Some of the following story is adapted from a BBC News report by Philippa Roxby Health, dated 23 November 2019.
The original trial of ipilimumab was in 2005. It’s a tear-jerker story of Sharon Belvin, who was dying. Sharon was a 22 year old grad student just two weeks away from her wedding when she received news that would forever change her life. Sharon was diagnosed with late stage melanoma, a skin cancer that spreads easily, that had metastasized to her lungs. But the cancer was completely destroyed by the new drug in 12 months.
WHAT IS IMMUNOTHERAPY?
It is a treatment that does not kill cancer cells itself but instead stimulates the body’s immune system to attack them.
Pembrolizumab, approved in the USA by the FDA in 2014, is a newer cancer immunotherapy drug now being used to treat a wide range of advanced cancers, including melanoma, lung cancer, head and neck cancer, Hodgkin lymphoma, and stomach cancer. The drug trade name is Keytruda.
Dr Jim Allison was the discoverer of the immunotherapy drug mechanism by doing tests on mice in the lab. His story – how to tweak the immune system cells so they would destroy the cancer cells — is summarized HERE. The original immunotherapy drug was called ipilimumab (trade name Yervoy) and was approved in 2011 by the FDA for the treatment of metastatic melanoma. Dr Allison received the Nobel prize for medicine in 2018. He now works at M.D. Anderson Cancer Center in Houston.
HEAD AND NECK CANCER.
Now we shift forward to 2019 where around 12,000 people in the UK are diagnosed with head and neck cancer each year.
Half are diagnosed at stage III or IV when it is hard to treat.
Most cases are linked to smoking and alcohol but the recent rise in cases seems to be linked to HPV (human papillomavirus). HPV is the most common sexually transmitted infection.
The HPV virus infects the skin and cells lining the inside of the body and can be spread through close skin-to-skin contact. Boys and girls are now being vaccinated against HPV at school, but it will be several decades before HPV stops being a risk factor.
Derek Kitcherside, 70, from Leicestershire, believes he wouldn’t be here without pembrolizumab. He was diagnosed with cancer of the voicebox in 2011. When he started coughing up blood three years later, after receiving standard treatment, he was told the cancer had spread to his lungs and was probably incurable.
Derek asked to go on a drug trial (see below) and travelled to London every three weeks for two years for treatment with pembrolizumab. “My tumor was shrinking all the time and I felt a bit better every time I went,” he said. “It made a huge difference to my life.”
Regular scans show the disease is now stable and the tumor is still getting smaller.
HEAD AND NECK CANCER DRUG TRIAL AND RESULTS.
For a quarter of patients, pembrolizumab kept head and neck cancers at bay for an average of two years – five times longer than under chemotherapy.
Normally, immunotherapy is used after standard treatments like chemotherapy have failed but this UK trial, involving 882 patients from 37 countries, suggests it should be used earlier – and for some people it should be the go-to option.
The drug is given to patients regularly through a drip when their cancer has returned or spread and is considered incurable.
In people with advanced head and neck cancer who responded to the drug – one in four (25%) – their cancer shrank or stabilised for an average of 23 months. By comparison, although more patients (36%) responded positively to standard chemotherapy treatment, the improvements lasted on average for only 4.5 months.
Those with larger, more aggressive tumors were given the drug in combination with chemotherapy to help slow progress of the disease – which was kept in check for an average of 7 months.
At the moment, the recommended treatment for head and neck cancer is a toxic combination of chemotherapy and antibody therapy, which often makes people feel very sick. The extreme treatment can also cause damage to the kidneys, hands and feet.
Patients given the immunotherapy drug experienced far fewer side-effects.
The drug is less toxic – patients live longer and feel better.
The trial results show that immunotherapy can have dramatic benefits for some patients with head and neck cancer when used as a first-line treatment.
In the US and the EU, pembrolizumab has been approved for use on its own and with chemotherapy for advanced head and neck cancer, but not yet in the UK.
POST-SCRIPT: PARTIAL HISTORY OF IMMUNOTHERAPY.
The following points are excerpted from an article on immunotherapy in Time Magazine, dated 4 April 2016.
• A drug called pembrolizumab, approved to treat melanoma, sent Jimmy Carter’s melanoma which had spread to his brain into remission seemingly overnight.
• Administered in pill or IV form, the therapies trigger the immune system to fight cancer cells while keeping healthy cells intact.
• Some trials have produced outstanding results. People with certain types of B-cell leukemias and lymphomas hadn’t responded to any other treatment, but more than 80% of them have seen their cancer disappear since taking pembrolizumab.
• Immunotherapy is central to Obama’s “moon-shot” funding request of $1 billion to cure cancer.
• Currently, there are 3,400 immunotherapy trials in the USA, and many more around the world.
• Waiting in the wings are 7 million people who die of cancer every year.
• Leading cancer experts predict that immune-based therapies will eventually replace chemotherapy. “The results are just too good”, said one.
• Leukemias and lymphomas are benefiting most, because they have a distinguishing feature that scientists can train immune cells to target.
• But researchers are studying how to apply immune-based treatments to the biggest group of cancer patients – breast, colon, lungs, pancreas. If a person’s immune system is activated in just the right way, they may be able to avoid chemo and radiation altogether.
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