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Immunotherapy transforms lung cancer, the biggest cancer killer

Combinations, pre-surgery treatment both help stop cancer spread

Immune therapy drugs can transform lung cancer treatment, giving patients years of extra life, doctors reported Monday.

They found that pre-treating lung cancer patients with immune therapy drugs before they have surgery can help melt away the tumor and at the same time limit or even stop its spread.

And combinations of immunotherapy drugs have helped other lung cancer patients get off more toxic standard chemotherapy while also extending their lives.

The results are so startling that it is likely every lung cancer patient should be given the option of immunotherapy first, said Dr. Roy Herbst, a lung cancer specialist at Yale Cancer Center who was not involved in the studies.

“I have never seen progress move so fast,” Herbst told NBC News.

“The results today are really a paradigm shift. They will mean more lung cancer patients getting immunotherapy up front.”

Immunotherapy helps the body’s immune system fight off cancer through a variety of mechanisms: by boosting immune system activity, uncloaking tumor cells and with the use of engineered immune system proteins that very specifically target tumors.

They include the new class of drugs that appear to have stalled former President Jimmy Carter’s melanoma.

The drugs had been shown to help lung cancer, the No.1 cause of cancer death globally and in the United States.

And the new results, released at an American Association for Cancer Research conference in Chicago and published in the New England Journal of Medicine, show more creative use of the drugs could change the way doctors treat lung cancer.

Donna Fernandez, now 64, of Dallas, TX says she is alive thanks to immunotherapy cancer drugs.
Donna Fernandez, now 64, of Dallas, TX says she is alive thanks to immunotherapy cancer drugs.Bill Arscott / American Association for Cancer Research

In one study, a team at Johns Hopkins medical school treated 20 patients with one of the immune therapy drugs before they had surgery to remove lung cancer tumors.

A year later, 16 patients were alive and the cancer was still undetectable. Two more had their cancer come back but now have no symptoms after extra treatment. One died of lung cancer and one died of an unrelated head injury. So a year and a half later, 18 of the lung cancer patients are still alive.

“I have never seen progress move so fast."

It was a small study but it shows the immunotherapy drugs can help patients straight away, Herbst said. Until now, because the drugs are new, they’re usually used most in patients with advanced cancer.

The immunotherapy drug — in this case it was the one called Opdivo — starts killing the tumor by breaking it up, releasing small pieces that stimulate a broad immune response.

“When the surgeons open the patients, they see the tumor almost melting away. That is extraordinary,” Herbst said.

“It eats it away like a Pac-man. It probably creates a roller coaster of immune response.”

These newly activated immune cells can move through the body, attacking the little bits of tumor that can cause metastasis, Herbst said.

“It is amazing news for patients with this disease,” he said.

The news is not all good. Not all patients are helped by the drugs and they are very expensive, costing more than $100,000 for a course of treatment.

And no one can say how long these patients will live before their cancer comes back. "I don’t use the term cure until you survive for 10 years," said Dr. Drew Pardoll of Johns Hopkins, who led the study that used the immune therapy pre-treatment.

In another study, combinations of immunotherapy drugs with standard chemotherapy doubled survival in lung cancer patients.

Dr. Leena Gandhi of the Perlmutter Cancer Center at NYU Langone Health and colleagues treated more than 600 lung cancer patients with standard chemo plus either a placebo or Keytruda, one of the immunotherapy drugs.

"They gave me four months to live and here I still am."

Those who got Keytruda plus chemo were 51 percent less likely to die than those who simply got the chemo, Gandhi’s team reported. About 69 percent of patients who got Keytruda were alive a year later while just 49 percent of those who got chemo alone were.

“Just a few years ago it was rare for patients with advanced lung cancer to live past two years. Now it is becoming more common to live past that point even with advanced lung cancer," said Dr. John Heymach, who chairs the lung cancer division at the University of Texas MD Anderson Cancer Center.

"Advanced lung cancer is no longer a death sentence for these patients."

The Keytruda-chemo combination was approved by the Food and Drug Administration last year.

Another study team tried combining two immunotherapy drugs: Opdivo and Yervoy.

Dr. Matthew Hellmann of Memorial Sloan Kettering Cancer Center and colleagues found that 43 percent of the patients who got the combination got an extra year of life without the cancer worsening, compared to 13 percent of those on standard chemo.

The American Cancer Society projects about 234,030 new cases of lung cancer will be diagnosed in the U.S. this year, and about 154,050 Americans will die from it.

Donna Fernandez of Rowlett, Texas, is alive thanks to immune therapy for her lung cancer. She was diagnosed with stage 4 lung cancer at age 59 and thought she was doomed because her father had died of lung cancer.

Fernandez, 64, tried chemo and hated it. “Chemo is not for the faint of heart,” she told NBC News.

“There was a time when I thought it was maybe not worth it any more,” she said.

“I was only sick for one week out of the three-week cycle. But that one week was horrible. I threw up and the fatigue is just unreal.”

Then in 2013 Fernandez was treated with Opdivo.

“It was like night and day,” she said. “I could go back to just about my regular activities again. I was never sick.”

Fernandez is not cured but she feels well and is using her extra time to enjoy time with her husband of 43 years, her son and her 88-year-old mother and to advocate for lung cancer research. She is headed to a rally in Washington later this month.

“They gave me four months to live and here I still am,” she said.