Harnessing T Cells to Beat Lung CancerBy
Until recently, there wasn’t much science could do for someone like Kaye Paterson. A social worker who lives outside Pittsburgh, Paterson first noticed a persistent cough in 2007. She was 27, had never smoked, and was otherwise in good health. “I never in a hundred thousand million years thought it was cancer,” she says. Her doctors didn’t either: It took them four years to make the correct diagnosis, and by then her lung cancer had spread. The prognosis was grim: Only 1 percent of those diagnosed in Stage IV live as long as five years.
In November, Paterson began treatment as part of a clinical trial for a new class of drugs called immunotherapies. Such drugs don’t target the cancer directly. Instead, they help the body’s immune system fight tumors, often by attacking the proteins that disguise the disease from T cells. The high expectations surrounding immunotherapies have sparked dealmaking in the pharmaceutical industry. A Dec. 29 report from Leerink Partners, a boutique investment bank that specializes in health care, estimates sales could reach $40 billion a year at their peak. Pfizer’s $117 billion bid for AstraZeneca was fueled in part by its desire to get its hands on MEDI4736, a lung cancer drug that’s undergoing Phase III trials. Rebuffed by Astra in May, Pfizer struck a deal with Merck KGaA worth as much as $2 billion for the rights to its immunotherapy drug, which is being tested on a rare skin cancer. So far only three immune treatments have been approved in the U.S., all for advanced melanoma.
Those three drugs—Yervoy and Opdivo from Bristol-Myers Squibb and Keytruda from Merck & Co.—are being tested on other cancers. The clinical trial Paterson is enrolled in combines two treatments.
Lung cancer killed 1.6 million people globally in 2012—more than liver and stomach cancers, the next two most fatal cancers, combined, according to the World Health Organization. The high fatality rate leads to what scientists call therapeutic nihilism. “Every oncologist has had lung cancer patients come in saying that their doctor told them to go home and get their affairs in order,” says Joan Schiller, chief of medical oncology at the University of Texas Southwestern Medical Center in Dallas.
Because many people believe the disease is self-inflicted, lung cancer lags behind other cancers in research funding. “Everyone says, ‘I didn’t know you smoked,’ ” Paterson says. The National Institutes of Health allocated $885 million to lung cancer research from 2010 to 2013, less than a third of what was targeted for breast cancer.
The most effective treatment for lung cancer is surgery, but that’s an option only when it’s caught early. For those in the late stages of the disease, the best hope is that genetic tests reveal their tumors can be treated with medicines that target anomalies in specific cells. These targeted drugs work in no more than a third of lung cancer patients. Also, their effectiveness tends to wear off, says David Gilligan, a British oncologist and a trustee of the Roy Castle Lung Cancer Foundation. “The new immunotherapies do represent a major advance,” Gilligan says, though he cautions the drugs are so new that no one knows how effective they will prove over the long term.
While Paterson waits to see the results of the latest treatment regimen, she’s spending time with her friends and family and trying not to think about the future. “If I focus on that, I won’t be able to enjoy the stuff I do have and the time I have with the people I care about,” she says. “I know what the outcome is likely going to be.”
The bottom line: Drugs that help the immune system battle melanoma are being tested on lung cancer patients.