Immunotherapy is a word you’ve may have heard... it's certainly a word you'll be hearing again.
Immunotherapy is a form of targeted therapy that has become a research focal point among top research institutions. In a nutshell, immunotherapy boosts the body’s immune system to find and ultimately attack harmful cancer cells. A number of cancers have the ability to hide from detection in the body. Immunotherapies are being developed and emerging — each in their own unique way — to help the body essentially outsmart these cancers.
Among these therapies is Keytruda, which prevents cancer cells from hiding. Keytruda is administered via an intravenous line, lasting approximately 30 minutes per treatment. Keytruda is typically given every three weeks, with the patient’s doctor determining how many treatments are needed.
Keytruda has been in the spotlight for nearly five years, dating back to Merck achieving “breakthrough status” by the Food and Drug Administration for the drug in 2013. Preliminary trails focused on the treatment of melanoma and lung cancer.
In 2014, the FDA approved Keytruda for the treatment of melanoma patients who carried a specific mutation. Subsequently, the drug has been approved for the treatment of a number of different cancers, including: non-small cell lung cancer; head and neck squamous cell cancer; classical Hodgkin lymphoma; urothelial carcinoma; select stomach cancers; and a specific type of cervical cancer that tests positive for the PD-L1 protein.
Additionally, Keytruda remains in trial phase for a number of cancers, including breast cancer. At Comprehensive Cancer Centers, the practice participates in more than 170 Phase I, Phase II and Phase III clinical research studies each year and has played a role in developing more than 70 FDA-approved cancer therapies.
Among those trials Comprehensive had access to in mid-2016 was Keytruda for a specific type of breast cancer. And, that access and the treatment that ensued turned out to be a life-changing scenario for a local patient who had exhausted so many other options.
Meet Audrey
Philadelphia native and Vegas local Audrey Marrow is unfortunately no stranger to a cancer diagnosis. In 2005 she was diagnosed with ovarian cancer and underwent chemotherapy and a hysterectomy. I first met Audrey four years ago, shortly after she noticed a lump in her right breast. After conducting the appropriate tests, we determined she had a very aggressive form of breast cancer, known as HER 2-Negative.
We immediately devised a treatment plan for her at that time that began with chemotherapy. She completed this regimen in February 2015 and in April 2015, had a complete mastectomy. Following the mastectomy, there was no residual breast cancer. However, during a follow-up appointment, we noticed cancer development in a left axillary lymph node. This was the opposite side of where her breast cancer had originally developed, which was certainly cause for concern.
So, in early 2016, we sat back down with Audrey to discuss her options. At the time, immunotherapy was certainly all the buzz and more and more therapies were being approved for trials for other cancer diagnoses. One of them was Keytruda for breast cancer.
After discussing options with Audrey and sending her pathology off for laboratory review, she was deemed to have the PDL-1 protein marker that Keytruda affects. Not wanting to return to chemotherapy regimen, Audrey signed on and immediately began the trial.
She’s been on the trial since. And, since embarking on the trial, it’s been a steady shrinkage of tumors and zero emergence of any new tumors. In the oncology world, we like to call this a “complete response” to the treatment.
Where Audrey was once frustrated by yet another cancer diagnosis and lacking the confidence that she’d return to normal health, she has now been cancer free for nearly two years. She has experienced zero side effects during the past two years as well.
With her newfound energy and livelihood, she’s been able to support some of her closest family members and friends during their own difficult times.
On New Year’s Eve, she’ll turn 70. Her spirits have been lifted and her spunk has returned, often asking me, “when are we heading on our vacation?”
Beyond Keytruda
The outlook for immunotherapy is bright.
Here in Nevada, the American Cancer Society estimates that 14,060 residents will be diagnosed with cancer this year. Approximately 2,180 of these cases will be breast cancer. Globally, each year, breast cancer accounts for nearly 12 percent of all cancer diagnoses. Amid the statistics, more and more trials are emerging to potentially help and heal each unique patient.
New targets are emerging — just like PD-1 and PDL-1 — for targeted therapies. And, the beauty of immunotherapy and targeted therapies is that when patients do respond, they are typically having a sustained response, living longer and happier.
In addition to Keytruda, there are a number of clinical trials available for breast cancer patients.
An example: Yervoy is a growlingly popular immunotherapy treatment, initially approved by the FDA in 2011 to treat specific types of metastatic melanoma. It has since been tested for prostate, lung and bladder cancer patients. Currently, there are a number of phase I and II trials available for recurrent metastatic, triple-negative and locally advanced breast cancers, sometimes being paired with the PD-1 antibody, Opdivo.
In cancer, unfortunately there is no magic formula that applies to all cancer patients just yet. But, it’s patients like Audrey and the promising Phase I, II and III trials that continue to grow locally and globally that give us hope and drive us to keep fighting.