Category Archives: Keytruda

Immunotherapy, Keytruda, Lung cancer, Nobel Prize

Immune therapy breakthrough for cancer wins Nobel

Two medical researchers, James Allison of the U.S. and Tasuku Honjo of Japan, were awarded the Nobel Prize for medicine this week for their breakthrough research in harnessing the body’s own immune system to fight cancer.

Allison and Honjo’s breakthroughs came way back in the 1990s. Their research eventually led to the production of immunotherapy drugs such as Yervoy in 2011 and later the well-known drug Keytruda.

Immunotherapy unleashes the body’s own immune system to attack cancer cells rather than chemotherapy. It tends to not have as many side-effects as chemotherapy and for certain kinds of cancers, such as melonoma, it has provided astounding results. Keytruda is most famous for being known as “The Jimmy Carter” drug because Carter was given the drug on an experimental basis several years ago when he had advanced melanoma and brain cancer. And Jimmy is still around today to talk about it.

Keytruda has shown success in treating certain kinds of small cell lung cancer (if patients have certain gene markers). While there are some reports that people with melanoma have been literally cured by Keytruda, it’s not a cure for lung cancer. However, for some patients, they live much longer on the average than with traditional chemo and have much better quality of life.

From a Scientific American article:

Allison, a professor at The University of Texas M. D. Anderson Cancer Center in Houston, discovered that a molecule called CTLA-4 (cytotoxic T-lymphocyte antigen 4) acts as a “brake” on the immune system; remove the brake and—in many cases—immune cells are unleashed to fight the cancer. Allison spent 17 years convincing others that this approach could work, leading to approval in 2011 of the drug Yervoy, which showed near-miraculous results for a fraction of patients with a lethal form of skin cancer.

The pharmaceutical industry is vigorously pursuing immunotherapy, and hundreds of trials are currently underway based on CTLA-4, PD-1 and other immune approaches.

For decades researchers had been trying to figure out effective ways to use the body’s own immune system against cancer. They tried vaccines and other approaches for ramping up immune activity. Allison’s insight, Perlmann said, was to trigger the brakes instead. “It represents a completely new principle because, unlike the previous strategies, it is not based on targeting the cancer cells but rather the brakes, the checkpoints of the host immune system,” he said. “It represents a paradigmatic shift and a landmark in the fight against cancer.”

Honjo’s research was completely separate from Allison’s, but used a similar approach.

From the article:

Meanwhile Honjo, of Kyoto University in Japan, was studying a different immune brake called PD-1 (programmed cell death 1), according to Thomas Perlmann, secretary general of the Nobel Committee, who spoke about the findings amid the prize announcement early Monday. Allison’s success with CTLA-4 in cancer persuaded Honjo to consider his molecule in cancer as well—and he found PD-1 therapy was even safer and more effective against a number of cancers, including lung cancer, which kills about 150,000 Americans a year. Drugs based on his findings also work in combination with Yervoy against a number of types of cancer.

Keytruda is not quite a miracle drug, unfortunately. Not everyone has the gene markers for it, but it has gained a massive reputation thanks to Jaimmy Carter. From a Times Now article:

While in theory it should work for most forms of cancer, it’s most effective on those with the highest numbers of mutations such as melanomas, lung cancer and smoking, he added.

And it has sometimes been met with too much enthusiasm by patients. In the US, some have reportedly asked their doctors to immediately use immunotherapy instead of traditional treatments like chemotherapy, even when they are more effective.

After his big win on Monday, Allison warned that immunotherapy will not replace all other cancer treatments. Instead, it is “going to be part of therapy that potentially all cancer patients will receive in five years,” he told a press conference in New York. Honjo, meanwhile, said he wanted to continue his research “so that this immune therapy will save more cancer patients than ever”.

 

 

Keytruda

Keytruda, a new hope

The issue of Keytruda has become near and dear to my heart the past few weeks with a close family member taking it to treat his lung cancer.

Keytruda is an immunotherapy drug that instead of poisoning the body, uses the body’s own immune system to attack cancer cells. It’s been very effective for melanoma.

