What Cancer Patients Should Know: Latest Immunotherapy News from ASCO 2018

Hello, I’m Dr. Jill O’Donnell-Tormey from the Cancer Research Institute, and I’m very lucky today to
have with me three experts that have all been here attending
a major cancer conference, The American Society of Clinical Oncology meeting here in Chicago. So we have Dr. Jeffrey Weber
and Dr. Catherine Diefenbach, who are both from the
Perlmutter Cancer Center at NYU Langone in New York City. And we have Dr. Charles Drake, who is from Columbia
University Medical Center. So thank you all for being
here, and for taking the time to let us know what
you’ve learned at ASCO. What have you found to
be the most promising, or the most exciting data
that came out in immunotherapy in the last few days here in Chicago? – I would say, not that
it’s the most exciting data, but it’s the most reassuring data that, for example, in melanoma, which is my field of specialization, that patients can safely
come off treatment, after say, a year or two
of getting a PD-1 antibody, and stay in remission
and several years later they’ll predominantly
still be in remission. And that’s a practice-changing thing, because it reassures
patients you can go one year, two years, stop treatment and be reassured that you’re going to stay in
remission for a long time. – Very good news. How about you, Chuck? – I think the most
interesting thing for me is the idea that if immunotherapy
is given before surgery, this can lead to really great outcomes in certain tumor types. So we saw in lung cancer
data that immunotherapy before surgery leads to
a very high response rate of tumor shrinking and we actually saw in bladder cancer that as few as two cycles of immunotherapy prior to surgery can lead to
pathologic complete responses. – So this is going to be
game-changing too, you think? – Eventually. – You think this will be adopted? Not yet, but it’s on the horizon? – It’ll have to, of course, go through larger Phase III trials, but it’s just a really stunning signal. – Catherine? – And I think on the
hematology front, what we saw is not really new data, but we saw that the CAR
T cell data has matured, and that at 15 months,
many of the patients with relapsed and refractory lymphoma, who don’t usually stay in
remission for very long — people who are in
remission at six months were in remission still at 15 months. And this is extremely promising for patients with relapsed lymphoma. – And then with CAR T cells, they’re getting one infusion, right? – So they get one infusion
and then they’re followed, so it’s very different from the paradigm of getting chemotherapy every
three weeks until you relapse. To get one infusion for patients
with refractory lymphoma, who go into this with disease,
and to be in remission at 15 months is extremely exciting. Unfortunately, in multiple myeloma, the CAR that was presented
there looks like people are relapsing at
about a one year time period. So, not every CAR is created equal, they don’t work as well in every disease, but I think really the
take-home message is that CARs are getting better,
they’re getting safer, some of the toxicity that we would see, the neurotoxicity, and
the cytokine release, which were really the
biggest problems with CARs, are getting better, and I
think CARs are here to stay. – If we’re going to reap the maximum amount of benefit from immunotherapies, it’s probably going to
come from combinations. Did we learn anything new
in the area of combinations? I was going to start with you, Chuck. – You know, what continues to surprise me, and in a good way, is
that when you combine chemotherapy with immunotherapy,
it tends to combine well. You tend to see higher response rate, and the longer term data
from some of those studies supports that this leads to survival. So I think that the study
that I was able to discuss was one for squamous cell lung cancer. And it was really impressive, the combination of
chemotherapy plus immunotherapy was far more beneficial
than the chemotherapy alone. – And I think this
surprises some patients. The preconceived notion that
chemotherapy is bad for you, for your immune system. And that’s changed. – Exactly. They surprisingly work well together. Way better than I think
we would have predicted from some of the animal studies. – Chemotherapy kills a lot of cells, and in killing cells it releases antigens, so it may well be that
in killing tumor bulk, both de-bulking the tumor
and making it smaller, and releasing antigen can
stimulate the immune cells to wake up and actually do
their job and kill the tumor. So, the more we learn, the
more possibilities we’ll have for really exciting combinations. – Where do we stand on
IO plus IO combinations? – So in kidney cancer,
we recently got approval for two-IO agents in the first line. It’s a combination of
anti-PD1, plus anti-CTLA-4, ipilimumab plus nivolumab. And this is really a very
beautiful and successful regimen response rates around 40% or 50%. Many of these responses
beautifully durable. So I think that we have some enthusiasm for these combinations. As you mentioned, there’s many, many
combinations in the clinic, and, you know, not all of
them will work, actually. And I think, over time, we’ll see from the clinical trials
which ones emerge. – I think one thing that’s
exciting that patients would like to hear is in melanoma, the results in terms of
long-term survival data. – There is a trial that was conducted three or four years ago, where
you either got pembrolizumab, one of two schedules, or you
got the control of ipilimumab, which was the earlier drug, the earlier immune drug
