An estimated 1 in 2 men and 1 in 3 women in the United States will be diagnosed with cancer in their lifetime.* New innovations in immunotherapy might be the key to finding a cure.
Last month, IVY members gathered for a discussion on Innovations in Medicine to learn about some of the most cutting-edge new breakthroughs in cancer research. This panel featured Jill O’Donnell-Tormey (CEO, Cancer Research Institute), Jedd Wolchok (Top Oncologist, Memorial Sloan Kettering Cancer Center), and Ethan Zohn (Cancer Survivor and Winner of Survivor, Season Three) and was moderated by Yacov Arnopolin, a member of the Cancer Research Institute Board of Trustees.
In the discussion, the panelists explored exciting new developments in cancer research, what the future of cancer research looks like, and what new research means for people who battle cancer and win.
YA: Ethan, as a person who has beat cancer twice — with two very different treatments — can you comment on your experience?
EZ: The first time I got cancer, it was an absolute shock. I was 35 years old, on top of the world, thinking my life was great. I had some really itchy skin, and I didn’t think much of it at the time. I tried every pill, cream, and potion known to man, and it wasn’t until a swollen lymph node popped out of my neck until they found a mass in my chest.
I was diagnosed with a rare form of blood cancer. I had multiple rounds of chemotherapy, 22 rounds of radiation, and an autologous stem cell transplant. That worked well; it got the cancer into remission for a while. But then it returned after about 20 months. This is when things got a little scary.
As a patient, it’s really hard to articulate what it feels like to be seriously ill. I’m a “positive outlook” kind of guy, but when an entire team of doctors tries all these ways to heal you that don’t work, you panic. You freak out. You just want to live for another day. Luckily for me, I was being treated at Memorial Sloan Kettering Hospital, and a new, smart targeted therapy emerged on the market that was available for a select group of people in my exact situation. (We’re talking about people with blood cancer who have had a transplant that failed.) It got the cancer into remission, and then I was able to get a second transplant, this time from my brother as a donor.
Cancer patients are desperate. We are literally waiting every single second of every minute of every day for a life-saving breakthrough, and for me when I relapsed that second time, I was running out of options. That’s when I really needed that silver lining: a ray of light, a glimmer of hope, a miracle. And do you know what a miracle looks like to cancer patients? It look like successful research and new drugs.
YA: One of the exciting successful treatments right now in cancer research is immunotherapy. Jill, can you tell us a little more about what immunotherapy is? How has it really changed cancer therapy?
JO: We are finally seeing some remarkable effects for immunotherapy in treating, controlling, and potentially curing some cancers. In very general terms, immunotherapy is a treatment that actually uses your body’s own immune system to recognize and destroy cancer.
The immune system has three major things characteristics working in its favor. First, the immune system has specificity. That means you immune system can actually go after cancer in your body and not after the normal cells.
It also has the ability to be adaptable. It’s a system; it’s not a drug. So while cancers tend to mutate or become unresponsive to other treatments, your immune system is able to adapt and therefore continue to respond.
Lastly, the immune system has memory. You all know you have childhood inoculations, and when you’re exposed to the virus, you don’t get it. The same type of thing happens as cancers are eliminated and come back; the immune system recognizes it and can mount another response again.
YA: What are the biggest changes we’ve seen in cancer research in the past few years?
JW: Chemotherapy and radiotherapy are probably the two words we think of the most when we think of cancer therapy. Those are interventions that target the cancer cells directly. They interfere with the way that the DNA unwinds and copies itself, and they do that in a very haphazard way, which is why people get so many side effects. They’ve not only damaged the cancer cells, but they’ve damaged other cells as well. So, the two advances that I think have really revolutionized the way we think about cancer right now are immunotherapy and targeted therapy.
Targeted therapies are also medicines that interfere directly with a cancer cell’s desire to divide, but in very specific ways. They are medicines that are given to people who have a particular abnormality in their cancer cells that makes them sensitive these medicines. It’s not some haphazard, smash hammer kind of approach.
Immunotherapy, on the other hand, is the ultimate form of personalized medicine. It is your body’s very specific way of recognizing what’s foreign and what’s you, redirected to define foreign as a cancer.
