Transcription:
Immunotherapy at Maimonides Cancer Center

Caitlin Whyte (Host): Immunotherapy is critical to cancer care. So, in this episode, we are joined by Dr. Kevin Becker, the Division Chief of Hematology and Medical Oncology to talk about the care options here at Maimonides Cancer Center. This is Maimo Med Talk. I'm your host, Caitlin Whyte. Now to start us off, Dr. Becker, what is immunotherapy?

Kevin Becker, MD (Guest): So, immunotherapy is our drugs that try to help a patient's own immune system to fight the cancer. Probably the types of drug treatments that people are most familiar with in treating cancer are chemotherapies, and they can provide a contrast in what immunotherapy is. So, chemotherapies are really poisons meant to kill cells that kill more cancer cells than normal cells. Immunotherapies don't do anything directly to a cancer cell, but what they do is take the brakes off the immune system with the idea that when those brakes are off, a patient's immune system can fight and kill the cancer cells.

We had seen in the past that sometimes a patient's immune system could recognize and kill cancer cells, but most of the time that didn't happen. And we later learned that part of that was because cancer was exploiting those brakes on the immune system to protect itself and evade the immune system.

Host: You touched on it in that description, but just why is immunotherapy so critical to cancer care?

Dr. Becker: Yeah, I would say immunotherapy is really the biggest advance in cancer treatment that we've had at least in the last decade, or if not more. I think some of the crucial advances that we've seen with immunotherapy, one, are that we're seeing in many cases, better efficacy, better effectiveness in killing cancer cells compared to chemotherapy or other traditional treatments.

And at the same time, in the past, we usually achieved those improvements in effectiveness only at the expense of more toxicity. But here in contrast, we're actually seeing less toxicity, so more effective and less toxic. And that combination, both goals that we always aim for with our cancer treatments, achieving those in one treatment has been really, I think, outstanding. Other things that I think are important, that because of that's improved tolerability, we can actually expand the population of patients that can benefit from cancer treatment. So, you know, my specialties are thoracic or lung cancers and genitourinary cancers. In the past, it was not uncommon for me to see a patient who might be older or more frail and maybe have a lot of other medical conditions.

And sometimes I would have to tell them that there's really not any treatment that I can recommend because chemotherapy is the only option and chemotherapy would do you more harm than good. Because immunotherapy doesn't have the same side effect profile or the same risks as chemotherapy, there are now a lot of patients that I'm seeing that are older and sometimes frail, but that we can still consider immunotherapy and I've even seen older and sometimes frail patients benefit tremendously from immunotherapy.

That's something that we really didn't have as an option before. So, I've seen people that would not be coming to see me, getting treatment and getting better from their cancers because of immunotherapy. I think of several patients I've seen recently in their nineties where we've seen really substantial improvement in their symptoms and their quality of life because they got treatment, whereas they wouldn't have had any treatment options in the past before immunotherapy.

Host: It's incredible to hear those types of stories from you.

Dr. Becker: Yeah. Yeah. I think of one patient in particular, was I think 94 when he started seeing me and he had been in and out of the hospital with some bleeding complications from a bladder cancer. You know, he was not a candidate for surgery and wouldn't have been able to handle either chemotherapy or radiation, which were, or all the different types of treatments we had for bladder cancer in the past. We started giving him immunotherapy and the bleeding stopped. His symptoms all resolved. He really went back to being the same person he was before his cancer diagnosis, all without any side effects from the treatment. And so it was really incredible to see that change.

Host: So, when it comes to immunotherapy, what options are offered at Maimonides?

Dr. Becker: So, we have all of the currently FDA approved immunotherapies that we provide here and our doctors are using. I would say that our doctors are also very experienced in using immunotherapies in part, because we've been using them even for longer than they've been approved. We had some clinical trials of immunotherapies open at Maimonides even before there were approvals for widespread use of immunotherapy. So, our doctors are really expert in selecting who are the right patients to benefit from immunotherapy as well as how to manage the side effects from them when they do come.

Host: Well, that leads me into my next question. What kind of cancers can be treated with immunotherapy?

Dr. Becker: We've actually seen a really wide range of cancers for which immunotherapies have shown benefit. Some of the first cancers that we learned could be effectively treated with immunotherapy were malignant melanoma, lung cancer, and kidney cancer, but that number of cancers has really exploded. And we're now learning that different subtypes of many different types of cancer can benefit from immunotherapy. So, some colorectal cancers, bladder cancer, I mentioned earlier, a immunotherapy was actually one of the first or the first drug to get well, we call it tumor agnostic approval. So, an approval by the FDA for use in any type of cancer, no matter what type, as long as you had a specific test result in that type of cancer.

So, it's been really broad, the range of indications and the number of cancers that have benefited from immunotherapy. The main limitations in their use has been that not every person's cancer responds to immunotherapy. So, that's really the area of focus now is trying to add new drugs that might help immunotherapies, the currently available immunotherapies work better as well as looking at earlier stages of cancer.

Because right now, mostly immunotherapies are used in advanced cancers, but we and others are involved in some clinical trials, looking at whether using immunotherapies in early stages of disease can also have benefits to try to increase the number of people cured of their cancer and increase the number of people who can benefit from immunotherapy.

Host: Well, doctor, this all sounds so promising. Is there anything else you'd like to add to our conversation about immunotherapy at Maimonides?

Dr. Becker: Yeah, the one other really key point in my mind, in terms of why immunotherapy is advanced over other types of treatments that we've used in the past has been the durable responses that we see. So, thinking again about conventional chemotherapy as being the old way that we treated most cancers. Once you have given a dose of chemotherapy and it's out of a patient system, it really stops working. Immunotherapy, since it's not the drug directly treating the cancer cells, it's really just manipulating a patient's immune system.

And that immune system stays with them. We're seeing that some people are having ongoing responses to their treatment, even after they stopped the treatment. We're seeing some people who have metastatic cancers of various types that respond to treatment. And that those responses last for years. We call that when we're evaluating how well a treatment works, we look at survival curves. So, we look at how long people with that cancer who got that treatment live for. And we're seeing what we hadn't seen before with older treatments, is that in many cases with metastatic disease, the number of people surviving just sort of stabilizes a few years out so that people are living with it.

What we used to say was a terminal diagnosis, they live for years and we don't see any growth of the cancer. It's still a little bit soon for us to really determine are those people cured of what we used to think of as terminal cancers? It's possible, but it's still early for us to say. But what we definitely are seeing is people living with cancer diagnoses, metastatic cancer diagnoses for years, and sometimes even years after stopping their treatment, which is really not something we'd ever seen before immunotherapy came into use.

Host: Well, Dr. Becker, thank you so much again for being with us and telling us all about the services at Maimonides. To learn more, please visit maimo.org. This has been Maimo Med Talk. I'm your host, Caitlin Whyte. Stay well.