When Your Immunotherapy Stops Working

When Your Immunotherapy Stops Working

Immunotherapy is a new and different treatment option for people living with advanced lung cancer. It helps your body’s immune system better find and destroy cancer cells, even when they try to hide. The breakthrough therapy is helping some people with hard-to-treat cancer feel better and live longer.

But it doesn’t work for everyone. Currently approved drugs for lung cancer only help 1 out of 5 people. Scientists are hard at work to find new treatments to help more.

If you or a loved one is scheduled to have lung cancer immunotherapy, you need to know the key warning signs of treatment failure and what to do if they occur.

How Do You Know It Isn’t Working?

Three immunotherapy medicines, called checkpoint inhibitors, are FDA-approved for lung cancer: atezolizumab (Tecentriq), nivolumab (Opdivo), and pembrolizumab (Keytruda).

No one can tell you how well these treatments will work for you. There’s no blood test or other method to predict if the drug will shrink your tumor or make you feel better. However, there are some signs that it isn’t helping.

Tell your doctor if you have:

  • Cough
  • Pain
  • Trouble breathing
  • Any other symptoms that concern you

They may be a sign that your cancer is getting worse, or they may be side effects of treatment. Only a doctor can tell the difference. However, pain is rarely a side effect of lung cancer immunotherapy treatment.

Side effects don’t mean the medicine isn’t fighting your cancer — but a severe reaction can be life threatening and may require you to stop treatment. Serious side effects are rare, but include inflammation of the lungs (pneumonitis), liver, kidneys, intestines, and other parts of the body.

When the Cancer Looks Worse but Isn’t

Your doctor will order CT scans of your tumor to keep track of it and make sure your treatment is working.

Your cancer might look worse on the first CT scan after your start immunotherapy. But it may really be getting better. Doctors call this “pseudoprogression.“ It doesn’t mean the drug isn’t working. Immunotherapy causes your immune system to attack cancer cells. The rush of helper immune cells can cause your tumor to swell and look bigger. The report may say your cancer has progressed, when it really hasn’t.

Your doctor will review your scans and discuss your symptoms. She’ll decide if your treatment is really working and your cancer is stable.

  • If the scan shows a larger tumor but there are no new areas of cancer and you feel OK, it may be pseudoprogression. Doctors usually suggest you wait two or three more treatment cycles (about 2 months) then get another scan.
  • If you feel worse and the scan shows a larger tumor and new lesions, immunotherapy likely isn’t working. The doctor will recommend you stop it and try something else.

Other Treatment Options

If immunotherapy doesn’t work, you and your doctor will discuss other ways to treat your cancer. These include:

  • Chemotherapy
  • Targeted drug treatments

If these options also fail, your doctor may suggest you to take part in a clinical trial. They provide access to cutting-edge immunotherapy treatments that aren’t yet approved for lung cancer. These include other checkpoint inhibitors, therapeutic vaccines, and adoptive T-cell transfer.

If nothing helps at all, it may be time to ask your doctor if it’s time to stop treatment and start hospice and palliative care to ease your symptoms and make you feel better. An honest discussion will help you and your family make the most of every day.


New Cancer Drug Is So Effective Against Tumors, the FDA Approved It Immediately

A small but significant new study is blowing experts away after it found that a particular cancer drug overwhelmingly helped shrink or eradicate tumours in patients whose cancer had resisted every other form of treatment.

The study, which was published in the journal Science, followed 86 patients who had advanced cancer of the pancreas, prostate, uterus, or bone.

The patients were given pembrolizumab, which also goes by the brand name Keytruda, and the results were very promising.

Sixty-six patients had tumors that shrank significantly and stabilized, among them 18 patients whose tumours disappeared and haven’t returned.

The patients all carried genetic mutations that kept their cells from fixing damaged DNA.
Pembrolizumab is known as a PD-1 blocker, an emerging type of immunotherapy drug that helps the immune system find cancer cells and attack tumours.

