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June 8, 2018

An advanced breast cancer remains disease-free years after immunotherapy. Is she 'one in a million'—or the wave of the future?

Daily Briefing

    A novel therapy designed to target tumors using a person's own immune cells has helped a woman diagnosed with an advanced form of breast cancer typically considered incurable remain cancer-free for two-and-a-half years, according to a research letter published Monday in Nature Medicine.

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    The new approach "is being hailed as a development that could open a broad new front in cancer immunotherapy," according to the Los Angeles Times. Current immunotherapies have either demonstrated little to no effectiveness when it comes to treating solid cancer tumors, which account for 90% of cancer deaths, the Times reports.

    At the same time, however, lead researcher Steven Rosenberg, chief of the surgery branch at the National Cancer Institute, emphasized that the therapy is experimental and that several patients who've received this form of therapy have not responded.

    Research details

    For the research, scientists at NCI used a procedure called adoptive therapy to treat Judy Perkins, a 52-year-old breast cancer survivor who'd had cancer return and spread to multiple parts of her body about a decade after she underwent a mastectomy for early-stage breast cancer in 2003.

    For the procedure, NCI used Perkins' immune system cells, called tumor-infiltrating lymphocytes (TIL), to target the cancer cells in her body.  The team of scientists sequenced the genomes of Perkins' tumors to identify their mutations. The team then tested TILs extracted from her tumors to determine which TILs might recognize and target the mutations in her tumors. The team found 11 TILs capable of targeting the tumors and spent four months creating tens of billions of copies of those cells. Perkins received chemotherapy and then had the copies of her TILs infused back into her body.

    While the research letter focused on Perkins' treatment and response, other patients have received the same type of treatment with little success. For instance, Health News Review noted that Perkins was one of only three breast cancer patients in the Phase II clinical trial. While Perkins responded well, one participant had no response to the treatment and the other died of an infection, Health News Review reports. In total, Rosenberg, the TIL therapy has helped seven out of 45 patients with several forms of cancer, including advanced cervical, colon, and liver cancers, recover—representing a 15% response rate.


    Rosenberg said he thinks TIL therapy is "the most promising treatment now being explored for solving the problem of the treatment of metastatic, common cancers." However, he said the TIL therapy is not "ready for prime time today" and scientists cannot use it with most patients.

    For her part, Perkins said, "I have definitely hit the jackpot."

    Carl June, an immunotherapy expert at the University of Pennsylvania, said the research letter presents a "striking" case, but in June questioned whether the patient's response represented a "one in a million" case or "an approach that will benefit many women?"

    Crystal Mackall, founding director of Stanford University's Center for Cancer Cell Therapy, who was not involved in the research, said the approach used in the research is "elegant in its simplicity."

    Patrick Hwu, an oncologist and immunotherapy researcher at M.D. Anderson Cancer Center in Houston, called the research finding "encouraging," but said "the hard work that lies ahead" involves determining who best responds to TIL therapy. Hwu said, "The majority of cancer patients still don't respond to immunotherapy. So that's the huge area of need. And that lays the groundwork for why this may be so exciting"(McGinley, Washington Post, 6/4; Healy, Los Angeles Times, 6/4; Shannon, USA Today, 6/6; Stein, "Shots," NPR, 6/4; Joyce, Health News Review, 6/7).

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