National Cancer Meeting Highlights the Expanding Role of Immunology

June 19, 2018 | by Cary Presant, M.D.

Breakthroughs - Cary Presant 256x256 Cary Presant, M.D.
In early June, the world’s leading oncologists presented the most outstanding research from the past year at the annual 2018 meeting of the American Society of Clinical Oncology (ASCO) in Chicago. I was among the 40,000 oncologists who were impressed with how effective immunotherapy can be in some patients with cancer.

For example, lung cancer has been one of the most challenging cancers to treat. In the past three years, we have begun using drugs that unleash the body’s own immune system against many different types of cancers. But at ASCO 2018, new clinical trials were reported that added immunotherapy drugs (like pembrolizumab or nivolumab or atezolizumab) to standard chemotherapy and even biological therapy like bevacizumab. The results were impressive.

In various stages of widespread lung cancer, survival was increased when immunotherapy was added to chemotherapy by 25 to 35 percent. Response rates were higher and the length of remissions in patients was longer. Even some types of lung cancer, like small cell lung cancer, were shown to respond to immunotherapy, which had previously not been studied. Improvements by using immunotherapy were reported in many other cancers, including melanoma, lymphoma, leukemia, kidney cancer, bladder cancer and colon cancer.

Two studies suggested that the gut microbiome (those germs that inhabit our intestines) may be related to how well a patient responds to immunotherapy. As well, how many antibiotics a patient takes just before or during immunotherapy can reduce the benefits of immunotherapy.

Presant’s Key Takeaways from ASCO:
  • If you have cancer, always ask if immunotherapy is an option.
  • Ask if your tumor specimen has been tested for possible response to immunotherapy (tests like mutational tumor burden, microsatellite instability MSI or level of PD-L1) or response to targeted therapy (like ALK, ROS, EGFR) or if you need another biopsy.
  • Ask if your genetics led to your cancer, and if your blood or saliva has been tested for hereditary gene mutations.
  • Ask if you can limit your intake of antibiotics before and during your immunotherapy.
  • Make sure that all symptoms you develop during any therapy are immediately called in to your doctor or her or his nurses or assistants, since prompt therapy can increase survival and quality of life.
  • Ask if you qualify for a clinical trial.
Immunotherapy can be an important weapon in your fight against cancer, so be sure you discuss it with your doctor. Work with him or her to develop a plan that uses immune therapy along with surgery, radiation therapy, chemotherapy, targeted therapy, hormonal therapy, supportive therapy and clinical trial treatments where appropriate.
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Cary Presant, M.D., works in the Department of Medical Oncology & Therapeutics Research at CIty of Hope. He has been a practicing hematologist and medical oncologist in Southern California since 1979.

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