Immunotherapy drug could halt the return of the ‘most aggressive form of breast cancer’ and ‘save thousands of lives’
- Women with triple negative breast cancer were given the drug Keytruda
- Keytruda was taken alongside chemo to shrink tumours before surgery
- More than 60% of the patients showed no sign of cancer after the operation
An immunotherapy drug could prevent a ‘particularly aggressive’ form of breast cancer returning, research suggests.
Scientists gave more than 700 women with triple negative breast cancer Keytruda (pembrolizumab), a drug which has been shown to be effective in lung and skin forms of the disease.
The patients took Keytruda alongside chemotherapy to shrink their tumour, before having the malignant mass surgically removed.
Some 64 per cent of the women showed no sign of cancer after going under the three-pronged treatment, the study found. This is compared to 51 per cent of those who had chemo and a placebo.
Fifteen months later, the disease was 37 per cent less likely to return in the women who took Keytruda, the Queen Mary University of London researchers added.
The scientists have called the results ‘very promising’, with the drug having the potential to ‘cure more patients’ and ‘save thousands of lives’.
Over 700 women with triple negative breast cancer were given Keytruda (pembrolizumab)
‘Triple-negative breast cancer is a particularly aggressive form of cancer with the potential to devastate lives,’ lead author Professor Peter Schmid said.
‘We have been desperately looking for better treatment options. These early results suggest the addition of immunotherapy to chemotherapy leads to a substantial reduction in recurrences in this form of breast cancer.
‘These are preliminary results, but they are very promising. If we prevent the cancer from coming back, we cure more patients, but we need longer-term data to confirm this.’
He added, according to The Sun: ‘The potential of this is massive — this approach could save thousands of lives.’
Keytruda (pembrolizumab) is an IV immunotherapy that works with a cancer patient’s immune system to help them fight the disease.
It does this by blocking PD-L1 on the surface of cancer cells. This takes the brakes off the immune system, setting it free to attack cancer cells.
Keytruda, developed by Merck, has been approved by the FDA to treat the following cancers:
- Advanced melanoma
- Advanced non-small lung
- Head and neck squamos cell
- Classical Hodgkin lymphoma
- Primary mediastinal B-cell lymphoma
- Bladder and urinary tract
- Advanced stomach
- Advanced cervical
- Those with a ‘DNA mismatch repair’, which can include breast
In the US, Keytruda – injected twice a week – can be used in adults or children with any of the above cancers that cannot be surgically removed or have progressed following treatment.
In June 2018, NHS England announced the drug will be routinely available on the health service for patients with lung cancers that have spread. It can already be dished out for patients with melanoma or Hodgkin lymphoma.
Some patients have also chosen to have the treatment privately.
Studies show the drug can shrink different types of tumours and boost a patient’s response to other treatments.
But Keytruda can also cause the immune system to attack healthy organs and tissue, which can be life threatening. Complications may include colitis, hepatitis or kidney failure.
One in eight women in the UK and US will develop breast cancer at some point in their lives, Cancer Research UK statistics show.
In the UK, triple negative breast cancer makes up 15 per cent of cases of the disease – around 7,500 people each year.
And in the US, it is responsible for 10-to-20 per cent of breast cancers, according to Breastcancer.org
Triple negative tumours do not have receptors for the hormones oestrogen and progesterone or the HER2 protein.
As a result, hormone treatments and the HER2-binding drug trastuzumab (Herceptin) do not work.
Patients are therefore usually forced to have chemotherapy and surgery.
Immunotherapy is increasingly being used to fight cancer by boosting the body’s natural defences.
To investigate its potential in triple negative breast cancer, the scientists tested Keytruda in 124 clinics across 21 countries between March 2017 and September last year.
Keytruda was given to 748 patients before and after surgery, while 390 women had chemo and a placebo.
After surgery, 64.8 per cent of the patients who received immunotherapy had no signs of cancer versus 51.2 per cent of those treated with chemo and a placebo.
Full results will be presented at the European Society for Medical Oncology (ESMO) 2019 Congress in Barcelona.
