Thinking about a cure

I’m always disappointed when I hear about immunotherapy drugs like Keytruda and Opdivo, both approved for use in New Zealand but not yet funded by government agency PHARMAC.

They sounded like game changers a few years ago and do work for a few people. But unlike melanoma, head and neck cancer is not such a fairy story when it comes to these “checkpoint inhibitors”. Twenty percent of people will have a good response but this does not mean a cure. They might have a “complete response” for a while or a “partial response” or maintain stable disease.

Apparently the improvements Keytruda, for example, brings about are exciting for oncologists who look at the improvements in overall survival rate. But isn’t the average patient given only a few more months, not even years? Is it worth mortgaging your house or using up you life insurance to pay for a few below par months? I guess there’s that small hope of a complete response and certainly if it was a young person in my care I would go for it. Hope is precious. I’m thinking of the average head and neck cancer patient already battered by surgery, radiation and chemo and then having their life stretched out for a few months by a wonder drug that does not quite fulfil its promise yet.

Fortunately you CAN test to see if your tumour will respond to Keytruda. There are markers on a tumour that indicate a better response. These proteins are called PDI. If your tumour expresses more that 50% PD1 than your tumour is much more likely to respond.

The REAL hope lies further down the track I feel. I heard a young  researcher say this a couple of years ago and a Merck representative  said it yesterday. Keytruda could work well in combination with traditional chemo or with radiation. In lung cancer there is a 60% response rate with a combo of Keytruda and chemo. If one agent is only partly successful, then combine it with another agent.

Keyrturda and Opdivo (the Coke and Pepsi of the immunotherapy world) sound so magical. Technically they are able to stop cancer cells turn off the killer white cells in our immune system, the T-cells. The drugs can stop this from happening and the T-cells can then attack the cancer cell, knocking them back a bit or for some people in some cancers, knocking  them right out.

So it’s good news that New Zealand will probably start funding the two drugs in the next year or so. For a few patients they could be the game changer we all so desperately want but for me the hope lies in the future, in combinations.