Finally, Some Much-Needed Esophageal Cancer Progress
- A new drug called Tevimbra (Tislelizumab-jsgr) is now FDA-approved for advanced or metastatic esophageal cancer, which is extremely difficult to treat
- Tevimbra is an immunotherapy drug. Immunotherapy works by boosting the immune system’s response to fight cancer.
- The approval was based on the RATIONALE-302 trial, which was designed to investigate the efficacy and safety of Tevimbra when compared with regular chemotherapy.
- Tevimbra significantly improved overall survival (how long a patient lives after they are diagnosed or begin treatment).
A promising new therapy for advanced, or metastatic, esophageal cancer was recently approved by the Food and Drug Administration (FDA). This new drug belongs to a class of immunotherapy agents and is called Tislelizumab-jsgr (brand name Tevimbra).
Read MoreWhat is Immunotherapy?
The immune system uses its white blood cells to attack cells in the body that are abnormal or foreign. Cancerous cells have the ability to prevent the immune system from doing its job. The cancer produces certain proteins to protect the tumor from white blood cells. As a result, the body does not recognize the tumor as abnormal.Immunotherapy drugs, like Tevimbra, stop this from happening and ensure the white blood cells recognize the cancer cell properly and attack it. The cancer cells themselves are not necessarily difficult to fight. However, they continue to divide rapidly. So, immunotherapy drugs help a patient’s immune system control their cancer on its own before it can spread.
Esophageal cancer isn’t as common as breast or prostate cancer, but it tends to have a worse prognosis. “Esophageal cancer, we know is a tough one,” Dr. Brendon Stiles, a thoracic surgeon at Montefiore Medical Center, told SurvivorNet. “It’s one of the cancers with some of the lowest cure rates out there, but like many cancers, if we find it early, we can often treat it effectively.”
But now, there is a new hopeful treatment for patients with advanced esophageal squamous-cell carcinoma (ESCC).
“Immunotherapy is here to stay. And it’s really changed the face of cancer,” Dr. Stiles says.
PD-L1 and PD-1 inhibitors
Tevimbra belongs to a class of immunotherapy drugs called anti-PD-1 monoclonal antibody.
PD-L1 is a protein found on cancer cells while PD-1 is a protein found on normal cells. When they bind to each other, the immune system fails to recognize the cancer cell and switches off its defense mechanism marking the cancer cell as a normal cell. Between 40% and 50% of people with esophageal cancer have this protein.
Antibodies that target PD-L1 on cancer cells play a critical role in preventing the binding between normal and cancer cells (PD-L1 and PD-1) which activates the immune system (specifically T-cells) to recognize the cancer cell and stimulate an immune response.
While immunotherapy drugs are gaining more popularity, it’s important to know that, as with any drug, they can come with side effects.
Side Effects
Like all cancer treatments, immunotherapy can cause uncomfortable side effects. Dr. Mohana Roy, clinical assistant professor at Stanford University School of Medicine, told SurvivorNet that most of her patients tolerate immunotherapy very well, but about 10% experience issues.
Common side effects include:
- Increased glucose levels
- Anemia (low red blood cells)
- Feeling tired (fatigue)
- Rashes
- Diarrhea and upset stomach
- Weakness
- Headache
- Impaired thyroid function
A concern with revving up the body’s immune system is that it could trigger significant inflammation. The body could start attacking its own organs, which can lead to serious and permanent issues.
With immunotherapy, it’s critical to inform your doctor about any side effects you may be experiencing.
“You do not know who it will affect and who it will not,” Dr. Roy said. “When I start someone on immunotherapy, I say, ‘Anything weird, I need to know about it.'”
Treating Esophageal Cancer With Immunotherapy
Immunotherapy is among the most-watched areas of medicine and is a relatively new type of cancer treatment. It harnesses the power of the immune system to recognize and kill cancer cells. In some patients, the results can be life-changing.
It’s already proved enormously effective in treating several cancers, but it doesn’t work for everyone.
Dr. Steven Rosenberg, Chief of Surgery at the National Cancer Institute, is a pioneer in immunotherapy research and treatment.
“Using a patient’s own immune cells is a very complex way to treat a cancer,” Dr. Rosenberg previously told SurvivorNet. His team has developed methods for genetically modifying a patient’s own immune cells “to recognize the cancer in a new way” and to kill it.
Thankfully, the government has approved new immunotherapy drugs to treat esophageal cancer, bringing hope to patients with advanced disease.
The New Approval
The approval is based on the RATIONALE-302 trial, a global, phase III study designed to investigate the efficacy and safety of Tevimbra when compared with regular chemotherapy for patients with unresectable (non-operable), locally advanced or metastatic ESCC.
Phase III trials are the most important piece of scientific evidence needed to approve new drugs.
Tevimbra significantly improved overall survival (OS) when compared to chemotherapy. Overall survival means how long people with a certain disease live after they are diagnosed or start treatment.
Patients treated with new drug had a median OS of 8.6 months versus 6.3 months for those receiving regular chemotherapy. After one year of treatment, the OS rate with Tevimbra was 37.4% vs. 23.7% with chemotherapy.
Coping with the Diagnosis
Coping with advanced esophageal cancer is challenging, but there are ways to manage the emotional and physical toll.
Experts recommend trying prioritizing the following:
- Seek Support: Connect with support groups, therapists, or spiritual advisors who can provide emotional support and guidance.
- Manage Symptoms: Work with your healthcare team to control symptoms and improve your quality of life. Palliative care can be particularly beneficial.
- Stay Informed: Understanding your condition and treatment options can help you feel more in control.
- Focus on Quality of Life: Prioritize activities and relationships that bring you joy and comfort.
While advanced esophageal cancer is a serious diagnosis, there is still hope. Treatments such Tevimbra can help manage the disease and prolong life.
Questions to Ask Your Doctor
- How aggressively should we treat my cancer?
- Am I eligible to receive Tevimbra? Am I more, or less, likely to respond to this treatment?
- What is my tumor’s PDL-1 level?
- What are the most common side effects of immunotherapy and how can I manage them?
- How much will this treatment cost?
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