For this 78-year-old patient, it seemed like the end of the line. His battle with cancer started two years ago when he was first diagnosed with early stage tonsil cancer. Within six to eight months, the disease had already spread to his lungs.
The patient received chemotherapy and radiation therapy, and for a time, the cancer seemed to have responded to the treatments. But less than half a year after the last cycle, the cancer came back.
This is one unfortunate case of head and neck cancer, which covers cancers of the mouth, nose, sinuses, salivary glands, throat, and lymph nodes in the neck.
“In head and neck cancer, over 90% of patients come in the early stages of the disease, because usually symptoms are in the mouth, the throat, or in the neck lymph node, which can easily be seen,” said Prof. Morteza Aghmesheh, an oncologist and cancer researcher from the Wollongong Hospital in Australia.
“Our problem is the rate of recurrence – it is very high. In more than half of the patients, the cancer recurs, and only 40% of the patients get to live for five more years,” he added.
Morteza shared these in a recently-held symposium attended by cancer experts, clinicians, and stakeholders such as the Department of Health and the Philippine Alliance of Patient Organizations, to discuss updates and innovations on early cancer detection, treatment, and patient and caregiver support.
During his sharing on head and neck cancer, Aghmesheh said that under usual circumstances, this 78-year-old patient would be out of options: “Only 5% of head and neck cancer patients respond to the second line of chemotherapy, and the median life expectancy is down to six months. Also, given his history, this patient was no longer a candidate for radiation and he was not a candidate for surgery. This patient would have been dead.”
Fortunately, he received a new form of cancer therapy that was approved around the time that his relapse was discovered. This treatment was called immunotherapy and it was applied through an immune checkpoint blocker called pembrolizumab. Unlike the mechanism of chemotherapy, immunotherapy fights the cancer by enabling the immune system to recognize and fight cancer cells.
Today, two years after his first immunotherapy treatment started, the patient is alive and shows no symptoms, Aghmesheh reported.
“The interesting thing about immunotherapy is, when a patient is responsive to it, he or she will usually continue to receive benefits from the treatment. So when you follow these patients for two years, you’ll find that 70 to 80 percent of them remain responsive to the treatment. That is not the case with chemo,” Aghmesheh said.
The difference, he explained, is that chemotherapy directly targets the cancer cells in a process that also harms other healthy cells, inevitably causing a multitude of undue effects. Immunotherapy, on the other hand, strengthens the immune system so it is able to fight the cancer. The immune system remembers the cancer cells and attacks them when the cancer recurs.
A second case described by Aghmesheh involved a 60-year-old patient—also diagnosed with cancer recurrence—who had so much pain in his right jaw that he needed a high-dose opioid patch to drive up levels of the feel-good hormone dopamine. But even then, his pain was poorly controlled.
“After three rounds of pembrolizumab, he started to say, ‘I don’t feel any pain.’ So I started to reduce his analgesia. Within four months, he was no longer on any painkiller. His scans show his lymph nodes are continuously shrinking. There’s a good chance that in the next few months he will have complete remission,” said Aghmesheh.
Aghmesheh added that similar results are being seen in other fields of cancer treatment, such as lung cancer and melanoma. Disabling symptoms disappear, sometimes as early as the second or third dose. Most importantly, most of the patients that respond positively continue to do so.
“In cancer treatment, we are now talking about getting a portion of advanced cancer patients that have high potentials of being cured and it was previously unheard of,” added Aghmesheh.
Today, in the Philippines, pembrolizumab is already approved for the treatment of head and neck squamous cell carcinoma, non-small cell lung cancer, melanoma, gastric cancer, urothelial cancer, and classic Hodgkin’s lymphoma. Potential patients may consult their medical oncologist to learn more about immunotherapy.
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