Immunotherapy Comes of Age

Dr. Mary Jo Fidler on Using the Body’s Immune System to Fight Lung Cancer
By: Deborah Copaken

"I became interested in medicine in grade school after volunteering at an emergency room which I found exciting, and then in college I rode along with the student run emergency service," said Dr. Mary Jo Fidler, an oncologist at the Rush University Medical School who's turned her childhood passion for saving lives into a career in the burgeoning field of immunotherapy, particularly as it relates to the treatment of lung cancer.

Immunotherapy - using the body's own immune system to fight cancer - has become such a promising new weapon in the oncological arsenal that it has already attracted the attention of those far outside the medical establishment. Sean Parker, founder of Napster and founding president of Facebook, recently donated a whopping $250 million to the cause. Not that Dr. Fidler knew who Sean Parker was or had heard that Lady Gaga, Tom Hanks, Sean Penn, and Bradley Cooper were all guests or performers at his celebratory party.

"I missed that one," she said, laughing. "I have a little bit going on. I'm having a baby, I'm moving, we just got a dog." Humbly left off this list is the fact that Dr. Fidler spends the majority of her waking hours working to treat her patients with one of the most promising treatments of cancer in decades: immunotherapy. Recently, in the midst of her busy schedule and mere weeks before her due date, she allowed LUNG FORCE to ask her a few questions.

LUNG FORCE: What is the difference between immunotherapy and chemotherapy?

Dr. Mary Jo Fidler: Chemotherapy is basically a poison that affects cancer cells more so than regular cells in the body. It affects the cells usually during the process of replicating, in cell division. Immunotherapy currently available for lung cancer patients works by reactivating immune cells that have already "seen" the cancer but became silenced by its signals.

LF: So the general premise is to allow the patient's own immune system to attack the cancer, right?

MJF: Right, and research is ongoing to see if manipulating the immune system in other ways to attack the cancer will improve results.

LF: Would immunotherapy ever be the first thing you'd recommend?

MJF:This research in immunotherapy is moving very quickly. Recently we saw that patients with high expression of the PD-L1 protein, a biomarker for the most commonly used class of immune checkpoint inhibitors, was able to identify patients that would benefit from pembrolizumab as a first treatment. Right now I am reluctant to recommend immunotherapy in lung cancer as the first-line of defense for patients without high expression of this protein based on other available research but think that immunotherapy is still a great option for patients in the second-line treatment setting regardless of their tumors PD-L1 protein expression. We are still awaiting data from other PD-1 directed therapies and data combining these drugs with chemotherapy as a first treatment option. The important thing to keep in mind is that patients who have molecular drivers of their cancer (for example mutations in EGFR or ALK) still should have targeted therapy be their first treatment of choice, not immunotherapy or chemotherapy.

LF: It's ten years from now. Do you see immunotherapy as a more standard form of therapy for cancer?

MJF: I think right now immunotherapy has become a standard form of therapy for non-small cell lung cancer, just not up front for the majority of patients. A recent trial identified a group of patients that will likely benefit from upfront immunotherapy though this group is thought to represent only about 25% of lung cancer patients. I think ten years from now, there's a good chance that these kinds of drugs and agents will be used right away when patients are diagnosed. I think that immunotherapy will not replace surgery and radiation for curable, early stage cancer. There are many clinical trials underway, and we hope that with the excitement and the many patients participating, that this new therapeutic field will advance very quickly.

LF: What is your greatest challenge right now in terms of pushing forward with immunotherapy?

MJF: I think identifying the patients most likely to benefit from immunotherapy is the greatest challenge. In the future I hope we can identify which patients may benefit more from the currently available agents, from combination immunotherapy strategies, or even from chemotherapy.

LF: Do you have any advice for someone who is considering going on immunotherapy? What could help them manage their expectations?

MJF: We're still working on who the best patients are for immunotherapy. It may not replace tried-and-true treatments that we have for lung cancer in certain settings, but I think that there's great excitement. But, we're still really working to identify the best patients for it and find out when is the best time to use it.

Watch two LUNG FORCE Heroes and Dr. Fidler discuss lung cancer immunotherapy.

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