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For the first time, one of the new immunotherapy drugs has shown a promise against breast cancer in a major study that combined it with chemotherapy to treat an aggressive form of the disease. However, the benefits for most women were small, asking questions about whether treatment is worth its high costs and side effects.
The outcome was discussed on Saturday at a cancer conference in Munich and published by the New England Journal of Medicine.
Drugs called checkpoint inhibitors have transformed the treatment of many types of cancer by removing a chemical brake that keeps the immune system from killing tumor cells. Their discovery recently earned researchers at the Nobel Prize. So far, they have not proven to be valuable against breast cancer.
The new study tested one from Roche called Tecentriq plus kemo versus kemo alone in 902 women with advanced triple-negative breast cancer. About 15 percent of cases are this type – their growth is not driven by the hormones estrogen or progesterone or the genes that Herceptin targets, which makes them difficult to treat.
Women in the study who received Tecentriq plus kemo went on average on average for two months without their cancer becoming more difficult than those who are only chemo – a modest advantage. Combo did not significantly improve survival in an early perspective before long-term follow-up is complete.
Previous studies showed that immunotherapy works best in patients with high levels of a protein that the drug paints and the plan for breast cancer study required to analyze how women went according to the fact that Tecentriq improved overall survival.
The drug failed that test, but researchers still looked at protein-level results and saw encouraging signs. Women with high levels receiving combination treatment lived approximately 25 months on average compared with about 15 months for women who received kemo alone.
It’s a big difference, but it takes longer to see if there’s a reliable way to predict benefits, Dr. Jennifer Litton from MD Anderson Cancer Center in Houston said. She had no role in running the study but included a few patients in it and supervised 14 other testing immunotherapies.
“We are really hopeful that we can identify a group of women who can get a much bigger and longer response.”
Another breast cancer specialist without role in the study, Dr. Michael Hassett at the Dana-Farber Cancer Institute in Boston said he felt “careful excitement” that immunotherapy might be useful for some breast cancer patients.  Side effects need a closer look, both doctors said. Almost all study participants had typical chemo-side effects such as nausea or low blood cells, but severe were more common with combination therapy and twice as many women on discontinued treatment for that reason.
Three of the six deaths from side effects in the combination group were blamed for the treatment themselves; Only one in three such deaths in the chemistry group were.
The cost is another concern. Tecentriq is $ 12,500 per month. The subject of this study was Celg’s Abraxane, which costs about $ 3,000 per dose plus doctoral fees for IV treatments. Older chemotherapy costs less but requires patients to use a steroid to prevent allergic reactions that can interfere with immunotherapy. Abraxane was chosen because it avoids the need for a steroid, said a study leader, Dr. Sylvia Adams from NYU Langone Health.
The study was sponsored by Roche and many study leaders consult or work for the company or own stock in it.