The study was small, and there was no control group (i.e., a group that didn’t receive pembrolizumab that scientists could compare results against), but the results were so striking that the US Food and Drug Administration, or FDA, has already approved pembrolizumab for patients whose cancer comes from this particular genetic abnormality.

According to the New York Times, this is the first time a drug has been approved for use against tumours that share a particular genetic profile, regardless of where they appear in the body.

Dr Jack Jacoub, a medical oncologist and director of thoracic oncology at MemorialCare Cancer Institute at Orange Coast Memorial Medical Center in Fountain Valley, California, told Yahoo Beauty that the study was “interesting, welcomed, and exciting.”

There has been a general opinion that the immune system is integral in the development and spread of cancer and these new findings show that targeting the immune system to treat cancer can be effective.

“To finally see now proof that targeting the immune system improves the situation and doesn’t necessarily correlate with one specific cancer … that’s a really powerful message,” Dr Jacoub said.
Dr Jacoub also points out that the FDA’s move to approve pembrolizumab quickly was a big step.
“The FDA doesn’t take these kinds of things lightly,” he said. “The data was so good, they had to approve it.”

Dr Jacoub says he suspects that drugs like this will be used in the future in connection with more established cancer treatments for specific types of the disease.

“This may improve outcomes,” he said.

“This form of therapy, plus something else, may allow us to potentially cure and eradicate cancer. These are the steps that are getting us closer to that goal.”

risk for melanoma

This is why redheads are more at risk for melanoma

It’s been acknowledged for some time that people with red hair and fair skin are more likely to develop skin cancer. But for the first time, medical researchers have uncovered the reason behind this connection, as well as a possible prevention plan.

Investigators from Boston University School of Medicine (BUSM) proved that MC1R (melanocortin 1 receptor) — the protein involved in pigmentation — is affected by a modification process called palmitoylation. But the researchers found that enhancing palmitoylation in MC1R proteins —demonstrated in a lab experiment using molecules and ultraviolet light — was shown to reduce risk of melanoma.

“We hope our study allows for the development of a pharmacological prevention strategy for red-headed people to protect their skin and let them enjoy the sun like other people,” said Dr. Rutao Cui, professor of pharmacology and dermatology at BUSM, said in a press release.

Making up 1 percent to 2 percent of the world’s population, redheads carry variants of MC1R, which increases their risk of skin cancers — the most dangerous being melanoma. According to estimates from the American Cancer Society, about 87,110 new cases of melanoma will be diagnosed (about 52,170 in men and 34,940 in women) in the United States in 2017. Rates of melanoma have been rising for the last 30 years, and while it accounts for only about 1 percent of skin cancers, it is responsible for a large majority of skin cancer deaths.

“This is very exciting!” Shannon Trotter, a dermatologist who specializes in melanoma and skin cancers at The Ohio State University Comprehensive Cancer Center, tells Yahoo Beauty. “Research that focuses on prevention and reducing melanoma risk is much needed. This study is promising, but more research will be needed to see how we can put this into practice.”

Trotter explains that palmitoylation is a special process where proteins are changed by adding fatty acids. “This can affect the function of a protein in the body and have an impact on how our cells function,” she explains.

Jack Jacoub, MD, medical oncologist and medical director of MemorialCare Cancer Institute in Fountain Valley, Calif., tells Yahoo Beauty that both cancer cells and normal cells have different pathways that are actively in progress.

“And palmitoylation is one of those pathways,” he states. “This is a pathway that is also being investigated in other types of cancer-related therapeutics, just like other pathways are being investigated. But the researchers in this study took it one step further. Mitigating or reducing the risk is the big message — it’s very interesting.”

Trotter adds that because palmitoylation is a chemical process, “we might be able to use a medication that enhances its function to have a desired effect.”

Jacoub agrees, but believes a one-a-day prescription in the name of prevention could be a “very hard sell.”

“It’s going to have to be, I imagine, some dietary influence or environmental influence that can be changed,” he concludes. “Or it may be a limited intervention that will have a long-term effect against risks.”