Immunotherapy for MBC

Grannax2
Grannax2 Member Posts: 2,551
edited January 2018 in Stage IV/Metastatic Breast Cancer ONLY

Does anyone know of immunotherapy in clinical trials for MBC? Specifically for MBC Er+Pr+Her-? Or are there any companies working on that type of TX?

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  • zarovka
    zarovka Member Posts: 3,607
    edited July 2017

    Grannax2 ....

    This is the best thread for that discussion. Make it a favorite if you are interested. It moves very slowly .... but several knowledgeable people post there when something happens. ERPR+ breast cancer is believed to be not immunogenic ... not a lot of immune cells make it into the tumors probably because they are good at creating a hostile environment. Immunotherapy is challenging for these types of cancers so most trials are focused elsewhere ... mostly on other cancers that are known to be more sensitive to an immune response but also on TNBC. TNBC is slightly more immunogenic and doesn't have a lot of treatment options so that has been the push for MBC at least as far as PD-1 inhibitors like Keytruda go. These drugs take the brakes off the immune system and generally synonomous with immunotherapy.

    In fact, immunotherapy is a a much much more diverse bag of tools and the NIH has a number of trials that do accept ERPR+ patients ... you need to be on your second or third line of therapy. These trials are not for sissies ... you are hospitalized for a month and not just for observation. But they have some remarkable successes. The research nurse who coordinates vetting patients for all the immunotherapy trials at the NIH Contact: Colleen E Buckley, R.N. (866) 820-4505 ncisbirc@mail.nih.gov. The important thing is to contact them well before you might need the treatment ... it takes months to get through their procedures and you really need to be on an effective treatment for that period.

    >Z<

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  • HelenFaith
    HelenFaith Member Posts: 53
    edited July 2017

    Grannax2,

    I just spoke with one of the leading breast doctors at MD Anderson and asked him about Immunotherapy and he said MBC does not respond to this therapy, the success rate is only about 5%. I will be flying to MD Anderson to see this doctor on the 27th and will be asking lots of questions and will again question immunotherapy for MBC..

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  • Heidihill
    Heidihill Member Posts: 5,476
    edited July 2017

    HelenFaith, I just saw something in the newspaper a week ago about CAR-T (chimeric Antigen receptor-T) cell immunotherapy. A panel just recommended it be approved by the FDA for pediatric uses, so not breast cancer yet. Maybe your doctor would know if they are working on it for breast cancer? http://fortune.com/2017/07/12/fda-novartis-car-t-cancer-treatment/

    Good luck on your appointment.

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  • zarovka
    zarovka Member Posts: 3,607
    edited July 2017

    HelenFaith - If by immunotherapy, you mean PD-1 inhibitors then what your doctor is saying is correct. Immunotherapy, however, can be defined more broadly and, if you do, there are actually many trials involving ERPR+ MBC. The success rate is low but the effect is often enduring which can make it worth considering.

    >Z<

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  • illimae
    illimae Member Posts: 5,710
    edited July 2017

    Heidi, I saw the FDA approval news too and a show called Breakthrough where a Leukemia patient was cured using car-t cells, it was very promising.

    Helen, while I don't think we're there yet, this is the kind of work that could snowball into something useful. I have a follow up with my MO at MDA on Monday, I'll ask about it too :)

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  • Bestbird
    Bestbird Member Posts: 2,818
    edited July 2017

    An excellent link for finding Clinical Trials designed specifically for patients with mbc is located at this link (please be patient, as the website is slow).https://www.breastcancertrials.org/BCTIncludes/AvonPfizer/BCTDemo.html

    Note: There are several issues with this mbc clinical trial search tool that may prevent a full list of applicable trials from being displayed.To bypass these issues so that a complete list of relevant trials will be displayed, please follow the directions below.

    After launching the tool, please enter information only in the following sections and nowhere else.

    •Year of Birth

    •Female or Male

    •Pre-menopausal or Post-menopausal (presented if "Female" was selected above)

    •Breast cancer type

    The results can be filtered by type of therapy, such as hormonal therapy, vaccines and immunotherapy, etc.

    Once the list of clinical trials is displayed, patients can refine the list by selecting the specific type of trials they are interested in (such as Chemotherapy, Hormone Therapy, Targeted therapy, Vaccines and Immunotherapy, etc.) by clicking on the desired category next to the "Jump to" prompt near the top of the page.

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  • Cure-ious
    Cure-ious Member Posts: 2,626
    edited July 2017

    'There is no a priori reason that MBC should not respond to immunotherapy, but as a monotherapy it is not very functional. For breast and many other cancers, there is intense research to understand how to us it in combination to greatly increase the overall response rate. Trials are testing combining immunotherapy with HDAC inhibitors, chemotherapy, and other drugs or immunotherapies to try to find which combinations work best. Other immunotherapies, like anti-CD47, are still in early trials but work wonderfully in pre-clinical studies. CAR-T is yet another approach, and although clinical trials can be very time-intensive or expensive (if not local), they are great opportunity to get the latest cutting-edge treatment that would no doubt be cost-prohibitive for insurance companies that cannot work on such a personalized scale.MOs re not necessarily the most up-to-date on everything being tested in this fast-moving area.

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  • zarovka
    zarovka Member Posts: 3,607
    edited January 2018

    The key to making PDL-1 inhibition work for more than a limited subset is to combine PDL-1 inhibitions with other therapies that overcome immune suppression. This article summarizes the most promising combinations as of Dec 2017. One of them stands out because they have expanded the trial to include TNBC. Most work on checkpoint inhibition is not being done on breast cancer so this is great news.

    Anti-PD-1 in combination with IDO inhibitor (epacadostat)

    Indoleamine 2,3-dioxygenase 1 (IDO) is an immunosuppressive enzyme that modulates T-cell function (10). It catalyses the cleavage of L-tryptophan, with the metabolites promoting regulatory T-cell generation and blocking of effector T-cell activation, which can contribute to immune surveillance avoidance by tumour cells. Epacadostat is a potent and selective inhibitor of IDO which, combined with ipilimumab and pembrolizumab (11) in proof-of-concept studies, has shown strong efficacy with improved response rates compared with prior data for immune checkpoint inhibitors alone, with minimal additional toxicity. Recently, a large programme of trials of epacadostat plus pembrolizumab was initiated in patients across five tumour types: metastatic melanoma, non-small cell lung cancer, bladder cancer, renal cell carcinoma, and squamous cell carcinoma of the head and neck. Combinations of epacadostat plus nivolumab are also in clinical trials.

    This is the trial.

    https://clinicaltrials.gov/ct2/show/NCT02178722

    The results reported in 2016 on an initial group of 19 pts who were treatment-naive for advanced melanoma, are 4 CRs, 7 PRs, and 3 SDs. Basically 14 of 19 people responded with stable disease or better. Normally we are seeing 20% response rates to PDL-1 inhibition. If I had TNBC, I would be looking at this trial.

    >Z<

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