New treatment boosts lung cancer survivability
SIOUX FALLS, S.D.—Eunice Richmond was working out in the yard the other day enjoying a gorgeous May day. She's also remodeling her kitchen.
It's something she thought she might never be doing almost two years ago when she was diagnosed with advanced lung cancer and faced the possibility of only six months to live. However, thanks to a new treatment that a regional Sanford Health research team helped develop and study, the 67-year-old Richmond and others are realizing that a longer life than they ever expected may lie ahead.
The new treatment, which boosts the immune system, is one of the biggest successes so far for immunotherapy. The treatment is a combination of chemotherapy, for decades the major treatment for the often deadly form of cancer, and Merck's Keytruda drug that activates a person's cancer-fighting cells.
"It's not a cure," said research project oncologist Dr. Jonathan Bleeker of the Sanford team that worked with 13 patients in the Fargo and Sioux Falls areas on the two-year study that involved 616 patients nationwide and in Taiwan..
However, the new treatment did have a dramatic effect.
Bleeker said it increased the survival rate of patients with advanced lung cancer by 20 percent from 49 out of 100 people still alive after one year to 69 out of 100 surviving after a year.
"In our world that's huge," Bleeker said. "Usually we get excited in advances when we have a 5 percent to 8 percent increase."
Richmond, a former nurse who worked at Veterans Administration hospitals for 20 of her 35-year career, said the tumor in her lung has basically shrunk to only look like scar tissue.
"It's just seems to be getting better and better," said the former nurse. She initially found out about her lung cancer after doing a mammogram because she was worried about the breast cancer that runs in her family..
A big, looming question for her, however, is that she doesn't know, and likely never will, if she was one of the half of the 616 patients who received Keytruda or if she was in the other half who got a placebo with their chemotherapy. Those not given Keytruda were allowed to switch to it if their cancer worsened.
"I think I did get the Keytruda, and my doctor does, too," she said. But because of the research guidelines she can't be told. It's what's called a blinded study.
Since she started in the study in August 2016, Richmond has had 31 treatments. The first was a heavy dose of chemotherapy, that then was reduced to a light dose, as well as the immunotherapy drug. She hasn't had any side effects, except that she gets a little tired for three to four days after each treatment.
Bleeker said the side effects can be significant, although less than 10 percent of patients had to stop the study because of them, and only one in five had any side effects at all.
Some of the side effects seen were thyroid troubles, skin rashes, diarrhea or a deep cough. The reason those symptoms can develop, Bleeker said, is because the Keytruda activates cancer-fighting cells that search and destroy, but they also can become "over-excited and attack normal cells."
"However what's good is that we can treat all of those side effects," said Bleeker, who hails from nearby northwest Iowa.
The new treatment isn't for everyone. When first diagnosed, oncologists will do a DNA of the cancer cells and see if a patient is a good candidate for the immunotherapy. Other drugs or chemotherapy may be a better solution.
"We call it in our world now a personalized approach," Bleeker said.
What the doctor loves, he said, is that Sanford at its clinics throughout the upper Midwest can now offer this treatment as an option to those possibly facing death.
"It's been the treatment of tomorrow being delivered today," said Bleeker.
Richmond agrees. She encourages others to join in research studies and didn't realize until she joined the Sanford program that opportunities in this region used to be rare. In many instances, people would have to travel to Denver or the Mayo Clinic in southeast Minnesota for any research studies, she said.
"I'm just glad I got to do something. It's better than nothing, and I feel blessed to have the opportunity (to do the study) and I can't say enough good things about how I've been treated at Sanford and the wonderful people," she said.
She also feels blessed that she's still alive. She's had great support from her husband, Bob, of 46 years, her son, daughter and three grandchildren, as well as her "church family."
"I just take every day as it comes," Richmond said. "At first, I was arranging for my funeral, but now I'm working on remodeling my kitchen and looking forward to my grandson graduating from college in a few years.
"I'll take what God gives me. But I'm feeling good about things now," she said.
At Sanford, Bleeker said the team of nine oncologists, six nurse practitioners and almost too many research assistants to count are looking forward to making the new treatment "the standard of care" with a goal of even improving the survival rate for patients above the 70 percent rate after one year and making the response to the treatment last for years.