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    Four oncology treatment advances to watch


    1. Immunotherapy: Checkpoint inhibitors

    Advancements in immunotherapy are ongoing. This therapy entails taking immune cells from a patient, genetically reengineering them to attack the cancer, and then reinfusing them back into the patient. “Immunotherapy shows great promise in treating blood cancers,” Thomas says. “But considerable research still needs to be performed to see if this will be effective in treating solid tumor cancers like breast and lung cancer.”

    Recent discoveries in immunotherapy research have shed light on how cancer cells turn off the immune system, which can allow cancers to grow and spread unchecked. “We’re using this knowledge to block the shutdown of patients’ immune systems using new checkpoint inhibitors,” explains Thomas. Checkpoints are parts of certain immune cells that need to be inactivated to start the protective response. “This allows the immune system to get back into the ballgame and fight the cancer. Considerable work remains on the best way to use these agents and how to best combine them with existing therapies.”

    Initially studied in melanoma, DeRosa says checkpoint inhibitors are now rapidly expanding to treat many other cancer types, having been FDA-approved in the treatment of non-small cell lung cancer, head and neck squamous cell cancer, classical Hodgkin lymphoma, and urothelial carcinoma.

    Response rates have been impressive. Patients with advanced melanoma, for example, now have a greater than 30% chance of five-year survival with combination immunotherapy, which was unheard of in the past, Kesari says.

    David Parda, MD, chair, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania, says checkpoint inhibitors such as Opdivo (nivolumab) are giving new hope to cancer patients. New therapies targeting the immune system are emerging regularly, with more expected in the coming year.

    “Our task now is to expand on the promise of immunotherapy by investigating why some patients respond dramatically to these therapies, yet most do not,” he says, adding that the network and Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins are collaborating on research and a clinical trial that will examine how Opdivo can be used most effectively for patients with esophageal cancer, an aggressive and highly lethal cancer. “Answers may lie in the individual tumor’s genetic makeup, in the combination of immunotherapy with standard therapies, or even in the timing of therapies.” 

    Michael V. Seiden, MD, PhD, senior vice president and chief medical officer, The US Oncology Network and McKesson Specialty Health, The Woodlands, Texas, points out, however, that at this time checkpoint inhibitors only offer a clinically meaningful response in a minority of individuals—for most tumor types it’s only effective in 15% to 20% of patients. “These drugs cost about $15,000 a month, so identifying the subset of patients who will have a great response is a high priority,” he says.

    Next: Advancement #2



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