Fort Wayne Medical Oncology and Hematology (FWMOH) is among clinical research sites across the nation where patients are able to access new immunotherapies for several types of cancers — ones for which doctors rarely, if ever, have uttered the word remission, let alone cure.
Long, working as a nurse at the time, remembers the days leading up to the diagnosis.
“I would walk down the hall at the hospital and have to lean against the wall to catch my breath," she said. "I knew something was wrong. I thought it was my heart.”
A long-time smoker, Long had successfully quit the habit about six months earlier but said, “I knew I was at risk for lung cancer.”
Long was initially treated with traditional chemotherapy, which acts to kill cancer cells, but it can also kill healthy cells.
Healthy, normal cells in the body reproduce when and where they are needed. They are specialized and remain in the part of the body in which they are genetically designed to be.
When normal cells are too old or are damaged, the body’s immune system destroys them.
“This is happening all the time in our body,” said Dr. Sunil Babu, a medical oncologist and director of research at FWMOH.
Sometimes, however, cancer cells go undetected by the immune system. The cancer cells mutate rapidly, multiply and take up residence in places they shouldn’t be.
“A lung cell is not supposed to go outside of the lung,” Babu said. In Long’s case, cancerous lung cells spread to the area around her heart.
Her specific cancer, non-small cell, is the most common type of lung cancer. Lung cancer is the leading cause of cancer deaths among both U.S. men and women. The five-year survival rate is 54 percent if the cancer is localized in the lung when detected, but only 15 percent of lung cancers are diagnosed at an early stage, according to the American Cancer Society.
Things improved for a time for Long, but tests showed chemotherapy was not adequately destroying the cancer.
Her oncologist, Dr. Michael Epstein, recommended she enroll in a clinical trial of an immunotherapy called nivolumab, known by the brand name Opdivo, which had already shown success in treating advanced melanoma. Opdivo is made by Bristol-Myers Squibb and received FDA approval in October.
Long has responded well, though Babu cautions the term "cure" isn't used with stage IV lung cancer. The hope at this point for patients such as Long is long-term remission and improved quality of life.
Unlike the way chemotherapy drugs work, immunotherapies “unmask the cancer cell to the patient’s own immune system,” explained Babu, principal investigator for the Opdivo clinical trial at FWMOH.
Our cells have proteins on the surface that keep immune responses in check by preventing too drastic of an immune response that damages normal cells.
“Some cancer cells find a way to hide from the immune system by expressing lots of these protective proteins on their surfaces,” Babu said.
Checkpoint modulators such as Opdivo and Yervoy, another immunotherapy used to treat both advanced lung cancer and melanoma, block the immune checkpoint proteins so the immune system can respond appropriately. Some advanced melanomas are now being put into complete remission, thanks to these kinds of immunotherapies.
Releasing the brakes on the immune system, however, can cause serious side effects, such as severe inflammation of lung, bowel and other tissues. People participating in clinical trials are the most closely monitored of any patients, Babu emphasized. Even the slightest symptom is recorded and monitored.
Other kinds of immunotherapies are also changing the face of cancer treatment. One involves taking a patient’s T-cells, a type of immune cell, genetically modifying them, growing them in the laboratory, and then injecting them back into the patient. Some pediatric and adult patients with resistant leukemias have responded to this type of immunotherapy.
Genomic profiling is another technology that enables cancer specialists to understand how a person’s specific cancer cells respond to treatments so therapies can be targeted to those cells.
The word "cure" has remained elusive, especially for advanced cancers, but Babu said, “The good news is there are many hopeful signs.”
Jennifer L. Boen is a freelance writer in Fort Wayne who writes frequently about health and medicine. This column is the personal opinion of the writer and does not necessarily reflect the views or opinion of The News-Sentinel.