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Reliance on Immunotherapy Agents Increases, as Does Optimism

 

Immunotherapy has gained wide ground since the FDA approved ipilimumab (Yervoy, Bristol-Myers Squibb) for the treatment of metastatic melanoma in 2011. In the years that followed, the agency approved other checkpoint inhibitors for lung and kidney cancers, Hodgkin lymphoma and urothelial cancer. Researchers at Englewood Hospital and Medical Center are optimistic that the list will continue to grow.

Brian Kim, MD, Hematology/Oncology Specialist
Brian Kim, MD, Hematology/Oncology Specialist

“Though immunotherapy has not yet gained official approval in other tumor types, we’ve seen responses in people with breast cancer, people with gastrointestinal cancers, gynecologic cancers and many others. With this type of strategy, we’re seeing success in some cases that are really unparalleled in the history of cancer treatment,” said Brian Kim, MD, a hematology/oncology specialist at Englewood Hospital. “In trials right now, we’re looking to expand these therapies to virtually every type of cancer.”

Maxwell Janosky, MD, Dermatologic Oncologist
Maxwell Janosky, MD, Dermatologic Oncologist

A major advantage of the agents, which work by disrupting cancer cell signals and leaving them vulnerable to the patient’s own immune system, is that they are generally far more gentle than standard chemotherapy agents.

“I was drawn to the field of immunotherapy during my fellowship when I saw that while cytotoxic chemotherapy has its role, enhancing the immune system to attack the cancer is much less toxic and much better tolerated,” said Maxwell Janosky, MD, a dermatologic oncologist at Englewood Hospital. 

Adverse Effects Need Close Monitoring

The agents, however, are not without their own toxicities that oncologists need to monitor and be ready to treat.

Approved and Unapproved Cancer Immunotherapeutics
Approved and Unapproved Cancer Immunotherapeutics

“Unfortunately, in enhancing the immune system, there isn’t a way to focus the immune system targeting the cancer, so there is a possibility that you can rev up the entire immune system, resulting in flares of inflammation that can be anywhere in the body,” Dr. Kim said.

The effects of excessive inflammation are similar to the symptoms of autoimmune diseases. Some of the most common reactions occur in the GI tract, where the reaction causes inflammation of the colon and diarrhea. Inflammation also can attack the pituitary gland, thyroid and liver, and can cause skin reactions, such as rashes and lesions.

“These inflammatory diseases can happen anywhere. Fortunately, the frequency of these problems has consistently been pretty low throughout all of the trials that have been conducted in immunotherapies so far,” Dr. Kim said. “Reactions that require an interruption of therapy, or treatments to address those side effects, are in the range of only 5% to 15%, which is a much lower frequency of side effects than we see with traditional chemotherapy.”

The treatment for excessive inflammation is an immunosuppressant, typically a steroid. “It’s important to identify these toxicities early and begin treatment,” Dr. Janosky said. “We’re very focused on offering personalized care for our patients, and we have a great multidisciplinary team that helps us do that.”

Of note, the steroidal treatments used to slow down the body’s immune response don’t reduce the effectiveness of immunotherapy. “You can decrease the inflammatory symptoms, but the cancer is still being attacked by the immune system,” Dr. Janosky said.

Researchers at Englewood Hospital have participated in trials that moved immunotherapy agents toward FDA approval, and they have witnessed the results of this treatment firsthand. “We’ve seen breakthroughs for a lot of patients, things we’ve never had before,” Dr. Kim said. “It’s a very exciting time for us as treating physicians, and of course for the patients.”

Dr. Janosky hopes that continued research will extend the drugs to patients with earlier-stage cancers. “We want to increase their cure rate,” he said. “That will result in more cancer survivors.”

Posted March 2017

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