Immunotherapy, Supportive Care, and Global Care: 2017 in Review

Immunotherapy has become a standard treatment option for people with various cancers, including melanoma, lymphoma, and lung, kidney, bladder, and head and neck cancers. This is remarkable. It has been decades since the last treatment breakthroughs for bladder cancer or melanoma.

A quick tour of immunotherapy drugs shows that several classes of drugs are emerging as cancer treatments. The first on the scene were the checkpoint inhibitors and PD-1 inhibitors. Checkpoint inhibitors have been shown to extend long-term survival in melanoma, the deadliest form of skin cancer. PD-1 inhibitors are remarkably effective in treating lung cancer, the most common cancer worldwide.  

Another form of immunotherapy, chimeric antigen receptor (CAR) T-cell therapy, has been called revolutionary. In the last 6 months, the U.S. Food and Drug Administration (FDA) approved 2 CAR T-cell therapies. Unlike checkpoint inhibitors, CAR T cells are given just once. A patient’s own immune cells are collected and treated in the lab, where they are engineered to express a special receptor. They are then grown to massive numbers and then put back into the patient. Tisagenlecleucel (Kymriah) received FDA approval to treat advanced leukemia in children. After that, axicabtagene ciloleucel (Yescarta) was approved to treat non-Hodgkin lymphoma.

These are just the first steps in a very promising field of cancer research. However, we can’t overlook the fact that these drugs are very expensive and may also cause serious side effects. In fact, because of the newness of these treatments, we can’t be sure that we even know of all of the possible side effects that a certain immunotherapy may cause.

In 2017, researchers put extra effort into finding how we can better support patients and caregivers. Rigorous studies examined many supportive interventions, such as using mobile apps to track symptoms or yoga to relieve side effects of cancer treatments. It is interesting that some of the results of these studies support our intuition about what works well, while others lead us to consider new techniques for improving quality of life not just for patients, but also for family caregivers.

Twenty years ago, clinicians and patients faced each other and talked while the clinician scribbled notes on a paper chart. Nowadays, computers in the exam rooms have completely changed how patient and clinician interact. A study presented at ASCO’s Palliative and Supportive Care in Oncology Symposium confirmed that patients prefer face-to-face communication with their doctors. Less easy, however, is how we can address this issue. We are all very grateful for the benefits of this technology, but we have to be aware of how it affects communication. I sincerely hope the cancer care community focuses on this issue moving forward. We need to harness some creative ideas to build a clinic experience that uses high-tech innovation without sacrificing effective, compassionate communication.

We also need to be clear about the chance of recovery when talking to patients. Discussing what we now call “goals of care” is becoming routine and is highly valued by both patients and clinicians. This involves exchanging precise information and making sure it is well understood. People with acute leukemia must make very challenging decisions, for instance, and a recent study showed that many patients with AML, a form of acute leukemia, may not fully understand the risks of receiving treatment or may have unrealistic expectations about the treatment.

Cancer is stressful for patients and caregivers across the lifecycle. Adolescents and young adults must face cancer at the same time that they deal with normal developmental changes. An important study identified the many specific challenges that these young people face and showed one way of helping them manage these difficulties. It is encouraging to see the cancer care community exploring behavioral and lifestyle interventions to improve resilience and provide healthy coping mechanisms.

Understandably, we applaud the gains made in cancer research and quality of life. But let’s also remember that vast numbers of people with cancer worldwide don’t have access to basic cancer care services. It doesn’t matter if we have the best treatments for cancer if no one is able to receive it. An incredible amount of imagination, drive, and dedication brought forth these research advances in 2017. Now, I would like to see these same traits used to increase access to screening, treatment, and supportive care around the world.

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