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Patients find hope in immunotherapy treatment for cancer

OCTOBER 24, 2016

Still in shock after learning she had cancer during a routine doctor's visit, Joann Fox barely took in what physicians said.

Radiation and chemotherapy were mentioned as options, but one treatment was new to Fox: immunotherapy.

"I just listened, because I'd never heard of it before," Fox, 77, said.

Immunotherapy, which uses certain parts of a person's immune system to fight diseases, could be an option for her non-small cell lung cancer, a doctor said.

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"I said, 'Let's go for it,'" she said. "What do I have to lose?"

More than two years later, Fox is well enough to enjoy her volleyball league and cherished choir.

Lung cancer "has, for a long, long time, been a very not-talked-about disease," said Dr. Jennifer King, director of science and research at the Lung Cancer Alliance.

Now, doctors and patients are cautiously optimistic about advances in immunotherapy.

"We're getting a lot more calls from people who are researching their treatment options, as opposed to those desperation calls: 'I know I'm going to die. Is there anything else I can do?'" said King. "It's become an empowering force."

Immunotherapy treatments work in different ways. Some boost the immune system, and others help train it to recognize and fight cancer cells.

The results have offered tentative hope to patients who may have been told they have a short time to live. Immunotherapy has provided long-term remission for some with a dismal diagnosis.

Sharon Long was diagnosed with cancer at 53. She said she felt crushed when chemotherapy stopped working. She tried immunotherapy.

Two years later, the treatment has kept Friday night dinner dates with her husband in their New Haven, Ind., home possible, she said.

"It's really nice that something has come along that can hopefully extend some time for people," Long said.

The five-year survival rate for lung cancer is just above 17 percent, King said. With metastatic disease, she said, that number is less than 5 percent.

Called "one of the most exciting new approaches to cancer treatment that has ever entered the clinic," in the American Association for Cancer Research's 2016 Cancer Progress Report, immunotherapy could be a game changer, health experts say.

"Now we can enhance our own body, which is the most powerful defense mechanism we have," said Dr. Edward S. Kim, chair of the Solid Tumor Oncology and Investigational Therapeutics at the Carolinas HealthCare System's Levine Cancer Institute in Charlotte, N.C.

Within the past two years, the FDA has approved immunotherapy drugs nivolumab (Opdivo) and pembrolizumab (Keytruda) to help treat lung cancer, the leading cause of cancer deaths.

This month, research unveiled at the European Society for Medical Oncology's conference in Copenhagen, Denmark, showed lung cancer patients who took Keytruda as a first treatment survived longer than those receiving chemotherapy.

The study, published in the New England Journal of Medicine, showed that 80 percent of patients using Keytruda were alive six months after treatment. For chemotherapy, it was 72 percent.

Former President Jimmy Carter, who had been diagnosed with melanoma that spread to his brain, was treated with Keytruda, which helped his body seek out and destroy cancer cells.

"Our immune systems are quite adept at fighting cancer cells and eradicating them," said Dr. Vamsidhar Velcheti, an oncologist specializing in lung cancer at the Cleveland Clinic.

The field of immunoncology itself is not new. But recent advances have prompted more interest. Last year, several cancer groups organized the first International Cancer Immunotherapy Conference. In September, the second annual event in New York drew 1,500 people.

"What lung cancer has done is, it's taken a small stage to Broadway," Kim said.

Despite initial excitement, immunotherapy doesn't work for everyone.

"The vast majority of patients do not respond to these drugs," Velcheti said.

The response rate is at about 15 to 20 percent, doctors said. Patients with previous immune disorders, such as lupus, may not be eligible to take the drugs.

In August, in an industry surprise, patients with advanced lung cancer in a clinical trial given Opdivo as a first treatment did not see a slowed progression.

But still, doctors like Velcheti say they are encouraged.

"There have been incredible advances really in the last two years," Velcheti said.

King added that the field is developing so rapidly that the Lung Cancer Alliance has updated its immunotherapy brochures every six months.

Two years ago, when Long's doctor told her about immunotherapy, she couldn't find much information online.

During chemotherapy, a tumor in her armpit had grown from the size of a pea to the size of a tangerine.

"I had cancer spots growing that we could actually feel," she said. "So we knew it was failing."

She then began treatment with Opdivo at Fort Wayne Medical Oncology and Hematology every other week, she said.

"We were noticing it was shrinking," she said of the tumor.

"To watch the immunotherapy just grab hold like that and go was really encouraging for all of us," Long said.

Cancer patients often try immunotherapy treatments through clinical trials, after exhausting other options, such as chemotherapy or radiation. The FDA, however, is considering approving Keytruda as a first-line option.

Doctors say the side effects — including, fever, rash, fatigue, diarrhea and possible inflammation of the bowel, lung or liver — of immunotherapy drugs are more manageable than those of chemotherapy or radiation.

"Now you're getting a single drug that's going to have less side effects overall than a two-drug chemotherapy regimen," Kim said.

More questions about immunotherapy drugs lie ahead.

"How do we use them best, in what combination, and what's really going to get the response rates way up?" King said.

Doctors and researchers say they want to build on what they know and learn how to make it better.

http://www.chicagotribune.com/lifestyles/health/sc-lung-cancer-immunotherapy-health-1026-20161024-story.html