We previously believed that to your immune system, cancer looked a whole lot like the normal cell that it came from. We wondered if the cancer cell was different enough to make your immune system realize it’s as dangerous as a virus or a bacteria or a fungus, which the immune system is really good at remembering and killing. We now know there are modern medicines that turn the immune system on in very powerful ways.
YA: Ethan, there was a significant change in the technology between your two bouts with cancer.
EZ: Yes, when I first had cancer in 2009, I had traditional chemotherapy. My hair was falling out, I couldn’t eat; I couldn’t sleep; I felt miserable. When I relapsed and I was on the smart-targeted therapy, the side effects were very minimal. I felt ok; I looked ok. I ran the New York City Marathon, while undergoing this therapy, so it definitely didn’t affect me in the same way. Two years, 2009 to 2011—the technology really progressed.
YA: What was it like for someone your age to go through cancer in terms of the social impact? What did it mean for you? What advice do you have for people?
EZ: 70,000 young adults* are diagnosed with cancer each year, and unlike pediatrics and older adults, there hasn’t been much been much difference in the survival rate for adults with cancer. And there’s a whole host of things that happen to a young adult with cancer. If you’re in pediatrics, your parents are taking care of you. If you’re an older person, you’re usually in a situation where you’re more financially stable, maybe you have a family or you’re in a relationship.
But as a young adult, that’s different. Usually, you don’t necessarily have the best health insurance. Maybe you’re single, and you’re looking to date people. The psychosocial part of being a young adult with cancer is completely debilitating. It’s a very lonely experience, and so my advice to people, if you are a young adult or know someone who is a young adult, get them to share their story. It’s not a good thing to be alone the whole time. There are wonderful organizations out there where you can connect with someone who’s going through a very similar thing that you’re going through.
YA: There’s been a lot of publicity recently about immunotherapy thanks to Jimmy Carter, who is being treated with immunotherapy. Ethan, once you go through this harrowing experience, how does that change your outlook and how you live your life?
EZ: Well I think when you’re first diagnosed, everyone rallies around you. It’s a fight, and you’re going to beat it. But then for me, the cancer came back, and that’s when things got a little bit scary. Getting through the second time was very different from getting through the first time because you realize you have to do everything you did before all over again. But in terms of do I live my life differently? I like my life before cancer; I like my life after cancer. However, I have made some big life changes.
I think the biggest thing for me was just living an authentic lifestyle. Sometimes you get caught up in everything, and you’re sucked into social media—how many likes do you get, do you have many Twitter followers—you forget about the things that really matter in life, like friends and family and a good meal and handshake and laughter. That’s what I focus on now.
YA: I was reading an American Cancer Society report from this year, and it mentioned that the great majority of cancer patients do not participate in clinical trials. Is that from a lack of awareness or people not wanting to get involved?
JW: I think we suffer as a field from the abuses of the past. In the past, protections in clinical research were not what they are now. Lots of people are rightfully afraid of clinical trials. They don’t want to be guinea pig. They don’t want to be randomized to a placebo. We do very few placebo-controlled trials, and if we ever do, they’re usually randomized against the standard treatment.
YA: Unfortunately, we all know someone who gets cancer. What is the best way for patients to get the best care and be aware of all the new therapies out there?
JW: In New York City, for example, we are blessed with many very highly specialized medical facilities. Outside of New York City, you should seek care from an academic medical center, usually one with a medical school. We always tell our patients, ask your doctor about clinical trials. If you don’t have an acceptable first line of therapy, then clinical trials are where you get access to cutting-edge treatment. There’s a lot of information available online, and a small fraction is useful or accurate. So be judicious about what you believe—it’s wonderful to educate yourself, but there’s a lot of information out there.
You might ask yourself, as a healthy, young human: what can we do to stay on right side the 50% of men or 67% of women who don’t get cancer? The simple answer is not a lot for most of the cancers, but there are a few where you can take steps to protect yourself. I’m melanoma expert, so wear sunscreen. The other thing is, don’t smoke. Don’t smoke anything. Don’t inhale anything into your body. Lung cancer is a positively awful disease, but you can do a lot to avoid it.
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