New immunotherapies could soon play a bigger role in fighting colorectal cancers
March 8, 2016 12:00 AM
Judy Blair, 51, of Whitehall, a colon cancer survivor, reacts Wednesday after receiving the proclamation of Colon Cancer Awareness Month from Mayor Bill Peduto at the City-County Building.
Judy Blair, of Whitehall, talks about her treatments to fight colon cancer and now being cancer free.
Edward Chu, deputy director at the University of Pittsburgh Cancer Institute.
James J. Lee, a Pitt assistant professor.
Gene Finley, deputy director of medical oncology for Allegheny Health Network.
By Adam Smeltz / Pittsburgh Post-Gazette
More than a year since her last chemotherapy session, Judy Blair still feels the neuropathy, a tingle and numbness that seep into her fingers and toes. She figures that might not change.
Her “chemo brain” flares, too, leaving the mother of three at an occasional loss for just the right words.
“It’s poison going through your body. It destroys the good stuff with the bad,” said Mrs. Blair, 51, of Whitehall, who underwent six months of the powerful chemical treatments before celebrating a cancer-free scan last April.
“But I’m alive. I’m alive,” she said on a frigid afternoon last month, having rebounded from chemo-induced hair loss and exhaustion. “That’s all I can say.”
Doctors hope such stinging side effects will soon become less common among the thousands of Americans diagnosed with colorectal cancers, the second-leading cause of cancer-related deaths in the United States. More than 49,000 people nationwide will die this year from the disease, and more than 134,000 will be diagnosed with it, according to the American Cancer Society.
Some of them may find gentler help from new immunotherapies, a chemotherapy alternative or supplement that can jolt the immune system into fighting certain tumors. Limited largely to melanoma and lung cancer cases, the concept may win federal approval within months to start treating more colorectal cancer patients, researchers said.
“The whole goal is to reactivate the immune system that’s been suppressed by the cancer,” said Edward Chu, deputy director at the University of Pittsburgh Cancer Institute. He said immunotherapies target cancer’s ability to “shut off” immune defenses, at times using antibodies to drive a natural counter assault.
Dr. Chu said the approach seems to work especially well for patients who have “a high level of mutations” in colorectal tumors, although it isn’t clear how many eventually might benefit from the evolving medicine. A federal database shows doctors are recruiting for at least several clinical trials centered on the method’s effectiveness for colorectal cancer.
Among the trials already complete, an immunotherapy developed by pharmaceutical company Merck appeared to tame tumors in about 60 percent of participating patients. Several have been treated through UPMC.
“That’s an amazing response. [For] some patients, the tumor completely disappeared,” said James J. Lee, a Pitt assistant professor who helped author the findings released last May. More conventional treatments had failed or weren’t available for most participants.
The trial was so successful, the Food and Drug Administration is accelerating reviews of the drug — called pembrolizumab — for some colorectal cancer cases considered metastatic, meaning the cancer has spread from its original location. Only patients with a rare genetic mutation make up that target group, which represents about 5 percent of the metastatic cases.
While about 15 percent of all colon cancer patients have the mutation, Dr. Lee said ongoing research should forge more immunotherapies to subdue other types of colorectal growths.
It’s too soon to know whether the technique can cure those cancers, but its immediate side effects already pale next to chemotherapy’s toxic impact, Dr. Lee said. Generally, patients on immunotherapies may endure colitis (inflammation of the lining of the large intestine that can lead to abdominal pain, bloating and diarrhea), an upset stomach or fevers, among other irritants.
For Frankie Jones, 52, of Vanderbilt, Fayette County, the switch is paying off. His colon cancer stopped growing after he joined an immunotherapy trial in December at UPMC’s Hillman Cancer Center in Shadyside.
“The chemo was really eating me up really bad when I was on it. The fatigue, the nausea — it just completely drains your whole body,” Mr. Jones said.
He said that hasn’t been the case with the immunotherapy, which has left him more active and buoyant. It also appears more effective than his yearlong chemo treatments, during which his cancerous cells continued to spread, Mr. Jones said.
The logistics of his therapy haven’t changed much: He still goes to a clinic twice a month for prolonged injection of the treatments. The process usually takes about an hour.
“People want to live even if they know they have a very hard tumor. It’s challenging,” said Gene Finley, deputy director of medical oncology for Allegheny Health Network. He said patients with advanced disease may gain special access to immunotherapies not yet approved for widespread access, thanks to “compassionate use” programs.
At the FDA, which regulates the drugs, a spokeswoman said the agency could not discuss the status of clinical trials or investigational drug applications. Dr. Chu estimated that immunotherapy for colon cancer might run upwards of $5,000 to $10,000 a month, with initial results often emerging within four months.
That price is about on par with another innovation known as targeted therapy, which tackles cells involved in cancer growth. More traditional treatments include surgery and radiation.
“Will [immunotherapy] ever replace the other treatments? I don’t believe so,” Dr. Chu said. “But we certainty need to know how to integrate immunotherapy with all of our other treatment modalities.”
Still, early detection could keep thousands of people from ever needing that care. Colonoscopies and other screening can reveal pre-cancerous polyps that doctors remove before cancer sets in, said Rich Wender, chief cancer control officer at the cancer society.
“The ultimate scorecard is our screening rates. There is no substitute for that. We have to see screening rates go up,” Dr. Wender said.
To push that cause, the cancer society is championing an “80 by 18” campaign to drive national colorectal screening rates to 80 percent by 2018. A federal task force recommends the checks for those between the ages of 50 and 75.
Meeting the goal should prevent 277,000 cases of colon cancer and 203,000 deaths from the disease, according to the society. March is Colon Cancer Awareness Month.
“It’s a passionate calling — almost a moral obligation — to do everything we can as a society to give everyone an equal chance to benefit from what has been proven to work,” Dr. Wender said.
Bloomberg News contributed. Adam Smeltz: firstname.lastname@example.org, 412-263-2625 or on Twitter @asmeltz.
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