Making Advanced Cancer a Chronic Disease

“CANCER SPREAD” HAS SUCH dreadful implications. Having helped individuals with cancer for over three decades, discussions around metastases still shake me.

Fortunately, age-adjusted death rates are falling globally. Death rates show a 17 percent decline from 1990 to 2016. Today we look at some advances in the management of advanced breast and melanoma cancers that have spread to distant sites of the body.

Breast cancer

Let’s be clear: When breast cancer has spread to distant organs (such as the bones, lung, liver, or brain), the disease is not currently curable. What has me excited this morning is a recent report about long-term survival for two subtypes of breast cancer. Let’s get right to the results:

Patients with two of the three major types of advanced breast cancer now have a median overall survival of at least 5 years, which is roughly a doubling of survival time over the past decade.

The two types of advanced breast cancer for which survival times have doubled over the past decade are HER2-positive (HER2+) breast cancer and ER-positive (ER+) breast cancer. HER2-positive means that the cancer cells have a particular protein sticking out like antennae.

Individuals with HER2-positive disease represent about 25 percent of patients with metastatic breast cancer and now commonly live as long as ten years. Doctors can use drugs that target the HER2 pathway that drives cell growth and division. The best-known of these is trastuzumab (Herceptin).

For those of you who would like to hear more about Herceptin, try this book:

Her-2: The Making of Herceptin, a Revolutionary Treatment for Breast CancerAmazon.com: Her-2: The Making of Herceptin, a Revolutionary Treatment for Breast Cancer eBook: Bazell, Robert

To see a film representation of the passionate and inspiring story of Dr. Dennis Slamon, the UCLA (USA) doctor who helped develop the breast cancer drug, Herceptin, try this:

Living ProofTop-rated Lifetime movie! Dr. Dennis Slamon has reached a breakthrough in his career. He has helped to develop a new…

Over half of the patients with advanced-stage melanoma, treated with two immunotherapy drugs, will be alive for more than five years. Photo by Amanda Dalbjörn on Unsplash

Melanoma

You may have heard about the revolutionary cancer management tool known as immunotherapy.

A group of investigators from around the world reported the results of using a combination of two immunotherapy drugs for advanced melanoma. Following treatment with nivolumab and ipilimumab drugs yielded a more prolonged progression-free survival and overall survival than with only one immunotherapy drug.

Striking to me are the long-term outcomes:

At a minimum follow-up of five years, the median overall survival was more than five years (median not yet reached) in the group that received two immunotherapy drugs in combination. Over half of patients with cancer spread to distant sites were still alive at the five-year mark.

Chronic disease survivors. Former United States President Jimmy Carter presented with advanced melanoma — his disease had spread to his brain. You know the rest of the story: First, doctors bombarded his cancer in the brain with a highly focused, high-dose radiation therapy known as radiosurgery.

The high-dose radiation therapy damaged the cancer cells in the brain. These dying cells then released substances into the bloodstream, attracting the attention of immune cells.

Carter then received immunotherapy; more specifically, he got a drug known as pembrolizumab (Keytruda). Three months after immunotherapy, the then-91-year old discovered that his tumors were gone. The drug supported his immune system’s response and appears to have completely eliminated any residual cancer.

More than five years later, President Carter has no evidence of cancer remaining. If you want to learn more about immunotherapy, please go here:

What is Immunotherapy?As of October 2021, the U.S.www.cancerresearch.org

You will not be surprised to learn that the 2018 Nobel Prize in Physiology or Medicine was awarded jointly to two cancer immunotherapy researchers, James P. Allison, Ph.D. of The University of Texas MD Anderson Cancer Center, and Dr. Tasuku Honjo of Kyoto University in Japan.

The Nobel Prize committee honored Allison and Honjo for their work on uncovering ways to activate the immune system to attack cancer.

Thank you for joining me today in exploring the promise of targeted therapy and immunotherapy in the management of advanced cancer.

PATIENT ADVISORY

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The article lives here: CancersMaking Advanced Cancer a Chronic Disease
Michael Hunter, MD
I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.
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