The oncology world appears to be on the verge of revolution, not simply evolution. The notion of immunotherapy as a means of cancer therapy has been one of the oncological “holy grails” for years. Major developments have been seen in melanoma first with ipilimumab which targets CTLA-4 and augments the immune attack on cancer. The inhibitors against PD1 and PDl1 have a different mechanism blocking immune tolerance to cancer, or as I like to think of it, removing the cancer camouflage, exposing it to attack. The Austin and other institutions are now in the throes of Phase I-III studies testing these new agents. This was as a result of data such as http://www.nejm.org/doi/full/10.1056/NEJMoa1200690 where an efficacy signal was seen for the first time.
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clinical trials
For those who are interested we have a whole host of studies in lung cancer at the Austin hospital testing agents targeting EGFR, ALK and PD1/PDL1. The breast cancer portfolio was a wee bit quiet for a year but this is expanding including studies in triple negative breast cancer. Phase I studies run by A/P Hui Gan include a novel PARP inhibitor (attractive in breast and ovarian cancer partic in the BRCA +ve patients).
We are very collaborative in Melbourne and I work closely with colleagues at Peter Mac , Royal Melbourne Hospital (only to name a few centres) to give patients the option to participate in studies that suit their particular circumstances better. This is often under the auspices of Cancer Trials Australia (see introduction). We strongly encourage patients to consider trials. Ultimately as their clinician, I want them to personally benefit from such participation. It is true that altruism is maybe an important part of developing new and better treatments and improved outcomes in cancer medicine, and in health in general. SW Aug 2014
Day 1 – world lung
- EGFR inhibitors can have modest efficacy in uncommon eEGFR mutations but not in T790m de novo mutations and exon 20 insertions (analysis of LUX studied with afatinib
- 4% risk of dangerous interstitial lung disease with EGFR TKIs in Japanese populations with a mortality of 1.5% . Note this risk incidence does not apply to Caucasian population
LUX 4 afatinib post progression in EGFR mutated disease
the study
http://jco.ascopubs.org/cgi/content/short/31/27/3335?rss=1 showed a small number of partial responses (good tumour shrinkage) and an average disease control time (PFS ) of over four months. Not startling..the overall survival was good (19 months average) but this reflects (more likely ) the better biology of EGFR m+ adenocarcinoma of the lung
