By: Annette McElhiney
As an avid reader of any and all material about cancer, my attention was grabbed by the article, “Hope and Hype Around Cancer Immunotherapy.”
Most of us are aware of the excitement currently generated by immunotherapy. So with heightened interest, I read this article and will share some of the quoted material with you.
To illustrate, look at the difference in opinion amongst researchers. “Some hospitals and health care systems call it a ‘miracle in the making’ and a ‘game-changer.’ It’s a treatment approach that harnesses the body’s own immune system to target and attack a disease, such as cancer. Immunotherapy can come in many forms — vaccines, antibody or cellular therapies, or drugs — and can be received through an injection, a pill or capsule, a topical ointment or cream, or a catheter.”
“While other treatment options — from targeted therapy to chemotherapy — still and will continue to play an important role in cancer research, immunotherapy simply expands the options and possibilities for patients, said Dr. Jeff Weber, medical oncologist and deputy director of NYU’s Perlmutter Cancer Center in New York, who added that he has seen many of his own patients respond positively to immunotherapy.”
Additionally, “Many companies are interested in immunotherapy, and there’s a significant weight of creative and capable minds now devoted to that field,” he said. “Obviously the major progress we’ve seen is the benefit to patients, but the other advance is now the increasing attention being drawn to the field and the large number of really smart, capable, creative, and clever people that are now in the business, and you’ve got to believe that that’s going to lead to even more advances.”
Other researchers disagree. Dr. Vinay Prasad, a hematologist-oncologist and assistant professor of medicine at the Oregon Health and Sciences University said, “The history of cancer research is one of episodic fads. The problem is, when fads are in vogue, we neglect everything outside the fad. We spend disproportionate energy chasing what’s new and forget the most rational science portfolio is broad; the most optimal portfolio is broad. There are truly some dramatic responses with immunotherapy, but like many cancer fads, it is easy to believe that the early success will extend to all cancers, and over and over, we have learned that there is no one solution to cancer.”
Dr. Phillip Greenberg, head of immunology at Fred Hutchison says, “Immunotherapy is going to be a critical and essential component of cancer care. It’s becoming increasingly evident that even for people who were achieving complete responses to standard chemotherapy in the past, there was probably a component of their immune system that was critical in making that work.”
“Using therapies that target different aspects of a cancer, to try to bring them together so that they synergize, that will unquestionably be a real focus in the next half-decade,” he said. “So, we’re going to see new forms of combination therapies.”
Dr. Otis Brawley, chief medical officer at the American Cancer Society says, “While I would not give up on the old and newer cytotoxic chemotherapies, the hormones and the hormone blockers, I also do not see this as either/or.” He thinks, “Both areas (new and old) are fertile ground for more research. I would like to see all of these modalities and several others pursued and investigated.”
However others see roadblocks for the success of immunotherapy. Dr. Vinay Prasad, a hematologist-oncologist and assistant professor of medicine at the Oregon Health and Sciences University points out, “Food and Drug Administration regulations, potential side effects and costs mean that only a small percentage of cancer patients may benefit from immunotherapy today. ” he continues “Immunotherapy side effects include possible skin reactions, flu-like symptoms, heart palpitations, diarrhea, infection, arthritis, or severe or even deadly allergic reactions. In 2015, it was estimated that ipilimumab and nivolumab ranged in cost from about $100,000 to $150,000, respectively, for a course of therapy.”
Dr. Phillip Greenberg sees success elsewhere. “As for the challenges that may come with bringing immunotherapy and other cancer therapies together, potential solutions are in the works in the form of personalized medicine.” He expands, “Personalizing therapies is a critical way of making therapies both more effective, less toxic and, in a sense, potentially less expensive in the long run, because you eliminate things that are not likely to be effective in a particular patient. Personalizing medicine to a patient’s disease is going to be a critical component.”
But Prasad isn’t enthusiastic about either immunotherapy or personalized medicine. “I joke that oncologists are putting their eggs in two baskets. Immunotherapy is one. The other is the use of personalized treatment, the idea we will sequence entire genomes and find the drug that will halt the cancer,” he said. “These are two most active areas. What has fallen out of favor is research into drugs that target cellular division or drugs that target resistance mechanisms,” such as some chemotherapies.”
Most researchers, though, agree that more funding is needed for research on immunotherapy and targeted medicine as well as for other methods. “More research is needed because combining cancer immunotherapy not only with standard treatment approaches, such as surgery, radiation and chemotherapy, but with newly emerging therapies could lead to novel insights, said Dr. Robert Vonderheide, a renowned cancer researcher and professor at the Abramson Cancer Center of the University of Pennsylvania.
He continues, “As breathtaking as recent successes of cancer immune therapy have been, there is more we can achieve for our patients by embracing an even broader view of cancer biology and therapy. There are great synergies, for example, from combining knowledge of immunology, genetics and tumor biology that we have only just begun to realize.”
“Vonderheide is leading vaccine-based trials for individuals at risk of hereditary breast, ovarian and other cancers associated with BRCA 1 and 2 gene mutations. The trials are conducted through the University of Pennsylvania’s Basser Center for BRCA.”
So, after reading the thoughts of all these researchers, I conclude that because cancer is such a complex disease, it requires complex answers. Hopefully, as research continues, we will better understand the multiple faces of cancer and be able to halt or slow its destructive progress.