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Immunotherapy: Enlisting the body’s own defenses as a possible cancer treatment in the future

By on January 28, 2019 in Columnist with 0 Comments
Jim Brown

By Jim Brown, M.D.

About 21,000 people in the United States are diagnosed with stomach cancer annually. 

Recently a relative very close to me was diagnosed with metastatic stomach cancer, which generally carries a poor prognosis. 

He was first started on two standard chemotherapy drugs that didn’t appear to be effective. Subsequently a different treatment, Herceptin, was added to his treatment regimen. 

Herceptin was approved by the FDA for treatment of a certain type of metastatic breast cancer and later a particular type of metastatic stomach cancer. Herceptin is not chemotherapy or immunotherapy but instead attacks a specific protein on the surface of some cases of metastatic breast and gastric cancer. 

My relative’s cancer receded dramatically, and soon his first two chemotherapy drugs were stopped, and he was declared to be in remission. 

Currently, he has continued on the Herceptin as his only treatment. 

He was told that if he relapsed, he would then be put into an immunotherapy trial. This stimulated my interest in the current state of immunotherapy for cancers of all types. 

Immunotherapy is the treatment that uses one’s own immune system’s antibodies to fight disease including cancer. This is also called biologic therapy. 

This treatment sometimes can boost our body’s general immune system while at other times it might train the immune system to attack specific cancer cells. 

At this time it is tried for certain types of cancers and used along with other forms of chemotherapy. 

Our immune system generally attacks new substances like germs that it does not recognize. It has more difficulty in attacking cancer cells since these cells originate in our bodies, and our immune system does not recognize them as “foreign.” 

Researchers are trying to develop ways to help our immune system recognize cancer cells and increase its ability to destroy them.

President Jimmy Carter is a well-known example of effective immunotherapy. 

Around 2015 President Carter announced that he had metastatic melanoma that had invaded his brain and liver. His prognosis was bleak at best. Most physicians knew his prognosis was poor and short lived. 

Later that year he was treated with a drug, Keytruda, which is a type of immunotherapy that had recently been approved by the FDA for treatment of metastatic melanoma. 

It seemed like a long shot to me at that time. 

In 2016, President Carter announced that he had become cancer free. This was truly miraculous. 

Now in 2019 in his 90s, President Carter appears healthy, physically active and mentally bright. 

Melanoma is a cancer in some ways is unique in that its cancer cells can be removed and studied in research laboratories. Currently only one in five melanoma patients treated with Keytruda seem to respond, but nevertheless this offers hope for future development of an immunotherapy approach to more cancers. 

I might add that Senator John McCain’s brain cancer was a completely different untreatable type than that of President Carter’s melanoma. 

We are still a long way from immunotherapy treatment for most cancers. 

There are about 300 kinds of cancers, according to Dr. Carl June of the University of Pennsylvania. There are many research and clinical trials going on now for the use of immunotherapy for several different cancers. 

Currently, there are promising therapies being researched and hopefully developed or genetically engineered to target tumors in more ways than now are available. 

To date, clinical trials at Memorial Sloan Kettering, the Fred Hutchinson Cancer Research Center and the University of Pennsylvania have demonstrated a remission rate of around 90 percent in several advanced cancers of the blood and lymph system. 

While not yet a cure, these studies are hopeful. 

I think immunotherapy will continue to develop and someday will hopefully be the standard future treatment for the many cancers that we do not have cures for today. 

Jim Brown, M.D., is a retired gastroenterologist who has practiced for 38 years in the Wenatchee area. He is a former CEO of the Wenatchee Valley Medical Center.

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