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More cancers falling to immunotherapy

Treatment appears poised to be key part of disease strategy

By Laurie McGinley, The Washington Post
Published: April 25, 2016, 6:06am

NEW ORLEANS — New immunotherapy drugs are showing significant and extended effectiveness against a broadening range of cancers, including rare and intractable tumors often caused by viruses. Researchers say these advances suggest the treatment approach is poised to become a critical part of the nation’s anti-cancer strategy.

Scientists reported Tuesday that the medications, which marshal the body’s own immune defenses, are now proving effective against difficult-to-treat head and neck cancer and an extremely lethal skin cancer called Merkel cell carcinoma. Both can be caused by viruses as well as DNA mutations, and the drugs help the immune system to recognize the virus-associated cancer and attack it.

Since pathogens are responsible for more than 20 percent of all cancers, “these results have implications that go far beyond a rare cancer” like Merkel cell carcinoma, said Paul Ngheim, an investigator with the Fred Hutchinson Cancer Research Center in Seattle who led that study.

The new data, plus research released Sunday that showed sharply higher survival rates among advanced-melanoma patients who received immunotherapy, prompted growing, albeit guarded, optimism among researchers who attended the American Association for Cancer Research annual meeting here. In addition to melanoma, the infusion drugs already have been approved for use against lung and kidney cancers.

“We are in the midst of a sea change in how we are treating cancer,” said Louis Weiner, director of the Georgetown Lombardi Comprehensive Cancer Center, who wasn’t involved in the studies. “We’re really seeing the fruits of many years of research into what drives cancer and how it interacts with the immune system to defeat it and survive.”

The latest findings, as well as hundreds of ongoing clinical trials across the country, suggest that immunotherapy could be beneficial for more than two dozen kinds of cancer — and maybe many more. One of the most prominent patients is former President Jimmy Carter, who last year was diagnosed with advanced melanoma that had spread to his brain. He was treated with one of the new drugs, Keytruda, as well as radiation. The combination worked so well, causing his tumors to disappear, that he was able to stop treatment in March.

“What’s happening to Jimmy Carter is happening to many, many people,” Weiner said.

Note of caution

At the same time, however, researchers caution that they have a long way to go in fully understanding the therapy and transforming it into a viable treatment for a majority of patients. “This period for immunotherapy is comparable to the 1960s for chemotherapy, when we were just beginning to use it,” said Roy Jensen, director of the University of Kansas Cancer Center. “There is so much to do and to figure out.”

Scientists don’t know why some patients benefit from immunotherapy and others don’t. In some trials, for example, less than a third of patients have had a positive response. Researchers think that proportion can be increased by combining these “checkpoint inhibitor” drugs — three have been approved by the government, with several more in development — or by adding conventional treatments such as chemotherapy, radiation and surgery. Yet much work is needed on how exactly to do that and on how to better comprehend cancer’s wide range of defenses.

The research successes are emerging just as the Obama administration, as well as private philanthropists, focus on ways to radically accelerate progress against cancer. Former New York Mayor Michael Bloomberg and tech billionaire Sean Parker have announced that they will invest hundreds of millions of dollars in immunotherapy research. On Wednesday, Vice President Joe Biden addressed the conference about the Obama administration’s anti-cancer “moonshot” initiative.

Head and neck cancer, a devastating disease that affects the patient’s ability to eat, breathe and talk, can be caused by the human papillomavirus, or HPV. Data released as an abstract Tuesday showed the immunotherapy drug Opdivo led to improved overall survival for patients with advanced cancer who had not responded to chemotherapy.

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