, however, there is another potential option. If there is an immunotherapy cancer drug in development for a cancer that you are being treated for, ask your oncologist whether there is a clinical trial that you can get into. To learn about cancer clinical trials or to find one yourself, read Bottom Line’s How to Get into a Cancer Clinical Trial…and Why You’d Want To. That’s your best bet to get one of these drugs for an off-label treatment without paying astronomical sums for it.

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Sources: Louis Weiner, MD, director, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC. He is an internationally recognized medical oncologist specializing in the treatment of gastrointestinal cancers. His lab researches novel immunotherapy treatments.

James P. Allison, PhD, department of immunology and immunotherapy platform, The University of Texas MD Anderson Cancer Center, Houston.