approved for melanoma. And the long term survival data suggests that you begin to plateau at year four. Patients do very well. And maybe some of those
patients are cured. And the patients who
had a response, meaning a complete response, a partial response, or even stable disease, meaning they never grew,
but they never shrank, 80-some odd percent of
those patients stayed in remission beyond two
years from finishing therapy. And of those who relapsed, even a moderate percentage of those, at least a third if not a half, could be put again back into remission, with the same drug or kind of drug. – I think what’s really
interesting is actually to understand that some patients who have a partial response, over
time their response deepens and becomes a complete response. We see this in lymphoma,
in Hodgkin lymphoma, quite frequently, and you
really wonder biologically, are we not able to gauge
response very well? So when we call people partial response, are we really looking at
an inflammatory effect? Or do people actually
have an immune system that learns to recognize
tumor better over time? – Another big theme is biomarkers. I think patients are going to be hearing more about biomarkers. So what is a biomarker? So the patient can understand,
when they’re saying, “We’re looking for a biomarker.” What does that mean? – When we talk about
biomarkers, we’re usually talking about what’s known
as predictive biomarkers. These are tests that can
tell whether a patient is more likely to respond
to a particular therapy. And for immunotherapy,
the most commonly used predictive biomarker
is looking at the tumor to see if it expresses
a molecule called PD-L1. There are many limitations
to this sort of biomarker, but it does have some strengths, and in first-line lung
cancer, patients are chosen for therapy based on their
expression of this biomarker. We learned recently,
a couple of weeks ago, that in first-line bladder cancer, we should probably be thinking about using this biomarker as well to
select patients who should receive immunotherapy versus
conventional chemotherapy. – In Hodgkin lymphoma, the tumor cells, which are quite rare and are
surrounded by immune cells, these Hodgkin’s tumor cells
uniformly express PD-L1. And so when you treat these patients with checkpoint inhibitors,
what you actually do is wake up the T cells. Say, “Wake up, do your
job, go kill the tumor.” – Something of interest to people that we hear is the microbiome. – I have started actually
one of the largest studies looking at the way the
microbiome impacts lymphoma. Looking at the impact of
the microbiome, which is the bacteria and the viruses
that live in your gut. And there’s really two
questions about that: How abundant they are. That is, do you have a lot
of bacteria and viruses in your gut or a little? And, what species do you have? Are they diverse? Lymphoma patients have a
very different microbiome, both in terms of abundance
of species and which species they are, compared to
normal, age-matched controls. So that is really the
first clue that we have that there may be really
physiologic differences in bacteria and viruses
that are driving differences in immune cell activation
in lymphoma patients. – So I think that we’re a
little bit a way’s away from figuring out exactly which are the good versus the bad bacteria
and moving forward. Nevertheless, it’s true, actually, there are ongoing studies taking bacteria from patients who
responded to immunotherapy and then giving them to patients who have not been treated yet, to
see if you can increase the chance of being a responder. – Will immunotherapy become
part of the precision medicine? Are we going to get
precision immunotherapies? – I think we will, I think
in five years or 10 years you’re going to be getting
a new patient in the clinic, you’ll get a sample of
poop, you get a blood test, you’ll get a biopsy, and you’ll put some amalgamated biomarker together, you’ll get a print-out and it’ll say, the optimal immune therapy
for this patient is … If they fail in this
manner, you go to plan B. If it doesn’t work, you go to plan C. So I think there will be, in the future, it’s not tomorrow, it’s going
to be five, maybe 10 years. – I think that I would
agree in general principle, actually, that there is
certainly the possibility that you could take a good molecular look at the tumor and the patient and come up with some predictive
algorithm that could tell you you need this cocktail of immunotherapy, potentially with conventional therapy. But I think that’s maybe more
in the 10-year kind of range. – I think, to take what
both Jeff and Chuck said, I think really understanding
how the immune system in the patient’s response to the tumor and what the communications are between the tumor and the immune system, I think understanding those communications is really what is going to allow us to personalize therapy for patients. And whether it’s
immunotherapy, or combining immunotherapy with targeted
therapy, or with chemotherapy. I think we have so many options
available for our patients. And the more we understand
the biology of the tumor, the better we’re going to be at being able to personalize therapy for our patients. But I’m a little, I’m not
quite as optimistic as Jeff, I think it’s more of a 10-year project than a five-year project. – We’re on the 10 year side. – Okay.
(laughing) – Well again, I want to thank you for taking the time to spend with us and have this conversation. I think the take-home message is that we should be very hopeful, we are still at the beginning,
we need a lot more research, but I think we’re on the right track and I think it’s all
great news for patients. So thank you very much. – Thank you.
– Thank you. – Thank you.

