Generally speaking, cancer is treated using some combination of three different protocols: surgical removal of cancerous tissue, chemotherapy to kill cancerous cells, and radiation therapy to shrink tumors or kill cancerous cells. The order in which these treatments are provided, and the decision about the use of each of these modalities, is based on many factors, including the type and location of the cancer, how far advanced it is, and the condition of the patient. The success of this approach has been varied. But now researchers from around the world are becoming increasingly excited at the results they are getting using an entirely new treatment, known as immunotherapy. The story of 52-year old Sandra Sayce of the United Kingdom is a perfect example of why.
Sayce was diagnosed with melanoma – a form of skin cancer – in 2001 after her general practitioner spotted several lumps on her shin. She had surgery to remove them, as well as her lymph nodes after it was determined that the cancer had spread to that area as well. She also received chemotherapy. Four years later she noticed small black spots appearing on her leg and found that the cancer had returned. This time it was not just in the leg, but also had spread to her liver and her lymphatic system. The cancer was identified as being advanced and classified as stage 4. She was started on chemotherapy, which slowed the growth of the tumors but did not stop it. Following this she was put on an experimental drug called 17AAG, which also proved ineffective. Finally, in 2006, she was asked if she wanted to participate in a clinical trial of a medication called ipilimumab, which is an immunotherapy drug that would enlist her immune system in the battle.
Immunotherapy is one of the most promising protocols that cancer researchers around the world are working on. Unlike medications and chemotherapy drugs, which cancer cells can develop a resistance to, immunotherapy works directly with the patient’s own immune system, essentially teaching it to recognize cancer and respond to it. According to James Larkin of the Royal Marsden in London,
“The critical difference with immunotherapy is that you are actually reprogramming the immune system, if you like. The idea is, if the tumor does change and evolve, the immune system can also change and evolve with the tumor. I can’t exactly prove that, but I fundamentally think that’s the critical difference.”
Ipilimumab has been used in the United Kingdom for approximately ten years now, with excellent results, and he recently convinced a leading pharmaceutical company in the United States to run clinical trials of the drug, as well as another immunotherapy drug called pembrolizumab. Though he has found that he gets a positive response in about 20 to 25 percent of patients by using one of these drugs, he has had even greater success by combining the two, and recently announced that six out of ten patients with advanced melanoma treated in this way had either stabilized or their tumors had shrunk. Though side effects do exist, they are relatively benign.
Though Larkin is enthusiastic about the results that the trials of ipilimumab, as well as of pembrolizumab and the combination of the two, he also is aware that it cannot be referred to as a cure just yet.
“The word cure is tricky obviously – and that’s quite important,” he says. “To say someone is cured of a metastatic cancer means that they then need to have a normal life expectancy and die of another cause 10, 20, 30 years later. So, of course, we hope that it’s going to result in cures but actually you can’t really say that because it’s too early. But let’s say that early indications are promising.”
As for Sandra Sayce, she is viewing the results of her treatment with great optimism and hope.
“It took me a couple of years to believe it was true,” she said. “You never quite lose that concern at the back of your mind, but there is no active disease and I have been stable for so long. My consultant said to all intents and purposes there is no reason why it would come back, but we are in territory where we don’t really know.”
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