Immune system therapy kills off cancers
Two years ago, Arrica Wallace was riddled with tumors from widely spread cervical cancer that the strongest chemotherapy and radiation could not beat back. Today, the Kansas mother shows no signs of the disease, and it was her own immune system that made it go away.
The experimental approach that helped her is one of the newest frontiers in the rapidly advancing field of cancer immunotherapy, which boosts the body’s natural ways of attacking tumors.
At a recent American Society of Clinical Oncology conference, doctors also reported extending gains recently made with immune therapies against leukemia and the skin cancer melanoma to bladder, lung and other tumor types.
The cervical cancer experiment was the first time an immune therapy has worked so dramatically against a cancer caused by a virus — HPV. In a pilot study by the National Cancer Institute NCI), the tumors of two out of nine women completely disappeared and those women remain cancer-free more than a year later. That’s far better than any other treatment has achieved in such cases.
Doctors are trying it now against throat, anal and other cancers caused by HPV, the human papillomavirus, and think it holds promise for cancers caused by other viruses, too.
This is “very, very exciting,” said Dr. Don Dizon of Massachusetts General Hospital, a women’s cancer specialist with no role in the study.
Wallace lives in Manhattan, Kansas, west of Topeka, and was 35 when her cervical cancer was discovered. It spread widely, and one tumor was so large it blocked half of her windpipe. Doctors said she had less than a year to live, but with sons aged 8 and 12, “I couldn’t give up,” she said.
She enrolled in the study, and researchers removed one of her tumors, isolated special immune system cells that were attacking it, multiplied them in the lab and gave billions of them back to her in a one-time infusion. They also gave her drugs to boost her immune response — “like Gatorade for the cells,” she said.
“It’s been 22 months since treatment and 17 months of completely clean scans” showing no sign of cancer, Wallace said.
The second woman to have a complete response has been cancer-free for 15 months so far, said one study leader, Dr. Christian Hinrichs of the NCI in Bethesda, Md. “There’s no way to know” if the results will be permanent, he said.
A third woman had tumor shrinkage that lasted three months. The other six women did not respond to treatment. Researchers are attempting to determine why.
Doctors are trying the treatment on several dozen more women with advanced cervical cancer, and it could some day be offered at many cancer centers the way bone marrow and stem cell transplants are now.
Other therapies in development
Many private companies are pursuing other treatments that are given like drugs aimed at the immune system. Also discussed at the conference:
• Bristol-Myers Squibb Co.’s Yervoy, the first immune therapy to improve survival of advanced, inoperable melanoma, also helped prevent recurrence when given to people with earlier stage disease at regular intervals after surgery, a study of nearly 1,000 patients found.
But severe side effects caused half to quit treatment, and five people died from it. Doctors think a lower dose might minimize these problems. The drug also costs more than $100,000 for initial treatment, so long-term cost is a concern.
• Nivolumab, an experimental therapy from Bristol-Myers, extended survival by 3 1/2 years on average when given with Yervoy to people with very advanced melanoma — far better than any previous treatments. Nine of 53 patients treated had complete remissions.
• Merck & Co.’s experimental therapy pembrolizumab gave one-year survival rates of about 69 percent in a study of 411 patients with very advanced melanoma, including many previously treated with Yervoy.
• Genentech’s experimental immune therapy for bladder cancer shrank tumors in 13 of 30 patients with advanced bladder cancer for which there are hardly any treatment options now. All signs of cancer disappeared in two patients.
Immune therapy struggled for years with just occasional small gains, but “now we have cruise missiles” giving better kill rates against many tumor types, said Dr. Steven O’Day of the University of Southern California.
Others tempered their enthusiasm, noting that some promising approaches produced more limited gains once they were more fully researched.
“Let’s not forget the history” of what seems like progress with a new approach, said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. “It doesn’t always work out the way it appears to be heading.”