March 30, 2015 | by Sumanta Kumar Pal M.D.
Karen Reckamp, M.D., M.S., has an office next to my own, and we often see patients at the same time. As such, I’ve gotten to know her quite well over the years, and I’ve also gotten a glimpse of many of her patients.
She specializes in lung cancer, and most of her patients have tumors that have spread widely to the bones, brain and other sites (termed “advanced,” or “metastatic,” disease). When I first started in the field about a decade ago, her patients had a characteristic appearance – weak and debilitated by chemotherapy, and dejected by a grim prognosis.
Now, things have changed.
Reckamp, co-director of the Lung Cancer and Thoracic Oncology Program, has been at the forefront of a number of lung cancer clinical trials that have had a marked impact on survival, meaning her patients have benefited from new therapies before they’ve become available to the general patient community. These clinical trials frequently involve drugs that more selectively target cancer tissue and spare normal tissue, enhancing effectiveness while limiting toxic side effects. This has had a palpable effect on what I observe in her clinic – her patients appear to be enjoying a far better quality of life than in years past.
One clinical trial that has generated a great deal of buzz in the lung cancer community involves a drug called nivolumab; Reckamp was one of the lead investigators in the study of the compound. Positive results culminated in the Food and Drug Administration approval of nivolumab for a specific type of lung cancer termed squamous cell cancer. Nivolumab is emblematic of many newer cancer therapies that are emerging in the clinic, with limited side effects but dramatic tumor reductions in many patients.
In short, the drug works by keeping the patient’s immune system primed to fight cancer. As with anything in nature, the immune system has built-in checks in place that would otherwise quell the anti-cancer immune response. Nivolumab works at those precise checkpoints and, is therefore, one of several agents referred to as “checkpoint inhibitors.”
“By activating a person's own immune system against the cancer, tumors can be killed, and this is done without chemotherapy,” Reckamp said. “An important aspect of this therapy is the potential long-term benefit when the immune system can reactivate to block cancer growth and progression.”
The term “long-term benefit” has been absent from nearly all previous dialogues regarding treatments for advanced lung cancer, a disease for which the average survival is roughly one year. Reckamp is currently involved in designing the next generation of clinical trials that will incorporate drugs like nivolumab. “Our goal now is to extend the benefit seen with nivolumab to a greater proportion of patients with lung cancer,” she notes.
From my perspective as an observer in her clinic, I would suggest she is heading in the right direction.
** Sumanta Kumar Pal, M.D., is an assistant clinical professor in the Department of Medical Oncology & Therapeutics Research and co-director of the Kidney Cancer Program at City of Hope.
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