27 November 2017

Immunotherapies and cancer: temper hype, celebrate hope

Cancer Clinical

In answer to the question immunotherapy: hype or hope?, leading US medical oncologist Dr Matthew Hellman definitely sides with hope.

Citing the success of immunotherapy in the treatment of melanoma, he told delegates at the recent Clinical Oncology Society of Australia conference in Sydney that it was now realistic for people with these previously fatal cancers to have hope.

Melanoma had been the “canary in the mine”, he said. With lung cancer now the new kid on the block, appearing to respond favourably to various immunotherapies in the latest clinical trials.

“This is just the beginning,” Dr Hellman, from the Memorial Sloan Kettering Cancer Center in New York, said.

One of the most exciting aspects of the new immunotherapies was their breadth of activity, he said, with the same therapy such as pembrolizumab appearing to show benefits for a number of different cancers.

They also appear to have continuing benefit even after finishing treatment as a result of ‘immunological memory”, a feature that is not possible with other therapies.

What’s more, because of their mechanism of action these therapies offer the potential of cure with a relatively safe side-effect profile. This is in contrast to previous chemotherapeutic regimens where increased toxicity commonly came at a cost of increased side effects.

Quality of life was a major advantage of the new immunotherapies, Dr Hellman said.

“We now talk about a ‘return to life’ concept, which is immensely satisfying.”

But there is a downside. The new immunotherapies aren’t suitable for everyone. They only help a subset of patients. And while immunotherapies, such as immune checkpoint inhibitors have been a real source of hope for cancer patients, we need to find more biomarkers to help us determine who are the people who will benefit from these therapies and better understand the determinants of response.

Haematologist Ian Kerridge, Professor of Bioethics and Medicine at the University of Sydney, similarly spoke of the enormous possibility and promise of the new immunotherapies.

However, he suggested media attention and clinicians’ own excitement on the scientific successes in the field of oncology was creating unrealistic expectations among the general population, and for people with cancer in particular.

“Patients live in a rhetorical sea of narrative that only speaks of benefit,” he told the conference.

The risk with creating such hope was, of course, that patients were not then prepared for a poor outcome, he said.

Such expectations might also “create a technological imperative that can sometimes harm patients, distort medical decision-making and drive up the costs of care”.

As clinicians, he said, we need to be conscious of how we, along with the media and industry, shape patient expectations.

We need to temper the hype while celebrating the hope.