New research led by Queen Mary University of London and St Bartholomew's Hospital shows that a combination of immunotherapy and chemotherapy can tune the body's own immune system to attack triple-negative breast cancer
There is new hope for people with an aggressive type of breast cancer, as an immunotherapy trial shows for the first time that lives can be extended in people with triple-negative breast cancer.
New research led by Queen Mary University of London and St Bartholomew's Hospital has shown that by using a combination of immunotherapy and chemotherapy the body's own immune system can be tuned to attack triple-negative breast cancer, extending survival by up to ten months.
The research, which is published today in the New England Journal of Medicine and presented at the European Society for Medical Oncology 2018 Congress in Munich, also showed that the combined treatment reduced the risk of death or the cancer progressing by up to 40 per cent.
Triple-negative breast cancer often affects young women, with many people diagnosed in their 40s or 50s. The standard treatment is chemotherapy, which most patients quickly develop resistance to. If the disease spreads to other parts of the body, survival is often only 12 to 15 months.
The new treatment combines standard weekly chemotherapy with the immunotherapy medication atezolizumab which is given once every two weeks. The combination works by chemotherapy 'roughening up' the surface of the cancer, which enables the immune system to better recognise and therefore fight the cancer as a foreign object.
Author of the trial Professor Peter Schmid, Professor of Cancer Medicine at Queen Mary University of London and Clinical Director of the Breast Cancer Centre at St Bartholomew's Hospital, explained: "These results are a massive step forward. We are changing how triple-negative breast cancer is treated in proving for the first time that immune therapy has a substantial survival benefit. In a combined treatment approach, we are using chemotherapy to tear away the tumour's 'immune-protective cloak' to expose it as well as enabling people's own immune system to get at it.
"Triple-negative breast cancer is an aggressive form of breast cancer; we have been desperately looking for better treatment options. It is particularly tragic that those affected are often young, with many themselves having young families. I'm thrilled that by using a combination of immunotherapy and chemotherapy we are able to significantly extend lives compared to the standard treatment of chemotherapy alone."
Based on the results of this trial this new treatment is currently under review by health authorities and will hopefully become available in the NHS in the near future. In the interim, patients at St Bartholomew's Hospital with triple-negative breast cancer are offered immunotherapy within ongoing trials.
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A video explaining the research can be found on Dropbox here: http://bit. ly/ 2yJkOmE
Research paper: 'Atezolizumab and Nab-Paclitaxel in Advanced Triple-Negative Breast Cancer'. Peter Schmid et al. New England Journal of Medicine http://www. nejm. org
About Queen Mary University of London
Queen Mary University of London is a world-leading research-intensive university with over 25,000 students representing more than 160 nationalities. A member of the prestigious Russell Group, we work across the humanities and social sciences, medicine and dentistry, and science and engineering, with inspirational teaching directly informed by our research.
In the most recent exercise that rated research in the UK, we were ranked 5th in the country for the proportion of research outputs that were world-leading or internationally excellent. We offer more than 240 degree programmes and our reputation for excellent teaching was rewarded with a silver in the 2017 Teaching Excellence Framework (TEF) awards.
Queen Mary's history dates back to 1785, with the foundation of the London Hospital Medical College. Our history also encompasses the establishment of the People's Palace in 1887, which brought accessible education, culture and recreation to the East End of London. We also have roots in Westfield College, one of the first colleges to provide higher education to women.
With a turnover of £1.5 billion and a workforce of around 17,000, Barts Health is a leading healthcare provider in Britain and one of the largest NHS trusts in the country. The Trust's five hospitals - St Bartholomew's Hospital in the City, including the Barts Heart Centre, The Royal London Hospital in Whitechapel, Newham University Hospital in Plaistow, Whipps Cross University Hospital in Leytonstone and Mile End Hospital - deliver high quality compassionate care to the 2.5 million people of east London and beyond.
spottedram on October 21st, 2018 at 00:17 UTC »
I have Stage 4 breast cancer which has now returned for the second time in May. My oncologist gave me hope when she told me" we now know we can't cure you but you are treatable."
SeanDangerfield on October 20th, 2018 at 22:32 UTC »
TLDR : Success as defined by extending life by 2-4 months. Still, not bad, and a step in the right direction!
mvea on October 20th, 2018 at 20:36 UTC »
The title of the post is a copy and paste from the title and first paragraph of the linked academic press release here :
Journal Reference:
Atezolizumab and Nab-Paclitaxel in Advanced Triple-Negative Breast Cancer
Peter Schmid, M.D., Ph.D., Sylvia Adams, M.D., Hope S. Rugo, M.D., Andreas Schneeweiss, M.D., et al., for the IMpassion130 Trial Investigators*
NEJM, October 20, 2018
DOI: 10.1056/NEJMoa1809615
Link: https://www.nejm.org/doi/full/10.1056/NEJMoa1809615
Abstract
BACKGROUND
Unresectable locally advanced or metastatic triple-negative (hormone-receptor–negative and human epidermal growth factor receptor 2 [HER2]–negative) breast cancer is an aggressive disease with poor outcomes. Nanoparticle albumin-bound (nab)–paclitaxel may enhance the anticancer activity of atezolizumab.
METHODS
In this phase 3 trial, we randomly assigned (in a 1:1 ratio) patients with untreated metastatic triple-negative breast cancer to receive atezolizumab plus nab-paclitaxel or placebo plus nab-paclitaxel; patients continued the intervention until disease progression or an unacceptable level of toxic effects occurred. Stratification factors were the receipt or nonreceipt of neoadjuvant or adjuvant taxane therapy, the presence or absence of liver metastases at baseline, and programmed death ligand 1 (PD-L1) expression at baseline (positive vs. negative). The two primary end points were progression-free survival (in the intention-to-treat population and PD-L1–positive subgroup) and overall survival (tested in the intention-to-treat population; if the finding was significant, then it would be tested in the PD-L1–positive subgroup).
RESULTS
Each group included 451 patients (median follow-up, 12.9 months). In the intention-to-treat analysis, the median progression-free survival was 7.2 months with atezolizumab plus nab-paclitaxel, as compared with 5.5 months with placebo plus nab-paclitaxel (hazard ratio for progression or death, 0.80; 95% confidence interval [CI], 0.69 to 0.92; P=0.002); among patients with PD-L1–positive tumors, the median progression-free survival was 7.5 months and 5.0 months, respectively (hazard ratio, 0.62; 95% CI, 0.49 to 0.78; P<0.001). In the intention-to-treat analysis, the median overall survival was 21.3 months with atezolizumab plus nab-paclitaxel and 17.6 months with placebo plus nab-paclitaxel (hazard ratio for death, 0.84; 95% CI, 0.69 to 1.02; P=0.08); among patients with PD-L1–positive tumors, the median overall survival was 25.0 months and 15.5 months, respectively (hazard ratio, 0.62; 95% CI, 0.45 to 0.86). No new adverse effects were identified. Adverse events that led to the discontinuation of any agent occurred in 15.9% of the patients who received atezolizumab plus nab-paclitaxel and in 8.2% of those who received placebo plus nab-paclitaxel.
CONCLUSIONS
Atezolizumab plus nab-paclitaxel prolonged progression-free survival among patients with metastatic triple-negative breast cancer in both the intention-to-treat population and the PD-L1–positive subgroup. Adverse events were consistent with the known safety profiles of each agent.