Category Archives: Immunotherapy

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”.

 

 

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.