Immunotherapy for Patients With Lung Cancer is Showing Promise
Physicians at MedStar Georgetown’s Lombardi Comprehensive Cancer Center have a new potential weapon in their arsenal against lung cancer that they were trying and studying.
July 17, 2015
Treatment Helps the Immune System to Fight Tumors
(Washington, D.C.) July 17, 2015 - It started off as a small cough in the spring of 2014. A throat clearing.
“I just thought it was a little cold,” said Robert Schoenbauer, then age 79 of Waldorf, Maryland.
But after three weeks the cough got worse.
“It kept me up in the night. I couldn’t catch my breath and I was getting really tired. Something just told me it was lung cancer.”
Tests revealed that Schoenbauer, a grandfather and avid cruise ship traveler indeed had lung cancer. Stage 3b and inoperable.
Even though he had quit, years of heavy smoking in his youth had caught up with him.
But physicians at MedStar Georgetown’s Lombardi Comprehensive Cancer Center had a new potential weapon in their arsenal against lung cancer that they were trying and studying. Schoenbauer enrolled in a clinical trial at Georgetown that included two FDA-approved chemotherapeutic drugs taken for about three months combined with the agent being studied, a new experimental immunotherapy, which he still receives every three weeks.
“Immunotherapies use antibodies which stimulate the immune system to defeat the cancer,” said Giuseppe Giaccone, MD, PhD, director of the lung cancer program at MedStar Georgetown University Hospital and associate director of clinical research at Georgetown Lombardi. “Cancer has the ability to inhibit the immune system so the tumor continues to grow. Immunotherapy blocks that inhibition and allows the immune system to attack the cancer. We have already seen great success with immunotherapies in melanoma and now, it’s working for some patients with lung cancer too.”
“Mr. Schoenbauer was not a good candidate for surgery or radiation and was looking for a novel treatment option,” said Deepa Subramaniam, MD, his oncologist at MedStar Georgetown. “He had squamous lung cancer which looked like a good target for immunotherapy.”
“I wasn’t nervous to take the trial drug,” said Schoenbauer. “I figured what did I have to lose? Then every time I came up here for a CT scan and checkup I just got better and better. The tumor got smaller and smaller and eventually it was gone. I could hardly believe it.”
“To date, Mr. Schoenbauer has no evidence of tumor,” said Dr. Subramaniam. “It is possible his cancer will remain in ‘remission’ for a long time after the discontinuation of immunotherapy; this is an area of ongoing research. But for now he is continuing with his immunotherapy treatment which he is tolerating very well.”
“I lost my hair when I was taking the chemo,” said Schoenbauer. “But once I stopped that, my hair grew back and I’ve really only had a little fatigue. That’s it. I am a very happy camper.”
“The news in the area of lung cancer and immunotherapy is very exciting right now for a couple of reasons,” said Dr. Subramaniam. “First, when a patient’s tumor shrinks or disappears from immunotherapy treatment, it appears that such a benefit lasts much longer than we would expect from chemotherapy. Frequently the benefit of immunotherapies lasts for more than a year. In addition, there have been many preliminary reports of patients in long-term remissions, allowing us to perhaps dream about ‘curing’ advanced Stage IV cancers. Still, for some patients, treatment with immunotherapy doesn’t work.”
“It’s too early to tell if this is a cure for this patient,” said Dr. Giaccone. “The response rate to immunotherapies overall is 20 percent which is good, but that means 80 percent still don’t derive benefit, and we need to find out why. Eventually we want to use immunotherapies in patients whose disease is less advanced and see if it works better in that case. We are also testing other immunotherapies here.”
“Generally patients tolerate the immunotherapies very well,” said Dr. Subramaniam. “In a recent large lung cancer study, side effects were less than with chemotherapy. Rare but serious side effects include those when your immune system attacks your own normal body cells and causes inflammation of the lungs, skin, liver or bowels. But we know how to manage those side effects very well. Serious side effects are seen more often with the class of immunotherapy called anti-CTLA4 antibodies and less with the anti-PDL1 or anti-PD1 antibodies such as those used with Mr. Schoenbauer.”
“I’m turning 81 this September and will celebrate my 60th wedding anniversary in October,” Schoenbauer said. “I hope the cancer never comes back. In the meantime I’m enjoying my kids and my grandchildren and looking forward to hopefully having many years ahead of me.”
To date, there are no approved immunotherapies for non-squamous cell carcinomas so they are only available as part of an investigational study. Georgetown Lombardi is researching immunotherapy in clinical trials for other types of cancer including adenocarcinoma, thymic malignancies and non-thoracic cancers.
Lung cancer is the leading cause of cancer-related death among men and women in the U.S. and, though more common in men, the number of deaths from lung cancer in women is increasing. According to the National Cancer Institute, an estimated 221,200 Americans will be diagnosed with lung cancer, and 158,040 will die from the disease this year.
This clinical trial is funded by Genentech.
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