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Editor's Letter

The Promise of Immunotherapy

By Kevin McLaughlin

When Science magazine named cancer immunotherapy the “Breakthrough of the Year” in 2013, it was with some trepidation. Staff writer Jennifer Couzin-Frankel of Science wrote that selecting cancer immunotherapy was “a topic of internal debate, even anxiety” among her colleagues.

​Kevin McLaughlin / Photo by Vera LaMarche
 
“In celebrating cancer immunotherapy—harnessing the immune system to battle tumors—did we risk hyping an approach whose ultimate impact remains unknown?” Couzin-Frankel wrote. “Were we irresponsible to label as a breakthrough a strategy that has touched a tiny fraction of cancer patients and helped only some of them?”

In the end, the magazine—which covers all kinds of science, not just life science or medicine—concluded that cancer immunotherapy “passes the test” as a breakthrough, citing clinical trial data showing positive outcomes and anecdotal evidence revealing remarkable results.

Among the immunotherapy successes is a patient whose story is recounted by Cancer Today writer Alexandra Goho. Roslyn Meyer was diagnosed with stage IV melanoma in 2005, and by 2008, the cancer had spread throughout her abdomen. Meyer had enrolled in a cancer immunotherapy clinical trial at the National Cancer Institute that was testing a form of the treatment never before tried on humans. “But I also understood that I was dead if I didn’t have it,” she says of the therapy, in which immune system cells called T cells were removed from her body, grown by the billions in a lab, and infused back into her body to fight her cancer. By March 2009 she had no signs of cancer and has remained that way for five years.

Meyer’s treatment, called adoptive immunotherapy, is just one method researchers are investigating for turning the immune system against cancer. The drug Yervoy (ipilimumab), approved by the U.S. Food and Drug Administration in March 2011 for patients with metastatic melanoma, uses another approach. It binds to a protein called CTLA-4 that puts the brakes on T cells in the immune system. Once Yervoy disables the brakes, the T cells are unleashed to destroy melanoma cells. Other drugs in the immunotherapy pipeline target additional proteins that also can block 
T cell activity.

In her Science column, Couzin-Frankel noted that so far immunotherapy has benefited only a small fraction of cancer patients. The three traditional pillars of cancer treatment—surgery, radiation therapy and chemotherapy—are still the go-to treatments for most patients. But the promise of immunotherapy may be fulfilled for more patients by combining immunotherapies or by using immunotherapy in tandem with traditional cancer therapies.

Oncologist Drew Pardoll thinks treating cancer through immunotherapy has reached a turning point. Writing in 
the AACR Cancer Progress Report 2013, Pardoll—the director of cancer immunology at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Medicine in Baltimore—adds molecularly targeted therapies as a fourth pillar of treatment, and goes on to say, “I have such confidence in the potential of immunotherapy that I think the years from 2010 to 2015 will be looked at historically as the time that immunotherapy became the fifth pillar of cancer treatment.”

These advances in treating cancer are real and exciting, but if they are to become widely available, more research is needed. Funding for biomedical research should be “a national priority,” says oncologist Charles L. Sawyers, the 2013-14 president of the American Association for Cancer Research and the chair of the Human Oncology and Pathogenesis Program at Memorial Sloan Kettering Cancer Center in New York City. Congress took a step in the right direction by rolling back the sequester—the mandatory cuts in federal spending in 2013—and restoring some of the biomedical research funding lost last year in the 2014 federal budget. But it’s not enough.

This year many legislators are up for re-election. If you think cancer research that leads to breakthroughs like immunotherapy is important and should be supported by the federal government, now is a good time to hold candidates’ feet to the fire. Contact legislators running for re-election and their opponents and let them know your vote will depend on whether they consider federal funding for biomedical research a national priority.

03/28/2014
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