When President Barack Obama called for a national moon shot to end cancer, the MD Anderson community and our patients cheered. For nearly 75 years, cancer has been our priority, and we are heartened to see it elevated to a true national priority.
Annual Report 2015 : Patient care
An immunotherapy drug to bolster a T cell surge
MD Anderson Melanoma Moon Shot researchers are combining two immunotherapies for the first time to double-team melanoma that has spread to other organs and resisted all forms of treatment.
Assistant professor of Melanoma Medical Oncology Rodabe Amaria, M.D. Photo: Wyatt McSpadden
Patients in a first-of-its-kind clinical trial will receive a vastly expanded dose of their own T cells — white blood cells that are the specialized warriors of the immune system — followed by a cancer immunotherapy drug known to promote the activation and survival of T cells.
“We’re excited about this combination because there’s no standard of care now for our metastatic melanoma patients if immune checkpoint blockade drugs fail,” says clinical trial leader Rodabe Amaria, M.D., assistant professor of Melanoma Medical Oncology.
Checkpoint blockade drugs allow the immune system to unleash T cells to attack tumors. The drugs work by blocking molecules on T cells that act as brakes, which prevent the immune system from launching an attack. To date, researchers have developed two types of drugs that target two separate brakes. Brake No. 1 is called CTLA-4 and brake No. 2 is named PD1. The drugs have revolutionized melanoma treatment, producing powerful and lasting responses in about 10% to 30% of patients who take one drug only, and in more than 50% of those who take both drugs combined.
That still leaves substantial numbers of patients in need of a new approach. For checkpoint blockade to work, there have to be T cells primed and willing to attack the cancer.
Enter T cell expansion and infusion. T cells that attempt to kill cancer are often found in tumors that are removed or biopsied. There just aren’t enough of them to succeed.
Patrick Hwu, M.D., head of Cancer Medicine and chair of Melanoma Medical Oncology, pioneered an approach that grows T cells on slices of a patient’s tumor in the lab, expands them to billions of cells over a few weeks, then infuses them back into the patient. The cells are called tumor-infiltrating lymphocytes, or TILs.
“We’ve treated about 100 patients with TILs. About 45 percent respond, and some of those responses last for years,” Amaria says. “There’s a lot of room for improvement.”
Patients in Amaria’s trial receive T cell expansion followed by a checkpoint blockade drug that blocks PD1. The trial is the first to combine TILs with a PD1 inhibitor.
This double-whammy combination may also stimulate small proteins that fire up the immune system, according to research conducted in Hwu’s lab by Weiyi Peng, M.D., Ph.D. In the clinical trial, 36 patients with metastatic melanoma will have surgery, so their tumor-attacking T cells can be expanded and then frozen. They’ll then be hospitalized and treated with chemotherapy to reduce their existing T cells before being infused with their TILs.
After that, they’ll receive interleukin-2, an immune stimulating protein, to bolster immune response. Three weeks later, they’ll receive the PD1 inhibitor drug Keytruda.
Patients’ tumors are biopsied once before and at least twice after treatment.
“Biopsies are a priceless learning opportunity,” Amaria says. “It’s so important to see what’s happening in tumors throughout the course of treatment so we can understand and improve how we manage disease.”
More Stories From Annual Report
In 2015, surgical history was made
Collaboration and a unique opportunity led to the world’s first skull and scalp transplant
Curing leukemia without debilitating side effects
Jamie Whittington has an aggressive form of chronic lymphocytic leukemia, but you’d never know it.
Bold advances require the latest technology
To meet a growing demand for clinical, diagnostic and support services, ground was broken in 2013 for The Pavilion, an eight-story, 184,800-square-foot facility connected to the Main Building.
In the face of cancer
It’s a phrase that describes our patients, who, faced with a disease that is unpredictable and unforgiving, remain strong and determined.
It describes our doctors, researchers, educators and staff, who are relentless in their drive to stop a plague that robs us all of friends, family and loved ones.
He took on the mystery of metastasis. Now he’s taking on brain cancer.
Few scientists have devoted as much of their career to understanding how cancer spreads as Isaiah Fidler, D.V.M., Ph.D.
Graduating to big things before returning to MD Anderson
When Joya Chandra, Ph.D., joined the faculty of MD Anderson’s pediatrics department in 2002, she felt an immediate kinship with the researchers, clinicians and, especially, with the students.
Where rivers of research and clinical data converge into one pool
A simple yet unprecedented goal drives the big data efforts of MD Anderson’s Moon Shots Program: to have every patient contribute to and benefit from the cancer
center’s research.
Bottom line: Converting discoveries into new treatments at a faster rate
When a clinical trial for a new breast cancer drug launched recently, researchers estimated it would take at least two years to enroll the 20 patients needed to make the trial a success. However, within four months, half the patients had already enrolled — and the drug worked for all 10.
Outsmarting cancer with genetic testing
Teresa Hall’s visit to a gastroenterologist three years ago wasn’t the first time she’d sought help for troubling symptoms.
Are you at high risk for pancreatic cancer?
A new clinic to identify and monitor those at high risk for developing pancreatic cancer continues to expand after opening last year.
We’re creating partnerships to detect a deadly cancer earlier
Building on MD Anderson research, a new company named Codiak Biosciences has formed to create therapeutic and diagnostic products using exosomes — small parts of cells that break away and float around the body.
Breast cancer screening guidelines aren’t a one-size-fits-all solution
It’s clear that breast cancer screenings save lives. But exactly when women at average risk of developing breast cancer should begin screening is much less clear.
