New Haven Register (New Haven, CT)
Trials with immunotherapy drugs offer hope in treating breast cancer
Joshalyn Mills of Branford and Nancy Witz of Kensington had the best possible results after being treated in clinical trials with immunotherapy drugs for aggressive breast cancer: Their tumors were eliminated.
But while there are dramatic successes with immunotherapy drugs, there are also many failures, and researchers are trying to find out why in hope of expanding the drugs’ effectiveness.
Other immunotherapy drugs not yet approved by the FDA are given to patients in breast cancer clinical trials, which is how Mills and Witz received theirs. Mills was in a trial in 2017, and Witz’s trial started last August. Both were diagnosed with triple-negative breast cancer.
Diversifying breast cancer trials
Mills discovered a lump in her breast on her 34th birthday at a fitting for her wedding gown. “I had to survive,” she said, noting that she and her husband have four children in their blended family. She started treatment a week after her honeymoon.
As a Black woman,
Mills said, she believes she wouldn’t have been offered a trial if she didn’t live in the New Haven area.
A higher rate of Black women die from breast cancer, according to the Centers for Disease Control and Prevention (CDC). In Connecticut in 2018, 24.6 out of every 100,000 Black women died of breast cancer compared to 15.8 out of every 100,000 white women, according to the CDC’s recent ageadjusted statistics.
New breast cancer cases reported in Connecticut in 2018 totaled 122.5 per 100,000 Black women and 136.4 per 100,000 white women, the CDC statistics show.
Nationally, in 2018, for every 100,000 Black women, 27 died of breast cancer, with new cases reported in 121, according to the CDC. For every
100,000 white women, 19 died of breast cancer that year while 128 new cases were detected, the CDC reports.
In addition, Black women have nearly three times the risk of triple-negative breast cancer than white women, according to a study led by the University of Pennsylvania’s Perelman School of Medicine.
Age is another factor in immunotherapy clinical trials. The participation of Witz, at 68, was unusual even though cancer disproportionately affects older people, Silber said. “If you’re testing a drug on a 40-year-old, you have no idea what adverse side effects would be in an older group,” she said.
Witz grabbed the opportunity. “I had no choice. We’re talking about death here,” she said. “Just give me my life,” she told Silber.
Side effects, financial barriers
Before her diagnosis last Memorial Day weekend, Witz was a substitute teacher, Eucharistic minister, comedian, swimmer and a former clown. She was diagnosed after seeking medical help for acute chest pains and indigestion-like discomfort.
Another issue is cost, which runs about $12,000 per dose, she said. Mills and Witz weren’t charged for the immunotherapy meds in their trials but were responsible for other costs, including chemotherapy and surgery. Mills said she is still paying off more than $6,000 in copayments not covered by insurance.
Patients prescribed immunotherapy have big bills if they have high deductibles, Lo said. “Deductibles can be anywhere from $3,000 to $10,000, and with these drugs, you go through your deductibles,” he said.
When immunotherapy works, it’s “very exciting,” said Dr. Patricia A. DeFusco, medical director of the Hartford HealthCare Cancer Institute Breast Program. “You want to cure these people,” she said.
Since Keytruda was approved, she has had two patients whose tumors disappeared after using it, which she called “phenomenal.”
“Over time, we’ll see if the responses are durable, that these cancers don’t reoccur,” she said.
Lo called immunotherapy quirky. While he has had successes with it, he said, he has also had patients for whom it does not work.
“That’s why we need to do very active research and why we need patients’ help” in clinical trials, he said.