18 thoughts on “What Cancer Patients Should Know: Latest Immunotherapy News from ASCO 2018

  • I'm always amazed at how little research is done on a cancer patients stool samples. Especially Colorectal Cancer patients.

  • I was diagnosed with stage 4 lung cancer in 2011, and that year we were excited to be celebrating my six year survivorship anniversary – a survival that was not remotely contemplated in 2016. Since i diagnosis i have learnt a lot about lung cancer, the first few years were confronting.
    I had no clue that my LUNG (left) was responsible for these combined symptoms! Fatique, chest, neck and shoulder pain. My life changed in just one breath when my Doctor diagnosed me with advanced lung cancer that was INOPERABLE, INCURABLE and TERMINAL. I will always remember the pain and tears from my husband’s face as well as my daughters and my close friends. Like many other people this was not the first time that my life was impacted by CANCER. In 2002 my sister was diagnosed with leukemia. Fortunately for us she was diagnosed at an late stage and she pass away. So when my doctor gave the news about me, We all put in mind positive energy to fight agaisnt it, Because I was not going to let that put an end to my smile. now i lives a normal healthy and active lifestyle thanks to the “Dr Adebola Herbal Herbs” which my husband doctors prescribed him. SO many good people have lost there life because of greed, The government will preach agaisnt herbal herbs because it only one true cure, But will make profil with pills because the money you treat the more money you spent, Thanks to my husband Doctor who told us this. I will want to advice anyone out here going throught sorrow with Cancer to reach out to Dr Adebola and I guarantee you that you will be cured. Contact him via: ([email protected])

  • The problem with PD1 therapy is the immune system will once again ignore the cancer once the blockade inhibitors run out. Blockading self recognition proteins also means alot of other healthy cells can get attacked if they use the same cell recognizer to protect itself from autoimmune attack.

  • I’ve been on Keytruda Immunotherapy for a few months now and doing well. I had Squamous Cell Carcinoma. After an operation and skin + muscle graft, I had radiation. The cancer was starting to come back. I did not think that I would do well on chemo, so I chose to go on immunotherapy treatments. I’m more than halfway through this treatment and feel great.

