- Immunotherapy opens a new era in cancer care, but some debate whether it detracts from other research
- “We are at the end of the beginning for cancer immunotherapy,” one expert says
Some hospitals and health care systems call it a “miracle in the making
” and a “game
.” It’s a treatment approach that harnesses the body’s own immune system to target and attack a disease, such as cancer. Immunotherapy
can come in many forms — vaccines, antibody or cellular therapies, or drugs — and can be received through an injection, a pill or capsule, a topical ointment or cream, or a catheter.
Ninety-two-year-old former President Jimmy Carter
famously received a form of immunotherapy two years ago that he called “the key to success” in his melanoma fight. He had the treatment along with surgery and radiation.
Yet as promising as the therapy seems, could the spotlight on immunotherapies detract from other areas of cancer research? Some experts argue yes, while many others don’t seem concerned.
Now, cancer researchers from around the world are convening in Chicago on Friday for the American Society of Clinical Oncology’s annual meeting
to discuss various treatment methods, including immunotherapy.
While other treatment options — from targeted therapy to chemotherapy — still and will continue to play an important role in cancer research, immunotherapy simply expands the options and possibilities for patients, said Dr. Jeff Weber, medical oncologist and deputy director of NYU’s Perlmutter Cancer Center in New York, who added that he has seen many of his own patients respond positively to immunotherapy.
“It’s made a big impact in the field in a sense that influential investigators in many different fields are now quite interested in immunotherapy,” said Weber, who will be among the researchers attending the ASCO meeting.
“Many companies are interested in immunotherapy, and there’s a significant weight of creative and capable minds now devoted to that field,” he said. “Obviously the major progress we’ve seen is the benefit to patients, but the other advance is now the increasing attention being drawn to the field and the large number of really smart, capable, creative, and clever people that are now in the business, and you’ve got to believe that that’s going to lead to even more advances.”
However, the history of cancer research is one of episodic fads, said Dr. Vinay Prasad, a hematologist-oncologist and assistant professor of medicine at the Oregon Health and Sciences University. To him, immunotherapy might just be another fad.
“The problem is, when fads are in vogue, we neglect everything outside the fad. We spend disproportionate energy chasing what’s new and forget the most rational science portfolio is broad; the most optimal portfolio is broad,” he said. “There are truly some dramatic responses with immunotherapy, but like many cancer fads, it is easy to believe that the early success will extend to all cancers, and over and over, we have learned that there is no one solution to cancer.”
On the other hand, a swelling interest in immunotherapy could enhance — rather than inhibit — other research fields, leading to some unexpected solutions, said Dr. Philip Greenberg, head of immunology at the Fred Hutchinson Cancer Research Center in Seattle and a professor at the University of Washington.
“Immunotherapy is going to be a critical and essential component of cancer care. It’s becoming increasingly evident that even for people who were achieving complete responses to standard chemotherapy in the past
, there was probably a component of their immune system that was critical in making that work,” Greenberg said.
“Using therapies that target different aspects of a cancer, to try to bring them together so that they synergize, that will unquestionably be a real focus in the next half-decade,” he said. “So, we’re going to see new forms of combination therapies.”
‘Oncologists are putting their eggs in two baskets’
The research field already has seen dramatic responses in melanoma, kidney, lymphoma, lung cancer and other cancers using immunotherapies, said Dr. Otis Brawley, chief medical officer at the American Cancer Society, who will be attending this year’s oncology society meeting.
“I personally have seen patients with widely metastatic disease have remission and have long asymptomatic periods with good quality of life. Immunotherapy deserves support so that it can be further developed,” he said.
At the same time, Brawley added, there are other modalities that deserve equal support.
“While I would not give up on the old and newer cytotoxic chemotherapies, the hormones and the hormone blockers, I also do not see this as either/or,” he said. “Both areas are fertile ground for more research. I would like to see all of these modalities and several others pursued and investigated.”
As for immunotherapy, research showing that the drugs ipilimumab
stopped melanoma from advancing for nearly a year in 58% of cancer cases
garnered excitement at the ASCO meeting in 2015
. Many other studies showing the promise of immunotherapy also have been presented at the meetings since then.
“I suspect that ASCO will be just like the last few,” Prasad said of this year’s meeting, which he will miss due to a time conflict. “Immunotherapy will be showered with praise; there will be little mention of the downsides, harms or costs or, worst of all, that it may have limits in fighting cancer.”
Food and Drug Administration regulations, potential side effects and costs mean that only a small percentage of cancer patients may benefit from immunotherapy today, Prasad said. Immunotherapy side effects
include possible skin reactions, flu-like symptoms, heart palpitations, diarrhea, infection, arthritis
, or severe or even deadly allergic reactions. In 2015, it was estimated that ipilimumab and nivolumab ranged in cost from about $100,000
to $150,000, respectively, for a course of therapy.
Prasad and Nathan Gay, an oncology fellow at Oregon Health and Science University, co-authored an editorial in STAT News
in which they used US national cancer patient data and FDA approvals of immunotherapy treatments to calculate the possible percentage of patients who currently could benefit from immunotherapy.
The editorial, published in March, showed that only about 8% of all cancer patients would benefit, if they could get access to and afford immunotherapy drugs, since the treatment has been approved for only a few cancers.
“Since that article, we have had some new data,” Prasad said of the editorial. “Maybe the number is as high as 12% or 15% at present, and it may peak at 15% or 25%. That would be a great success, but to me, the glass will still be 75% empty.”
Weber, however, prefers to view the glass as half-full.
Those numbers don’t take into account the trajectory of how immunotherapy drugs are being developed, Weber said.
In other words, the numbers in the editorial paint an unfair portrait of the beneficial impact immunotherapy could have for cancer patients since the immunotherapy field is still growing, he said.
“When you contemplate the fact that there are hundreds — literally, I think the last count it was something like 800 combination immunotherapy trials
going on in different indications — you’ve got to figure that the number or proportion of patients that will benefit from these drugs is going to expand over the next decade,” Weber said.
“Potentially, in the future, my belief is that virtually any cancer patient would be a candidate (for immunotherapy),” he said. “The best is yet to come.”
Greenberg also called the editorial pessimistic and disappointing.
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