600,000 Americans die every year from cancer. We continue to encounter many patients whose doctors have told them, "There's no hope." In many cases, this statement isn't accurate.
Despite its hundred-year-old history, immunotherapy is still "new" to many patients and physicians. Few doctors have experience prescribing it. Misconceptions about immunotherapy abound.
Immunotherapy is also complex. Unlike traditional chemo or drugs that target the tumor, successful immunotherapy requires mobilizing multiple aspects of the patient's immune system.
Multiple pieces need to be in place: T cells to target cancer. Releasing the immune system's "brakes" with CTLA-4 inhibitors. Stripping-away of PD-1 tumor defenses. Modifying the tumor microenvironment (with certain drugs, Coley's Toxins, or even dietary interventions such as the ketogenic diet).
During this transition period, opportunities abound for informed patients to take advantage of immunotherapy. The following is an example.
In early 2014, we met a patient on the path to becoming another statistic. Mary had failed every single therapy for her refractory Hodgkin's lymphoma.
We showed her the scientific evidence for PD-1 and the strong safety profile. We argued it made strong sense for her to try PD-1 before a last-resort stem-cell transplant. We showed her the objective data that indicated the stem cell transplant was unlikely to work, and the comcomitant risks.
Mary was interested in immunotherapy. But—as has happened to most patients we've shared immunotherapy with—when she spoke to her oncologist about immunotherapy, he labeled it as "experimental" and dissuaded her from pursuing it.
She ended up going for the transplant. After months of hospitalization due to an obliterated immune system, the scan results came back.
The transplant had done nothing for her.
Even after that, her oncologist said there was nothing else to try except more chemo—admitting it was unlikely to help! Apparently, PD-1 was still "too experimental" and risky.
Then, Mary got lucky. Just when her oncologist had begun talking about hospice, Phase I data for PD-1 in Hodgkin's lymphoma was released. As we'd predicted 9 months earlier—PD-1 worked for Hodgkin's lymphoma. And it worked really well—an astonishing 87 percent rate of tumor shrinkage.
Let's stop and think about this for a moment. These were patients who had failed every conventional treatment, including debilitating doses of chemo. Yet, a simple outpatient infusion of PD-1 sent 9 out of 10 into complete or partial remission.
Finally, Mary's oncologist agreed to give her PD-1 off-label (where doctors legally prescribe drugs approved for other cancers). He combined PD-1 with radiation to one of Mary's tumors, as radiation can synergize with PD-1 by creating T cells against cancer.
Within a few short months, all of Mary's tumors vanished. The only side effect while her tumors were shrinking? Itchy skin.
How You Can Get Immunotherapy
Mary is alive today, tumor-free and back at work. If she hadn't pursued "experimental" immunotherapy, there is little doubt she would not be alive today.
Thankfully, she had pressed her oncologist about getting PD-1 two years before it was approved for her cancer. Mary's doctor was ultimately cooperative and helped her get off-label immunotherapy. Not all patients will be so lucky.
You see, pursuing immunotherapy during this transition period requires more than just information. The information must lead to strong conviction about immunotherapy, because there are often hurdles to overcome.
These hurdles include:
- The rigid ways by which the medical system operates
- Differing opinions and interpersonal frictions (e.g. my oncologist dropped me when I pursued immunotherapy, even though a leading figure in the field was guiding my treatment decisions)
- The fear of the moment (which can lead patients to accept suboptimal treatment recommendations)
- Issues of money (an approved treatment may be covered by insurance, but may not be the best treatment)
By examining the objective data and understanding how immunotherapy works, you can muster the conviction to chart your own course to take advantage of immunotherapy. You may have to examine the data yourself (if your oncologist won't do it with you).
Patients who drive their own care and study the data will learn that chemotherapy and targeted agents are often only able to delay cancer temporarily. (This applies to most solid tumors, not blood cancers like leukemia and lymphoma).
In contrast, they will see that immunotherapy offers the potential for remission that can last decades, even a lifetime—an effective cure.
Those convicted to pursue immunotherapy will be glad to learn that it's far more accessible than just a few years ago. It can be obtained through:
- Off-label treatment
- Clinical trials (immunotherapy trials have proliferated since 2014)
- Pay-for-service in foreign countries
In our book, we discuss all the above, including strategies on how to optimize and combine various immunotherapies to achieve better results than single-agent approaches (such as PD-1).
We explain the science behind combining immunotherapies—why and how it makes sense to mobilize multiple aspects of the immune system.
More than science and theories, we address practical ways how to get these various aspects of immunotherapy in place (including how to do it without going broke!)
In the years that we've battled cancer with immunotherapy, we've developed a passion for helping others understand it better. Few things give us greater joy than to see it salvage lives—patients who would've died had they not taken advantage of immunotherapy.
If you're a patient or caregiver, our sincere hope is that you, too, will benefit from immunotherapy and seize your chance to be cured.