‘Exciting’ treatments showing promise
The infusion was anticlimactic.
Dr. Robyn StacyHumphries received just 10 cubic centimeters — about two teaspoons — of CAR-T immunotherapy targeting her lymphoma.
But the results were dramatic. Within 24 hours, the enlarged lymph nodes in her neck, armpit and groin had shrunk. Within five days, they disappeared.
“It’s really miraculous,” said Stacy-Humphries, a Charlotte, North Carolina, radiologist who received her treatment through the Ohio State University Wexner Medical Center’s James Cancer Hospital. “CAR-T is
the biggest development in oncology in my lifetime. ... I just think it’s gonna change everything.”
CAR-T is a new therapy, currently in clinical trials for adults, that uses a patient’s own T-cells to fight aggressive diffuse large B-cell lymphoma. The T-cells, a component of the immune system, are filtered from a patient’s own blood, genetically altered to target molecules on cancer cells and then re-infused.
Stacy-Humphries received her infusion in September 2016. It has kept her persistent cancer at bay ever since.
“This is exciting because it gives us another option in the fight,” said Dr. Samantha Jaglowski, who is treating Stacy-Humphries.
The therapy is just one of a number of new ways researchers, clinicians and pharmaceutical companies are seeking to attack cancer cells.
“It’s really exciting at this moment now in oncology. Things are changing rapidly, and there are new options for patients,” said Dr. Malolan Rajagopalan a radiation oncologist in the Mount Carmel Health System. “It really helps us offer the best treatments.”
CAR-T is a form of immunotherapy. Such treatments harness the body’s own immune system to fight cancer.
The therapies have made breakthroughs in the past few years, especially when it comes to certain lung cancers, said Dr. Jorge Rios of the Mark H. Zangmeister Cancer Center on the Northeast Side.
“It basically changes the way your immune system acts with the cancer,” Rios said. “It’s been a tremendous success. It has completely changed the way we even see lung cancer right now.”
Rios pointed to National Cancer Institute data that show fewer than 5 percent of people with advanced lung cancer live five years or more after diagnosis. Early trials exploring immunotherapy have increased that survival rate five-fold.
Certain cancers avoid the body’s immune system by using a protein called PD-L1, said Dr. David Carbone, a thoracic medical oncologist at the Wexner Medical Center. Clinicians use intravenous therapy to block that protein with modified antibodies.
The protein, referred to as a “checkpoint,” acts much like a Star Trek cloaking shield to hide the cancer from the immune system, and the antibodies turn off that checkpoint, said Dr. Dean Lee, who oversees cellular therapy programs at Nationwide Children’s Hospital and the Ohio State University Comprehensive Cancer Center.
Once the checkpoint molecule is removed, the body sees the cancer cell as foreign and attacks it.
The therapy is used mostly with lung cancer and melanomas (skin cancers), but is also useful in a small number of colon, breast, bladder and head and neck cancers, Carbone said.
Another form of immunotherapy involves introducing a virus into cancer cells, thereby prompting immune-system cells to attack.
“These immune therapies are definitely resulting in true cures to people’s cancer,” Lee said.
Some other lung cancers are treated by targeting a specific gene mutation that acts like a switch to turn on cancer, Carbone said. The therapy also works on melanomas that have the same genetic mutation.
“There are six or eight different switches that we’ve identified that can be targeted with pretty simple oral drugs,” he said.
Other advances have come in the field of radiology.
With lung cancer, clinicians are using intensity-modulated radiation therapy, which targets tumors, avoiding organs, said Mount Carmel’s Rajagopalan. The process improves the quality of the dose being given and reduces side effects. Other advances include techniques that deliver radiation only when a tumor is still as opposed to when it is moving due to a patient’s breathing.
Breast cancer patients also have new radiation options, including techniques that protect the heart from the radiation. Women might lie on their stomachs or monitor their breathing with the help of gaming goggles, thereby separating breast tissue from the heart.
Rajagopalan also said there’s a new procedure that delivers radiation during lumpectomy surgery.
This means women can avoid post-surgery radiation treatments that might last four to six weeks. Instead, clinicians use a special device to deliver a high dose of focused radiation to the exact spot where the tumor was. It takes about 20 to 30 minutes.
“The big march from the radiation side has been to improve precision and decrease the amount of time patients have to undergo treatment,” Rajagopalan said.
Another new technique being used in Columbus involves looking at a patient’s genes to determine how they affect one’s propensity for getting cancer and how well one would respond to certain therapies, said Dr. Susan Vear, co-director of the Nationwide Children’s Hospital Program for Personalized Medicine and Pharmacogenomics in Pediatric Hematology/Oncology/Blood and Marrow Transplant.
Vear said her hope is that treatments will be developed to help patients move further and further away from using toxic chemotherapy drugs.
A number of other therapies are still in the testing stages. OhioHealth is part of a national trial in which researchers are examining whether aspirin can help deter breast cancer relapses, said Dr. Erin Macrae of Columbus Oncology and Hematology Associates. She said preliminary data show that it may be effective.
Researchers speculate that there is a tie between cancer and inflammation, and aspirin reduces inflammation.
Macrae said there are a number of studies looking at drug repurposing — using drugs that treat other things, like diabetes, to treat cancer as well. She said such a scenario in the aspirin trial would be a “winwin” because the medication is inexpensive and well-tolerated by most people.
Stacy-Humphries’ cancer was first diagnosed in 2005. It had relapsed twice before she found the CAR-T trial at Ohio State. Having previously had intensive chemotherapy, radiation and a transplant of her own stem cells, she was pretty much out of options after her latest recurrence in April 2016.
She eventually found the Ohio State program through a socialmedia posting.
“It’s like a miracle. It really is,” said Stacy-Humphries, 55. “I’m very, very grateful.”