What’s exciting in cancer research right now? In this post, I’ll review several of the most interesting cancer research stories that have been in the news this summer.
These are a few of the recent stories that seem to have the greatest potential impact, at least from my perspective, and that I know I’ll want to follow as they develop further.
Stories worth following include several studies presented at the annual meeting of the American Society of Clinical Oncology (ASCO) in June. Among those were a study on extending the use of aromatase inhibitors in breast cancer treatment; findings that a web app boosts survival for patients with lung cancer; and, research on the use of a “biosimilar” treatment that can substitute for the breast cancer drug Herceptin.
Hormone Receptor-Positive Breast Cancer Treatment
One of the studies presented at ASCO that got headlines was a clinical trial that examined the effectiveness of extending for a longer time an anti-hormone treatment for women with hormone-positive early stage breast cancer. The study was published in the New England Journal of Medicine.
Aromatase inhibitors are an anti-estrogen therapy for postmenopausal patients with breast cancer that is sensitive to the hormone estrogen. The current recommended length of time that women receive this treatment is five years.
This study found that there is a small benefit in extending therapy with aromatase inhibitors for an additional five years, for a total of ten years under the treatment. The benefit is mainly from a slight reduction in the risk of a new cancer developing in the unaffected breast. But the risk of a new “contralateral” breast cancer is already very low. And the extended therapy carries with it an increased risk of osteoporosis and bone fractures. In addition, other common side effects of these drugs–including joint pain and hot flashes–would still be part of the equation for many women.
Dr. Elaine Schattner, writing in Forbes, discusses a number of concerns with study. And Dr. Deana Attai, in a recent blog post, emphasizes that the risks and possible benefits of the extended therapy need to be weighed carefully by patients with their doctors. The patient perspective is further explored in an insightful post by Nancy of Nancy’s Point.
A remarkable study presented at ASCO found that lung cancer patients who used a web-based application to report symptoms as part of follow-up after treatment had better overall survival and quality of life than patients receiving standard follow-up care.
Most of the 121 patients in the randomized phase III clinical trial had stage 3 or stage 4 lung cancer and had completed initial treatment with chemotherapy, radiation or surgery. Those who were randomized to use the web app provided weekly information on any symptoms they were experiencing and had regularly scheduled doctor visits. Scans and other follow-up were scheduled as needed based on symptoms reported. Those patients receiving standard follow-up had regularly scheduled scans at 3-6 month intervals and doctor visits.
The results were striking. While rates of relapse were about the same for both groups, the patients using the web app had median overall survival of 19 months, compared to 12 months for those in the standard follow-up group. The use of the web app appeared to allow for earlier identification and treatment of relapse or complications, when patients were better able to tolerate it. In addition, quality of life was significantly better for the patients using the app.
Costs of Cancer Care: Biosimilar for Herceptin
Expanded use of a category of drugs known as “biosimilars” holds promise as a possible way to reduce costs for some very expensive cancer medications.
Biosimilars are drugs that are highly similar to the original drugs they substitute for. The term is applied to drugs called biologics, which replicate natural substances in our bodies. Prior to approval, the U.S. Food and Drug Administration requires clinical trial data demonstrating that a biosimilar is extremely close to the original drug in both safety and efficacy.
A recently completed clinical trial reported at ASCO found that a biosimilar to the drug trastuzumab (Herceptin) was comparable to it in both safety and efficacy, setting the stage for eventual approval of the drug to treat HER2-positive metastatic breast cancer. The drug goes by the name Myl-1401O.
In March 2015, the FDA approved the first biosimilar for use in the United States. OncLive reports that, if it’s eventually approved by the Food and Drug Administration, Myl-1410O would be the first biosimilar to treat cancer available in the United States.
Targeted Treatments: More “Graduates” from I-SPY2 Trial
In the Spring 2016 edition, we covered a potential new treatment combination for HER2-positive breast cancer that had recently “graduated” from the I-SPY2 clinical trial. The ongoing I-SPY2 trial uses an innovative approach that allows for a variety of potential new cancer drugs to be tested in relatively small numbers of patients to get an indication of their likelihood of success in larger trials.
Two additional treatment combinations–one for HER2-positive breast cancer that included the targeted therapy neratinib and one for triple negative breast cancer that included the targeted therapy veliparib–graduated from I-SPY2 this July and were reported in the New England Journal of Medicine. The treatment combinations will move forward to further study in phase III randomized trials.
Experience with these combinations as well as the I-SPY2 trial approach in general is discussed in a blog post on the trial’s website. This comment about the shorter timeframes for getting trials started under this approach is interesting:
A major achievement in the progression of I-SPY2 has been significantly reducing the time it takes to move forward from initiation of discussions with drug companies to enrollment of the first patients. I-SPY2 has compressed this timeline from an average timeframe of 18-36 months to five months. The I-SPY2 study start-up period takes approximately 45-60 days, with more than 50% of the sites opening and enrolling patients, as opposed to the traditional study start-up timing of 10 to 13 months, with less than 25% of the sites opening and enrolling.
Immune System Therapies: Risks in Some Combo Treatments
This summer we were reminded that experimental immune system therapies–which seem to hold a great deal of promise at least for some cancer patients–are not without risk.
A phase II clinical trial of CAR-T cell immunotherapy, a highly customized form of immunotherapy in which a patient’s own immune cells are reengineered to better attack the cancer, was temporarily stopped after three patients died from swelling in the brain.
Patients receiving CAR-T cell therapy are first given chemotherapy. This particular trial had been testing a combination of two chemotherapy drugs given prior to injecting the modified T-cells. All of the deaths were attributed to one chemotherapy drug that was used in the combination. The trial was later allowed to resume without the use of that drug.
An article in STATNews explores the implications of the fatalities for cancer immunotherapy research going forward. The article points out that there are dozens of approaches to immune system therapy, of which CAR-T cell therapy is just one. Further, it notes that CAR-T cell therapy has only been around a few years and “scientists are still piecing together its safety and efficacy.”
For More Information
For more on ASCO, Cancer.Net provides a summary of the highlights of the 2016 annual meeting. In a short video, Richard L. Shilsky, MD, Chief Medical Officer of ASCO, comments on the major themes of this year’s annual meeting.
In addition, a recent series of articles on immunotherapy in the New York Times explores novel uses of immune system therapies to treat cancer.
That’s it for this time. If there was another recent cancer research story or article that caught your attention or if you have thoughts on any of what I’ve included, I’d love to hear from you!
The I-SPY2 Breast Cancer Trial: How Clinical Trials May Be Changing
5 Cancer Research Stories Worth Following – Spring 2016
5 Cancer Research Stories Worth Following – Winter 2016
10 Things We Learned About Progress Against Cancer in 2015
Photo Credit: lakov Kalinin via Shutterstock