Cancer Coup

High Hopes for Immune Therapy

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Cancer killed 8.2 million people worldwide in 2012 and 22 million new cases a year are expected by the 2030s. That’s why even cautious scientists are so hopeful about immune therapies, new drugs that harness the body’s defense system to attack cancer cells. While forms of the treatments have been around since the 1980s, they once worked against just a few malignancies, and with serious risks to patients. New immune therapies can target a wide range of cancers, including tumors of the lung, kidney and bladder. The drugs allow immune systems to store information that may prevent recurrences, and some disable mechanisms that foil natural cancer defenses. The potential: a long-lasting treatment for difficult cancers that can enhance existing treatments. The market for the drugs could reach $40 billion a year.

The Situation

The U.S. Food and Drug Administration has in the last year approved a number of immune therapies, particularly in a new class called checkpoint blockers. Merck’s Keytruda has shown promise fighting advanced melanoma, a skin cancer that typically kills most of its victims within a year of diagnosis.  In a study in which 279 patients took the drug every two weeks, 74 percent survived a year or longer. In another study of patients with lung cancer, a much more common form of the disease, Opdivo, a drug developed by Bristol-Myers Squibb, prolonged survival by 3.2 months compared with a chemotherapeutic drug. Keytruda and Opdivo target the protein PD-1, which acts as a switch that shuts off cells that attack cancers. Other immune therapies work by supercharging the body’s cancer-fighting T-cells. Ultimately, the most successful treatments may be combinations of the drugs. In a recent trial, Opdivo paired with Yervoy, a Bristol-Myers immune treatment approved in 2011, stopped melanoma from progressing for almost a year on average, better than seven months for Opdivo alone.

Source: World Health Organization
Source: World Health Organization

The Background

Science first stumbled across the human body’s natural cancer defenses in the 19th century, when doctors noticed tumors shrinking after patients developed infections. Experiments in stimulating antibodies to fight cancer weren’t promising, so radiation, then chemotherapy, became the favored treatments despite sickening side effects. An early immune-therapy drug, Interleukin-2, was approved in 1992 and slowed growth in melanomas. But the drug produced aches, nausea, diarrhea and even heart attacks and strokes, so patients had to be kept in the hospital for treatment. As scientists learned more about the human genome, medicines were developed that could target parts of the body without damaging the rest. The current fascination with immune therapies was triggered in 2012, when Bristol-Myers presented data that Opdivo could treat patients with lung and kidney cancer, as well as melanoma.

The Argument

The therapies are so new, no one knows how effective they will be at preventing relapses. They don’t work in every patient. So far, they’ve only been proven effective for advanced forms of cancer, so it’s possible they won’t work in earlier stages. Costs may also be an obstacle to widespread use. For Yervoy, Bristol-Myers charges $30,000 per injection in the U.S. — a total treatment costs $120,000 — and the drug has serious side effects. There’s also the lesson of history: Cures for cancer have been predicted before, only to disappoint. Among notable examples are the angiogenesis drugs of the late 1990s, which some experts predicted would end cancer in two years. Some of those drugs, which restrict blood flow to tumors, are in use today but the cure for cancer remains elusive.

The Reference Shelf

  • The New Yorker published a history of immune therapy in 2012 by Jerome Groopman, a Harvard Medical School researcher.
  • The American Cancer Society has a primer on immune therapy.
  • Bloomberg News reported in June about recent advances.
  • Dr. Siddhartha Mukherjee examined the history of cancer and its treatment in a Pulitzer Prize-winning 2011 “biography,” “Emperor of All Maladies.”

First Published July 3, 2014

To contact the writer of this QuickTake:

Oliver Staley in London at ostaley@bloomberg.net

To contact the editors responsible for this QuickTake:

Jonathan I. Landman at jlandman4@bloomberg.net

Lisa Beyer at lbeyer3@bloomberg.net