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CHICAGO – New drugs dramatically improve the chances of survival for some people with difficult-to-treat lung, breast and prostate cancers, doctors said at the world's largest cancer conference.
Among the recipients, there is Roszell Mack Jr. who, at age 87, is still able to work on a horse farm in Lexington, Kentucky, nine years after the diagnosis of lung cancer that s'. was extended to the bones and lymph nodes.
"I go there every day, I'm the first one out there," said Mack, who helped test Merck's Keytruda, a therapy that helps the immune system identify and fight cancer. "I feel good and I have a good quality of life."
The disadvantage: Many of these drugs cost $ 100,000 or more per year, although the cost to patients varies depending on the insurance, income and other criteria.
The findings were presented Saturday and Sunday at the American Society of Clinical Oncology conference in Chicago and some were published by the New England Journal of Medicine. The companies that make the drugs have sponsored the studies and some studies have financial links.
Here are some highlights:
Lung cancer
Immunotherapy drugs such as Keytruda have transformed the treatment of many types of cancer, but they are still relatively new and do not help most patients. The longest study to date on Keytruda in patients with advanced lung cancer revealed that 23% of those who had received the drug as part of their initial treatment had survived at least five years, compared to 16 % of those who had already tried other treatments.
In the past, only about 5% of these patients lived as long.
"I strongly believe that life time depends not only on the length of life, but on the quality of life," said Dr. Leora Horn, of the Vanderbilt-Ingram Cancer Center in Nashville, Tennessee. She recruited Mack in the study of 550 people. .
Mack said that he had manageable side effects – mostly terrible itching – after he started using Keytruda four years ago. He went there last winter and the scanners did not reveal any active cancer; he and his doctor hope it will be in remission.
Last year, a smaller study revealed a five-year survival rate of 16% for similar patients treated with another immunotherapy, Opdivo.
"Both studies give a similar message: when these drugs work, they can have a very long-lasting effect," said Horn.
Breast cancer
This risk increases with age, but approximately 48,000 cases each year in the United States involve women under 50 years of age. About 70% of them are "hormonal, HER2-negative", that is, cancer growth is fed by estrogen or progesterone. and not by the gene that the Herceptin drug targets.
In a study of 672 women with this type of cancer who had spread or who were very advanced, the addition of Novartis Kisqali drug to the usual hormonal inhibitors, because the initial treatment helped more than the hormonal treatment alone.
After three and a half years, 70% of the women living in Kisqali were alive, compared with 46% of the others. Side effects were more common with Kisqali.
This is the first time that a treatment increases survival beyond what hormone inhibitors do for such patients.
Prostate
The options multiply for men with prostate cancer that has spread beyond the gland. The standard treatment consists of drugs that block the male hormone testosterone, which promotes the growth of these cancers, as well as a chemotherapy or a newer drug called Zytiga.
Now, two other drugs have been shown to increase survival when used as chemotherapy or Zytiga in men who were on regular hormone therapy and who continued to help.
One study tested Xtandi, sold by Pfizer and Astellas Pharma Inc., in 1,125 men, half of whom also received chemotherapy. After three years, 80% of people who received standard Xtandi plus treatment were alive, compared to 72% of men receiving only other treatments.
The other study involved 1,052 men who received hormone therapy with or without the drug Janssen Erleada. After two years, survival was 82% among those in Erleada and 74% among those who were not.
Men now have the choice between four drugs offering similar benefits, and no study has compared them yet, said Dr. Ethan Basch, prostate specialist at the Lineberger Comprehensive Cancer Center at the University of North Carolina, who has no financial ties with any drug makers.
Costs and side effects can help patients decide, he said. Chemotherapy can cause numbness and tingling in the hands and feet and may not be beneficial for men with diabetes who already have a higher risk of developing this problem. Zytiga must be taken with a steroid; Xtandi and Erleada can cause falls and fainting.
Chemotherapy has more side effects, but costs much less and only requires four to six intravenous treatments. The other three drugs are tablets that cost more than $ 10,000 a month and are taken indefinitely.
"I have patients who refuse to take these drugs because of the cost," Basch said.
Patients have more choices, but it is not clear that there are more benefits, "he added.
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