Norman Kaye’s story
While taking platinum-based chemotherapy for his lung cancer, Norman Kaye would joke that it gave him as much platinum inside his body as his wife had in her jewelry.
“My way of dealing with this cancer has been through a lot of positive attitude, and a lot of humor,” says Kaye, 63, of Wernersville, Pennsylvania.
When Kaye’s body could no longer tolerate chemotherapy and radiation, and “the chemo was not being effective,” he went to Lancaster General Health’s Ann B. Barshinger Cancer Institute. There, he conferred with Dr. Samuel J. Kerr, MD, hematologist-oncologist with LG Health Physicians Hematology and Medical Oncology, whose areas of expertise include small cell and non-small cell cancer of the lung, mesothelioma and thymoma.
Sifting through the choices, both patient and doctor chose to enter Kaye in a Bristol-Myers-Squibb trial for Opdivo, now an FDA-approved immunotherapy drug whose commercials promise some lung cancer patients “a chance to live longer.”
Immunotherapy’s side effects paled in comparison to the brutal hair loss, burned skin and lost fingernails Kaye endured from traditional treatment. Plus, intravenous delivery took less than an hour once every two weeks.
The latest tests showed that spots on Kaye’s lungs weren’t vanishing, but they weren’t growing, either.
“It’s prolonged my life by stopping cancer from spreading,” he said. “Has anybody told me it’s going to cure my cancer? No. On the other hand, I’ve had doctors’ opinions say I could live with spots for the next 40 years.”
Kaye, a retired auto dealership general manager, and his wife, Mary Ellen, try to “live life to the fullest.” While in the Opdivo trial, he got permission to miss a cycle so he could build energy for a snorkeling vacation in Honduras.
Kaye even wrote a poem for his doctor, clinical trials coordinator Krista Budzik, and all the Barshinger staff who are “absolutely positively wonderful at taking their time and making sure you understand what’s happening.”
“So to Dr. Kerr, Krista and staff,” he rhapsodized, “All I want to say is, due to all your magic, I’m still here for many more days!”
The promise of immunotherapy
For Dr. Joseph J. Drabick, there is the spry, 88-year-old farmer whose body was riddled with cancer.
“I’ve had patients who were eaten alive by cancer and took the immunotherapy drugs, and all the disease is gone, and that was years ago,” says Drabick, Professor of Medicine at Penn State Hershey Cancer Institute.
For Dr. David L. Bajor, it’s the medical student diagnosed with terminal melanoma who participated in an immunotherapy trial in 2005 and is, today, alive and well.
“In some cases, we’ve seen amazing things,” says Bajor, Instructor of Medicine in the division of Hematology/Oncology at Penn’s Perelman School of Medicine. “In some, we’ve seen cures.”
“Immunotherapy is a way of helping your body eradicate cancer using its own means,” says Bajor. That doctors can dare to speak the words “cancer” and “cure” in the same conversation demonstrates the groundbreaking potential of directing a patient’s immune system to contain and even eradicate cancer.
Still, doctors warn that research has a long way to go. Scientists don’t entirely understand the mysterious relationship that can prompt the immune system to call off an attack or empower cancer cells to put up their defenses.
A manageable condition
Bajor is striving to “make it so that pancreatic cancer isn’t a death sentence anymore.” Drabick studies cancers of the skin and kidneys, seeking those combinations and approaches that offer hope where there was little hope before. With immunotherapy, some cancers could become manageable, they agree.
A majority of patients still don’t get a response in terms of cancer eradication, but “they float along on the stability of their disease,” says Drabick.
“That’s a good thing in cancer if you’re stable, and things aren’t getting worse and you feel good,” he says. “We’re okay with that, but some patients can have dramatic responses, and I’ve seen them.”
Where to next?
Major new initiatives are seeking the clues to determining which patients are likeliest to respond to immunotherapy.
“If we know ahead of time that a patient won’t respond, we can find something else to offer,” says Bajor. “Similarly, with what we know about the biology of cancer and the patient, can we say there’s an extremely high chance that a drug or combination is going to cause a tumor to shrink? That’s what personalized medicine is.”
Doctors and researchers are “optimistic that immunotherapy is going to help many, many people, and that’s really satisfying,” says Bajor.
Fast Facts: What is Immunotherapy?
The immune system is meant to attack illness and disease, but it doesn’t always recognize cancer as an invader. Major advances in research are now harnessing the body’s own power to defeat or contain cancer.
Immunotherapy takes many forms. Checkpoint inhibitors release “brakes” that sometimes halt the immune system from working. Monoclonal antibodies deploy manmade immune system proteins to attack specific parts of cancer cells. Immune system modulators encourage the immune system to enhance its response to cancer. Vaccines marshal the body’s forces to fight cancer cells.
One vaccine approved for prostate cancer injects patients with an adaptation of their own DNA. Drabick is waiting for results of Penn State Hershey research into a patient-specific vaccine for metastatic kidney cancer.