Cautiously hopeful: Wednesday Weekly

There are a range of cancer treatments with mix and match combinations usually the approach of the day. Understanding how they work however is a challenge for the layman though the lead story this week offers a pretty good and accessible explanation for immunotherapy.

That’s followed by a few words of caution and a British celebrity success story.

# We must be truly exceptional at curing diseases in mice by now
# Never be afraid of failure. Remember, you can always be used as a bad example.
# It is impossible to dig only half a hole

Immune Therapies Take Center Stage in the War Against Cancer: Tips for Patients
The missiles doctors send to fight cancer in a patient have a new ICBM: immunotherapy. This revolution in cancer treatment has serious implications for patients and people wanting to prevent cancer.

For years the standard attack plan to fight cancer was catch it early, at stage I when it is most curable, and use surgery, radiation and chemotherapy to get the highest cure rates. But for the past several years and especially in the last few months, doctors and patients have new therapies to use to control the cancers. These new therapies are immunotherapy, and targeted treatments, precision drugs, improved hormonal agents, and biotherapies.

The most exciting of these new treatments are the FDA approved immunotherapies. For a long time, scientists have recognized that the body’s immune system has been sluggish to fight cancer once it has appeared.

Beginning in 1990 new types of treatments were developed that enhanced the immune system to overcome its otherwise low activity. The first was the drug ipilimumab (Yervoy), which targeted immune system blockade (CTLA-4) and resulted in increased immunologic T cells in the body to more effectively kill cancer cells. This was initially approved for advanced metastatic melanoma, but today it is also used in localized melanoma at high risk of recurrence, and is showing remarkable anti-cancer effects in combined treatments of lung cancer and other tumors. It was approved by the FDA “way back” in March 2011.

Then, another class of immunotherapy drugs was discovered that targeted another biological pathway (PD1-PDL1) that kept the immune system in check, preventing it from fighting cancer. The first 2 drugs used to stimulate the immune system nivolumab (Opdivo) and pembrolizumab (Keytruda) were found to produce remarkably long remissions in some patients with melanomas and kidney cancers. Today, these drugs are approved by FDA for use in many different cancers (lung, bladder, head and neck cancers). You have probably seen television ads for them without realizing that they represent the immunology of the future.

Most surprisingly, the FDA has even approved pembrolizumab for use not based on the type of cancer which a patient has (the standard approval mechanism in the past), but instead based on whether a cancer (regardless of cancer origin, like breast cancer or like lung cancer) shows unstable DNA changes (called microsatellite instability high, or MSI high). This is a first for the FDA, and a welcome change based on improved scientific discoveries.
Because of the success of nivolumab and pembrolizumab, other drug companies have produced drugs which also attach the PD1-PDL1 immune pathway and are now approved by the FDA, including atezolizumab (Tecentriq), avelumab (Bavencio) and durvalumab (Imfinzi). Oncologists and patients have many choices.

Thanks to pioneering work in laboratories, scientists have also been able to take the body’s immune cells and enhance them in test tubes to fight cancer or leukemia in a patient’s body. Inside a patient, immune T cells can kill cancer, but in the past were not active enough to control the cancer. By using special protein antigens, the activity of these T cells can be improved. The system is called CAR T cell therapy. On August 30, 2017, , the FDA approved the first CAR T cell immunotherapy of this type, called trisagenleleucel (Kimriah), to produce long remissions (probably cures) in children or young adults with acute lymphoblastic leukemia. Today, other antigens are being used to stimulate T cells to fight other leukemias, myeloma, lymphoma, and solid tumors like glioblastoma, to further extend CAR T cell therapy.

Immunotherapy is established as a very active part of anti-cancer treatments. Be sure you have the latest information to help you choose the best treatment for you. And remember to get your cancer preventive vaccines.

Full story:

Cancer cure is ‘pipe dream’, says world renowned doctor

(U.K.) A WORLD renowned cancer specialist says finding a cure for the disease is a “pipe dream” but that the future for cancer sufferers is positive.
Dr Siddhartha Mukherjee, 47, won the Pulitzer Prize for non-fiction in 2011 for his book The Emperor Of All Maladies: A Biography Of Cancer.

He told Desert Island Discs how the intricacies of the illness make it unlikely that we will ever be able to eradicate it completely.

Dr Mukherjee is the Assistant Professor of Medicine at the Columbia University Medical Centre in New York and studied at Stanford, Oxford and Harvard.
The father-of-two said: “This disease, I think, is not going away. The idea that we will erase it from the face of human history I think is a pipe dream. It is part of us."

“That’s not to be nihilistic about the treatment of cancer but it is to recognise that part of the complexity of treating cancer is that there are very few diseases where the fundamental of the disease is so locked in with the fundamental of who we are.”

Despite this, he still sees a positive future for cancer treatment.

He said: “In the next 10 years we are going to try to deploy [what we have learned about cancer] and it is like living on the edge of an experiment. We are going to ask the question if we do this systematically in cancers can we learn to treat cancers in a more rational and reasonable way.”

Full story:

Danny Baker. Not one for brooding

(U.K.)Danny Baker says: “Couldn’t be better,” when our waiter asks him how he is today. “Giving off sparks!” And, with the exception of the months he spent undergoing intense and gruelling treatment for the cancer of the head and neck that was diagnosed in 2010, the odds on him replying in precisely the same way on nine days out of 10 are high.

The radio presenter, comedy writer and one-time punk correspondent for the NME, was last contestant in and first voted out (“a tremendous joke in and of itself”) of the last I’m a Celebrity Get Me Out of Here! This excoriator of the “pin-headed weasels” and bean-counters of his radio employers BBC London, and chronicler of his upbringing in Bermondsey, south London, has one main aim in life: “To live for pleasure alone.”

But not everything can be turned into a joke. He always knew this book would be about his illness, from which he fully recovered – aside from an extreme sensitivity to spicy food that even today leaves his eyes streaming over his lunch – after a period of treatment during which he was unable to eat or drink, or even to turn his head from side to side.

“My first thought was to make it funny,” he says, and there’s no way you can do that, otherwise people will feel cheated, they’ll say you’re hiding stuff.” The upside, he’d been told, was that he had a good chance of survival; the downside was the severity of the cure. “You cannot take even a sip of water,” they said. “And the one lasting image I had was running a tap – when I could still get to the bathroom – and watching it run and overflow and just look at it and look at it.”

He says he doesn’t know what his wife will make of his account of his illness, although he’s told her “it’s a bit strong”; as a family, they rarely discuss it now that it’s in the past.

“I didn’t really learn any lesson out of it,” he tells me. “Terrible I know. I don’t appreciate life more, but then I couldn’t have appreciated life more.”

Full story:

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Diana Ayling

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