Keytruda is sometimes known as “The Jimmy Carter drug.” He is the most famous Keytruda patient. In 2015, Jimmy Carter was diagnosed with inoperable cancer in his brain and liver and was given months to live. Three years later, after being given Keytruda on an experimental basis, he’s still kicking and cancer-free. In fact, now, many cancer patients are left asking their doctors “can I get the Jimmy Carter medication”?

That doesn’t mean Keytruda is some kind of “miracle drug.” It hasn’t worked on everyone. But, after being shown that it was more effective than chemotherapy for melanoma, they started giving it to lung cancer patients.

This is the best description I’ve seen about Keytruda. That it “wakes up” the body’s natural immune system and teaches it to recognize that cancer cells are not normal cells and need to be destroyed.

Keytruda is manufactured by Merck and its chemical name is pembrolizumab. There’s some similar auto-immune cancer drugs, one of which is called Opdivo.

The drug has created so much buzz that it’s gotten attention in L.A. Times articles that it could be a more effective first-line defence against lung cancer than traditional chemotherapy.

Some people call Keytruda a “miracle drug,” but it isn’t quite that. Not yet. It doesn’t cure everyone with melanoma or lung cancer, but apparently it is more effective than traditional chemotherapy. It’s a promising breakthrough. It works fantastic for some people.

Hopefully, immunotherapy will ultimately lead to a total cure for lung cancer.

Immunotherapy, Keytruda, Lung cancer

New drugs making progress against lung cancer

Lung cancer is one of the deadliest forms of cancer. At one time 90 percent of the people who developed lung cancer died from the disease. The number is better now, but the death rate for lung cancer is still one of the highest for any form of cancer.

The five-year survival rate today for lung cancer is still only about 17.7 percent and more than half the people who are diagnosed die within a year. However, early detection is key. Lung cancer is a bitch about metastasing to other parts of the body. If it can be caught early while still localized in the lung, the five-year survival rate jumps to 55 percent.

They haven’t found a cure, of course, but no drugs are making big progress on lung cancer, as well as prostate and breast cancers.

One of the main drugs used against a certain kind of lung cancer (that younger people and nonsmokers tend to get) is Xalkori, makde by Pfizer. This new drug is called Alecensa, made by Roche.

The AP did a big story on this last week. From the story:

“Roche’s Alecensa stopped cancer growth for 15 months longer than Pfizer’s Xalkori did in a study of 303 people with advanced lung cancer and a mutation in a gene called ALK. About 5 percent of lung cancer patients — 12,500 in the U.S. each year — have an ALK mutation, especially younger people and nonsmokers who get the disease.

Alecensa kept cancer from worsening for 26 months versus 11 months for Xalkori. It also penetrates the brain better: Only 9 percent of those on it had their lung cancer spread to the brain during the first year of treatment versus 41 percent of those on Xalkori. Serious side effects and deaths were less common with Alecensa.

The federal Food and Drug Administration approved it in December 2015 for ALK-related lung cancers that worsened despite trying Xalkori. The new study tested it as initial treatment and is aimed at getting full approval for that.

Xalkori is around $10,000 a month and Alecensa about $12,500.”

So, this drug extends the life of lung cancer patients by two years on the average.

Look at the price tag, though. Imagine trying to pay for that without medical coverage.

Obviously not a cure, but maybe making a dent in that terrible survival rate. Incredible with the advances in treating cancer, especially childhood leukemia, that they have made so little progress in treating lung cancer. I think that is partly because of the stigma that continues to surround lung cancer compared to other kinds of cancer.

Another promising front is immunotherapy with drugs such as Keytruda (this is an esperimental drug taken by Jimmy Carter when he was diagnosed with terminal brain cancer a few years ago and he’s still kicking). I’ve written about this before.

From a Medscape article:

The overall response rate (ORR) of 45% reported for pembrolizumab (Keytruda) first-line is unprecedented, Dr Soria said. Together with the superior progression-free survival (PFS) and overall survival (OS), as well as the better tolerability, when compared with chemotherapy, these findings indicate that pembrolizumab is now “the new gorilla” in the treatment of (non-small cell lung cancer), and probably a new standard of care, he said.

There was also good news on the breast cancer and prostate cancer fronts. A new drug called Zytiga delayed cancer growth for 18 months for men with advanced prostate cancer, while a drug called Lynparza helped delay breast cancer growth for seven months.

Keytruda, Lung cancer

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.

— 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.”