Immunotherapy: Every lung cancer patient is a candidate
From Florida Hospital - Apopka
If you chat with Mark A. Socinski, MD, thoracic medical oncologist who specializes in treating patients with lung cancer, he’ll tell one of the most exciting days in lung cancer was October 9th, 2016, at the European Society for Medical Oncology conference. Dr. Socinski’s also the executive medical director of the Florida Hospital Cancer Institute.
“We had a session where four major clinical trials were presented in lung cancer evaluating the role immunotherapy plays in treating lung cancer,” he says. “That session created such optimism about the future of therapy for advanced lung cancer in terms of how we select patients for certain treatments, when we use certain treatments and how we combine certain treatments.”
And more good news: Dr. Socinski says that almost every lung cancer patient could be a candidate for immunotherapy. “As long as they don’t have a contraindication (a situation where a therapy, surgery or other procedure shouldn’t be used because it could be harmful to an individual) for the use of immunotherapy like an auto-immune disease that would cause problems if you used immunotherapy.”
“In fact, we now have evidence in selected patients that immunotherapy is superior to chemotherapy,” he adds. “And that’s where all the excitement is.”
How did this come about?
In the 1990s, researchers discovered that cancer cells carried certain proteins on the surface that enabled them to escape attack from the body’s immune system.
Known as PD-1, this allowed the cancer to suppress the immune system and to live and multiply without any interference from the immune system.
So what is immunotherapy?
Immunotherapy harnesses your body’s own immune system to fight diseases, in this case cancer. And, unlike chemotherapy, which kills cancerous cells, immunotherapy acts on the cells of your immune system, to attack the cancer. This can be done in a couple of ways:
• By stimulating your own immune system to work harder or smarter
• Providing your immune system with components, such as man-made immune system proteins
All that said, you may be wondering how this treatment works.
“With immunotherapy, patients are given an IV,” he says. “The way it works is that there is a PD1 receptor. People call it the brakes of the immune system. So if you push the brakes, what happens? You stop. And so the immune system stops. If you have a treatment that releases the brakes, the immune system can go back to work, recognize the cancer and destroy it. Antibodies to both PD-1 and PD-L1 (the ligand that binds to PD-1) have been developed”
Are there side effects?
“Ninety to 95 percent of patients tolerate these immunotherapies almost like you’re giving them a saline IV,” Dr. Socinski says. “In 5 to 10 percent of patients there can be adverse effects. It’s almost like an auto-immune disease.”
“The most common side effects are diarrhea, skin rash, thyroiditis, lung inflammation, encephalitis and kidney injury,” he says. “Pretty much anything that ends in -itis.”
Available Immunotherapy Medications
There are three drugs available: Keytruda, Opdivo and Tecentriq.
“If you have a high expression of PD-L1, we’ve found that immunotherapy with a drug called Keytruda is superior to traditional chemotherapy, which we’ve used for decades.”
Which types of cancer are treated with immunotherapy?
Not only is it beneficial for lung-cancer patients, but there’s a growing list of immunotherapy treatments used for other cancers like melanoma, Hodgkin’s disease and cancers of the kidney, bladder and head and neck cancer.
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