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, 94, has been treated with one of these drugs for the melanoma that had 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 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 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 and was one of the recipients of the 2018 Nobel Prize for this work, 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 for treating certain types of melanoma as well as other cancers such as malignancies of the lung, bladder, head and neck, stomach, kidney and colon. These drugs also are recently approved to treat lymphoma and triple-negative breast 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.
The CAR T-cell therapy tisagenlecleucel (Kymriah) has been FDA-approved for adults with certain types of non-Hodgkin’s lymphoma and children and young adults with acute lymphoblastic leukemia. Another CAR T-cell therapy, axicabtagene ciloleucel (Yescarta), is FDA-approved for diffuse large B-cell lymphoma.
WHAT TO DO NOW
If you are being treated for cancer, ask your oncologist whether there is an immunotherapy cancer drug readily available for you or in clinical trials. To learn about cancer clinical trials or to find one yourself, consult ClinicalTrials.gov and 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 without paying astronomical sums for it.