Jimmy Carter on the forefront of possible breakthrough in lung cancer drug

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Jimmy Carter was diagnosed about a year ago with advanced liver cancer that had metastasized into his brain and other organs. Usually, for a 90-year-old man, the prognosis is not good.

However, a year later, Carter is at the moment cancer-free and apparently has no plans of dying any time soon. Carter was given an experimental immunotherapy drug called Pembrolizumab (trade name Keytruda, which I’m going to use because it’s easier to spell), which worked wonders on his cancer.

Keytruda has also been shown to be effective in treating small-cell lung cancer, still one of the most difficult types of cancer to treat. Despite the dramatic drop in smoking rates the past 25 years, lung cancer remains the No. 1 cancer killer in the West.

Because Keytruda is working so well in treating lung cancer among 300 trial patients, the drug company Merck announced that it will no longer hold trials and will make Keytruda available to these lung cancer patients. According to Merck, Keytruda worked as well if not better than conventional chemotherapy and helped stopped the growth of lung cancer tumours.

From an NBC story:

The details are not available yet. “We look forward to sharing these data with the medical community and with regulatory authorities around the world,” said Dr. Roger Perlmutter, president, of Merck Research Laboratories.

Independent committees look at the details of the patients and how well they are doing in drug trials like these. It was one of these independent committees that recommended stopping the trial based on what they saw but that doesn’t necessarily mean they shared the details with the company or anyone else.

“I suspect the findings were significant enough that this will be a practice-changing finding,” Dr. Pasi Janne, lung cancer specialist at Harvard Medical School and the Dana-Farber Cancer Institute, told NBC News.

Keytruda has not been approved yet for wide use by the Food and Drug Administration, but the process of getting its approval has begun. Keytruda has been OK’d for patience for whom standard chemotherapy has failed. Merck is seeking its approval as a first-line drug for lung cancer. The FDA has been known to give quick approval to these kind of immunotherapy cancer drugs.

From NBC News:

They treat cancer by stopping tumor cells from cloaking themselves against the normal, healthy immune system response.

They work on the principle that it’s not where cancer starts that matters, but the genetic mutation that causes the cancer. So a lung tumor in one patient may look like the melanoma in another.

Keytruda — known generically as pembrolizumab — targets the activity of genes called PD-1 (anti-programmed-death-receptor-1) and PD-L1. The interaction between the two genes lets some tumors escape detection and destruction by immune system cells.

PD-1 stops immune cells from attacking normal healthy cells by mistake. Tumor cells make PD-L1 turn on PD-1 when immune cells approach.

This trial only included patients whose tumors cells made a lot of PD-L1. That is only a portion of people with lung cancer – 25 percent in one recent trial.

Immunotherapy is a whole new way of treating cancer, including lung cancer,” said Janne, who was not involved in the study. “Having seen patients benefit who failed existing therapies, now doing well on these new therapies, is fantastic.”

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