‘We know if cancer is completely gone out of the breast, they have a much better long-term survival, the cure rates are much higher,’ Professor Schmid said.
‘Whereas in patients where there is still cancer visible at the time that we do the operation, they have a higher risk of recurrence.’
Fifteen months later, there was a ‘favourable trend’ towards the patients staying cancer-free, which Professor Schmid calls ‘incredibly encouraging’.
Keytruda is an ‘anti PD-1 inhibitor’, which make cancer cells more ‘visible’ to the immune system.
In recent years it has become widely available on the NHS for lung and skin cancer, and is used in some cases for types of bladder cancer and lymphoma.
ESMO spokesman Professor Fabrice André, of the Institut Gustave Roussy in Villejuif, France, said: ‘Triple negative breast cancer represents an unmet medical need, since the only approved medical therapy at early stages of the disease is chemotherapy.
‘This study could have a major impact on treatment for these patients.’
Future research will track cancer recurrence in both Keytruda and placebo-treated groups over a long time, the scientists said.
WHAT IS BREAST CANCER, HOW MANY PEOPLE DOES IT STRIKE AND WHAT ARE THE SYMPTOMS?
Breast cancer is one of the most common cancers in the world. Each year in the UK there are more than 55,000 new cases, and the disease claims the lives of 11,500 women. In the US, it strikes 266,000 each year and kills 40,000. But what causes it and how can it be treated?
What is breast cancer?
Breast cancer develops from a cancerous cell which develops in the lining of a duct or lobule in one of the breasts.
When the breast cancer has spread into surrounding breast tissue it is called an ‘invasive’ breast cancer. Some people are diagnosed with ‘carcinoma in situ’, where no cancer cells have grown beyond the duct or lobule.
Most cases develop in women over the age of 50 but younger women are sometimes affected. Breast cancer can develop in men though this is rare.
The cancerous cells are graded from stage one, which means a slow growth, up to stage four, which is the most aggressive.
What causes breast cancer?
A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply ‘out of control’.
Although breast cancer can develop for no apparent reason, there are some risk factors that can increase the chance of developing breast cancer, such as genetics.
What are the symptoms of breast cancer?
The usual first symptom is a painless lump in the breast, although most breast lumps are not cancerous and are fluid filled cysts, which are benign.
The first place that breast cancer usually spreads to is the lymph nodes in the armpit. If this occurs you will develop a swelling or lump in an armpit.
How is breast cancer diagnosed?
- Initial assessment: A doctor examines the breasts and armpits. They may do tests such as a mammography, a special x-ray of the breast tissue which can indicate the possibility of tumours.
- Biopsy: A biopsy is when a small sample of tissue is removed from a part of the body. The sample is then examined under the microscope to look for abnormal cells. The sample can confirm or rule out cancer.
If you are confirmed to have breast cancer, further tests may be needed to assess if it has spread. For example, blood tests, an ultrasound scan of the liver or a chest x-ray.
How is breast cancer treated?
Treatment options which may be considered include surgery, chemotherapy, radiotherapy and hormone treatment. Often a combination of two or more of these treatments are used.
- Surgery: Breast-conserving surgery or the removal of the affected breast depending on the size of the tumour.
- Radiotherapy: A treatment which uses high energy beams of radiation focussed on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. It is mainly used in addition to surgery.
- Chemotherapy: A treatment of cancer by using anti-cancer drugs which kill cancer cells, or stop them from multiplying
- Hormone treatments: Some types of breast cancer are affected by the ‘female’ hormone oestrogen, which can stimulate the cancer cells to divide and multiply. Treatments which reduce the level of these hormones, or prevent them from working, are commonly used in people with breast cancer.
How successful is treatment?
The outlook is best in those who are diagnosed when the cancer is still small, and has not spread. Surgical removal of a tumour in an early stage may then give a good chance of cure.
The routine mammography offered to women between the ages of 50 and 70 mean more breast cancers are being diagnosed and treated at an early stage.
For more information visit breastcancercare.org.uk or www.cancerhelp.org.uk
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