Immunotherapy Works For Some, But Not For All

By Jennifer Ball

The premise of immunotherapy treatment for cancer is that it uses the body’s own immune system to attack cancer cells with the vigor it attacks other diseases. We talked to Dr. Al Benson, professor in hematology/oncology at Northwestern University Feinberg School of Medicine, who is involved in immunotherapy trials. He just finished a clinical trial in pancreatic cancer, and is now studying esophagogastric and colorectal cancer.

The concept behind this treatment has been around for a while. More than thirty years ago, Dr. Benson was involved with a study autologous tumor vaccines for colon cancer, where they took cells from the tumor and manufactured a vaccine to give back to patients. The clinical trials it entered were negative, but it just shows that these ideas have been around for a long time. The true promise of immunotherapy is a relatively new finding, but it doesn’t work for everybody.

“What’s been very exciting is, though incomplete, our knowledge of the immune system is increasing,” Dr. Benson said. “There are now drugs that can affect the immune system. We are seeing patients that are deriving considerable benefit including control for much longer periods of time. There’s still a tremendous amount of work to do. Not everybody is benefiting from this therapy.”

Dr. Benson said that cancers with large numbers of mutations, true for melanoma and a rare subset of colon cancer, can be especially responsive to immunotherapy treatment. But there also may be tumors where this treatment is not as effective. Researchers can try to make these tumors more sensitive to the treatment. “There’s a lot more work that needs to be done,” he said.

There are a number of clinical trials being conducted on the topic at Northwestern University. They are looking for people who would benefit from the treatment. For people who want to get involved in a clinical trial, Dr. Benson said talk to your clinical team about potential trials you may join. It’s important to ask the question.

Another interesting area of cancer research is genomic profiling. Researchers look for drugs that may be a match to their patients’ genetic profiles. “It’s not just immunotherapy, it’s targeted therapy,” Dr. Benson said. “Many people refer to it as personalized medicine. There’s growing number of clinical trials that do that.” However, they might not always find a match for a patient in these trials either.

Patients and clinicians are increasingly concerned about cost of treatment, Dr. Benson pointed out. There are combinations of some drugs that could amount to well over $200,000 a year. “For some individuals, that may mean they have no possible access to that drug,” he said.

For society, it’s increasing the cost of treatment exorbitantly. As a society, many people are asking whether we can afford that cost. “These treatments are such that people may need to stay on them for long periods of time to control their disease,” he said.

In the news, you may read about the rising cost of healthcare premiums. This will place a greater burden on patients seeking care. It jeopardizes health care for many people, Dr. Benson said. As we develop new drugs, they are all expensive, including those for immunotherapy and targeted therapy. There are drugs that cost $10,000 a month or more. “There’s this tension for developing new drugs that are good for some individuals, but it’s coming at a high cost,” he said.

This is putting more pressure on doctors in selecting the right patients for trials. With the high cost, researchers don’t want to chance that it won’t work. There are also side effects that researchers don’t want to expose patients to if the treatment won’t work. “We’re trying to identify truly personalized approaches,” Dr. Benson said. “There are examples where we can do this now, but it’s not where we need to be.”

It is very encouraging that we are developing treatments, such as immunotherapy and targeted therapy. But we need to do more research to increase this understanding. All of these strategies have come about because of clinical trials. “At the same time, we have to generate far better strategies to benefit the cost of care,” he said. “If we don’t there will be many many people who will not have access to these therapies.”