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BREAST CANCER IMMUNOTHERAPY CAUTIOUSLY MOVES TOWARDS PRIME TIME

Mutation-specific tumor infiltrating lymphocytes used to achieve a complete remission in a patient with widespread metastatic disease

A team led by Steven Rosenberg M.D., Ph.D. at the National Institute of Health, reported in Nature Medicine that they have achieved a complete, durable remission in a patient with widespread metastatic disease. The patient, Judy Perkins, an engineer from Florida, developed hormone receptor positive breast cancer in 2003. A decade later, the disease recurred, with widespread metastatic disease including the chest wall and liver (see images above). After failing chemotherapy and hormonal therapy she learned about this experimental treatment at the NIH. She continues to be tumor-free 22 months after completing treatment.

rosenberg-1Rosenberg’s team analyzes DNA from each patient’s cancer looking for mutations unique to their cancer. They then retrieve tumor infiltrating lymphocytes (TIL) and grow their numbers in the lab. They then painstakingly identify those TILs which appear to attach the tumor’s mutated protein. After again expanding their numbers in the lab, they are infused into the patients. Patients also receive interleukin, the immune booster as well as the checkpoint inhibitor pembrolizumab (see recent post on the BCN website :(The use of checkpoint inhibitors in breast cancers).

Despite this success, Rosenberg and others are cautious. Two other patients with metastatic breast cancer have failed the treatment. "Is it ready for prime time today? No," Rosenberg says. “Can we do it in most patients today? No." He does believe however, that it’s the most promising treatment being explored for metastatic disease. "The excitement here is that we're attacking the very mutations that are unique to that patient's cancer and not in anybody else's cancer. So, it's about as personalized a treatment as you can imagine," Rosenberg says.

http://www.bbc.com/news/health-44338276

https://www.nature.com/articles/s41591-018-0040-8

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