Christina S. Baik MD, MPH, Seattle Cancer Care Alliance and University of Washington School of Medicine talks about cancer trials and their importance.
Interview conducted by Ivanhoe Broadcast News in September 2019.
Tell us a little bit about the trial that Jim was on that included Pembro.
BAIK: This trial was called keynote 21. This was one of the early trials that added pembrolizumab to chemotherapy. Actually, this has become the standard of care these days where all patients who don’t have specific genetic alterations are receiving this drug, the combination of chemo and pembrolizumab as first line treatment. And keynote 21 was really the first study that investigated this triplet therapy.
How long ago was that?
BAIK: The first few patients were enrolled in 2014 and the FDA approval for the regimen came in 2018, so fairly fast.
That’s pretty new.
BAIK: In the world of oncology. Yeah.
What is the chemo portion of it?
BAIK: For patients with adenocarcinoma which is a subtype of non-small cell lung cancer, patients are getting carboplatin and pemetrexed which is a regimen that has been standard of care for the specific adenocarcinoma and we’ve added pembrolizumab to that regimen.
How does pembrolizumab make the team of drugs work better?
BAIK: There are a lot of theories behind that and we haven’t fully proven that in science, but the idea is that chemotherapy would kill the cancer cells which release proteins into the body and the immune cells of the patients themselves would be able to recognize that. It’s essentially priming the immune cells to work harder against the cancer. Before this regimen came about, we used to give patients pembrolizumab or any other immune checkpoint inhibitors as single agent, and the efficacy was quite modest. Not everyone was benefiting from this drug. And as researchers we were thinking, what can we do to make this better? How can we improve upon what we have? And a lot of strategies have been explored. Adding radiation to immunotherapy, adding another drug for immunotherapy. But for this particular clinical trial we’re looking at chemotherapy with immunotherapy which turned out that that was very effective for many patients.
It seems like everything’s in combination anymore when you hear about trials. Is that kind of the way you’re going?
BAIK: Initially a lot of these drugs are developed as monotherapy meaning, one drug at a time. But a lot of times the effectiveness with just one drug is not very high. So we are looking towards combining with other drugs to look for synergy. But at the same time there are two sides to the coin right? The more drugs we add, the more side effects there are. So in clinical trials there are two things we’re always looking for – is it working for patients? But at the same time are we able to preserve the quality of life of those patients and not making patients too sick from all the side effects? One thing I usually tell my patients is that we want to make sure that the treatment is not worse than the cancer itself. So at the end of the day what we’re trying to achieve is that patients are able to live a relatively normal life with their cancer, which means that we want to make sure that the side effects are acceptable at the same time as improving the effectiveness. So there are a lot of combination treatment clinical trials, but we always have to keep that in mind.
So moving forward then, since this is now standard of care which is fantastic, will you continue to try to combine immunotherapy with a pathway blocker with other chemos as you go forward? Or what happens next?
BAIK: There have been already many many trials looking at other chemotherapies. So I mentioned before that keynote 21 was using a specific chemo for a type of lung cancer called adenocarcinoma. But since the proof of concept has been shown that this can work for patients, it’s been tried in other lung cancers such a small cell lung cancer and squamous cell lung cancer where other chemos with immunotherapy such as pembrolizumab and other immunotherapy drugs were studied and shown benefit. And as consequence now for all these other types of lung cancers, we also use the combination of chemo and immunotherapy.
Seems like in cancer care, in the last five years, it seems like it’s taking off. Is that true?
BAIK: It’s really true. I think part of it is that we are starting to understand the science better and a lot of people are investing in understanding the science because we really have to understand what’s happening at the cellular level, really understanding the biology of it in order to develop effective therapies. And I would say for things like immunotherapy. the investigation into the basic science has been going on for decades. So this is not a novel idea that all of sudden came out of nowhere. This is really built upon the work of many researchers starting in the lab, really trying to understand the biology of cancer. I think those decades of work is starting to come to fruition where the results are being used in clinical trials, and we’re starting to see the results of clinical trials. So I think that the recent advances are the results of the work into basic science oming to fruition, and also a result of the way we’re running clinical trials which has become more efficient than before. And FDA also now has mechanisms where they’re accelerating approval for treatments that look very promising so that we’re not waiting decades for a treatment to be approved.
Because patients don’t have decades.
BAIK: That’s right. Exactly.
What haven’t I asked you about the trial or cancer trials in general that you think we should put in the story.
BAIK: Keynote 21 was the first step for other larger trials that led to the full FDA approval of chemotherapy and immunotherapy l. So I think one thing that’s important for patients remember is that, while the treatment was approved in 2018, the trial was available since 2014. So you can see that patients who were in the trial were able to benefit from this treatment before it became FDA approved. A lot of patients when they go into clinical trial – they ask themselves, what’s in it for me, I would say a lot of people do it purely from altruism but this is a mechanism by which patients can receive treatment of tomorrow. I think that’s one thing we like to say here, that you’re getting a treatment for tomorrow when you enroll in clinical trials. So that’s the first thing I would say about clinical trials. The other thing that I will mention is that we still have lots of patients who are not benefiting from newer treatments like these, like immunotherapy. So not everybody’s benefiting. So there is still a lot of room for research and trying to understand why that is. Why is Mr. X having years of good disease control versus Mr. Y is having two months of disease control? What is happening in the tumor that results in such discrepancy? So we’re still trying to understand that, and a lot of important work is done in the lab, which may be not very familiar for a lot of patients but it’s very important to support that part of the science as well.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Karen Brandvick
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kbrandvi@seattlecca.org
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