  • this is a bit of a long shot im not a doctor but fascinated with the human body i had an idear in 1997 and would like to know if its possible any one can answer but dont abuse me please im just trying to help ,first take a sample of a cancerous tumor ,assuming its a solid tumor but in principle my i dear could work on all cancers , infuse or infect what ever the correct word would be the cancer cells with a harmless retro virus ,vaccinate the patient from the virus placing the cancer and virus which now joined back into the patient,then by nature the virus will multiply as would the cancer but together,and in doing so would create the specific immune response needed to kill the cancer or at least keep it at safe levels also insuring any time a flare up would occure as long as a booster like in tetnas would keep the immune response current is this poss at all


    Hello everyone out there i am here to give a testimony of how i was cured from CANCER i never thought Dr.MUSTAFA can cure my cancer, until i was cured with his herbal medicine, I have tried almost everything but i couldn't find any solution on my disease, i have spend alot of money to buy CANCER drugs from hospital, and several medications but no avail, until one day i was just browsing on the Internet when i come across a great post of !ROLLAND who truly said that he was diagnose with CANCER and was healed by Dr MUSTAFA that very week through the help of his herbal medicine, so i really wonder why people called him the great healer, i never knew it was all because of the great and perfect work that he has been doing, so i quickly contacted him, and he ask me some few questions and he said a thing i will never forget that anyone who contacted him always get his or her healing in just three weeks after doing all he ask you, so i was amazed all the time i heard that from him, so i did all he ask to do and he prepare the herbal medicine and send it to me through DHL courier service only to see that after 3 weeks i was heal from cancer which he said i will be healed, so after 3 weeks all the strength that left me before rush back and i become very strong and healthy, this disease almost kill me, so i went to hospital for the final test and the doctor said i am negative, i was very happy about the healing of Dr.MUSTAFA from the ancient part of Africa, thank you sir for your great work. If you also need his help in any kind of diseases you can reach on [email protected] or you can call or Whatsapp him on +2347010821863.

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  • If you want cancer to go away stop covering everything we eat and drink in chemicals. Stop eating so much processed sugar. And get outdoors and be more active. Sleep 8 hours a night, stress less, live more. If everyone did this 80% of cancers would disappear. People are stuck in doors, get no sunlight, eat shitty foods, and drink too much alcohol, glued to their phones and spend their lives worrying about pointless shit beyond their control

  • I'm a medical student. I'm interested to work on cancer disease. I want to research on cancer cell.But how can i get the oppurtunity to be succeeded, anybody,would you please reply?

  • I have metastasized colon cancer in my liver stage 4 I have been on Keytruda (pembrolizumab) for about 13 months now. We have seen a great response in tumors as they are significantly smaller than when we began the treatment. Oncologist would like to continue treatment after surgery. the surgery would hopefully remove the remains of cancer in my liver, because of my situation ( I have lynch syndrome) I am being told that a very very long term of Immuno therapy is needed. My question is …. is it possible for the cancer to become immune to this therapy and once again attack my system ignoring the treatment? Should I eventually stop this treatment and give my body a break? my side effects are extreme fatigue, weight gain, decreased sex drive, among a few other things.

  • This is extraordinary the progress humanity has made in the fight against cancers. It is disappointing that it's still evident the progress of cancer research, as well as other research, is being controlled and ultimately held back by profit and money. It seems to me that we should have many cancers already figured out, but because the development of cancer therapies is driven by profit, requiring so much money, the advance of the science is highly selective and based upon the potential profit to be made. Another world IS possible… #resourcebasedeconomy … only together will we realize that world!!!

    www.thevenusproject.com & www.resourcebasedeconomy.org

    It's not the perfect #solution. There will be no single perfect solution, the transition will not be easy and it will take time and effort from each one of us. But a resource based economy IS a world and life improved by orders of magnitude over the current capitalist consumer paradigm. Literally for #EVERYONE.

    Knowledge is free… understand it… then share!!

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