The Keytruda and Immunotherapy Revolution
- New research has found evidence that cancer drug Keytruda can reverse HIV latency, potentially leading to a new HIV treatment option.
- The study participants included 32 cancer patients who also were living with HIV.
- This data, according to researchers, is “consistent with anti-PD-1 (Keytruda) being able to reverse HIV latency in vivo and support the rationale for combining (Keytruda) with other interventions to reduce the HIV reservoir.”
But now, researchers have found evidence that Keytruda can potentially reverse HIV latency, which is the ability for the virus to “hide” inside T cells of HIV patients. This newfound evidence, published this week in Science Translational Medicine, could lead to a new HIV treatment option, as Keytruda could flush the dormant virus from those cells.Read More
A research team at the Fred Hutchinson Cancer Research Center in Seattle conducted the study, and evaluated the impact of IV infusions of Keytruda on HIV latency; the infusions were given every three weeks. The study participants included 32 cancer patients who also were living with HIV.
The researchers observed a median 1.32 fold increase (a fold change is the measure describing how much a quantity has changed between an original and a subsequent measurement) in unspliced HIV RNA (similar to DNA).
It was also observed that there was a 1.61 fold increase in the unspliced RNA to DNA ratio in sorted CD4+ T cells. (CD4+ T cells help coordinate the immune response through stimulating other immune cells to help fight infection.) In addition, the researchers observed a 1.65 fold increase in plasma HIV RNA.
This data, according to researchers, is “consistent with anti-PD-1 (Keytruda) being able to reverse HIV latency in vivo (tests, experiments, and procedures that researchers perform in or on a whole living thing) and support the rationale for combining (Keytruda) with other interventions to reduce the HIV reservoir.”
According to Medical Xpress, Professor Sharon Lewin, director of the Peter Doherty Institute for Infection and Immunity and one of the study’s authors, says that, until now, “there had only been case reports to show the effect of anti-PD-1 (Keytruda) because people with HIV who also need this treatment for their cancer are very rare.”
“It’s not straightforward to bring this approach to the clinic in people living with HIV without cancer,” Professor Lewin says.
“The side effects of immunotherapy currently are significant, for example, five to 10 percent of people will get an adverse event,” she adds. “In a cancer setting this isn’t a major concern as you have a life-threatening illness, but in HIV, the situation is very different. People can now live normal and healthy lives with HIV, so any intervention for a cure must have very low toxicity.”
“In this study, we were able to show that in a cohort of 32 people who have cancer who are also living with HIV, pembrolizumab was able to perturb the HIV reservoir, which is a very exciting result and involved many groups around the world.”
The Keytruda and Immunotherapy Revolution
Immunotherapy is hailed as the new frontier in cancer treatment, and Dr. Steven Rosenberg is its pioneer. Dr. Rosenberg is chief of surgery at the National Cancer Institute.
One of his first ever surgeries, some 40 years ago, involved a man whose cancer had disappeared. That case set Dr. Rosenberg off on a four decades-long investigation into the possibilities of immunotherapy, researching how to harness the body’s own ability to fight cancer.
While there are many immunotherapy options, Keytruda is revolutionizing the cancer treatment world as it is gaining more and more U.S. Food and Drug Administration approvals to treat various types of cancers. In fact, in 2021 alone, Keytruda was approved 15 times to treat different types of cancers, from early-stage breast cancer to kidney cancer.
“Previously, (Keytruda) was used only for metastatic disease, but it’s shown such a good response there (treating early-stage triple-negative breast cancer) that now is used for earliest-stage disease, not because they have metastasis, but because it’s now been shown to reduce the risk of metastasis occurring,” Dr. Wui-Jin Koh, senior vice president and chief medical officer at the National Comprehensive Cancer Network, tells SurvivorNet.
Another example of immunotherapy drugs garnering additional approvals was in November when pembrolizumab was again approved by the FDA, this time for the adjuvant treatment (additional cancer treatment given after the primary treatment) of patients with renal cell carcinoma at an intermediate-high or high risk of recurrence following nephrectomy, or following nephrectomy and resection (removal) of metastatic lesions.
While this drug is great, “Keytruda is not for everyone,” Dr. Anna Pavlick, previously professor of medicine and dermatology at NYU Perlmutter Cancer Center and now a professor in the Division of Hematology & Medical Oncology at Weill Cornell Medicine, tells SurvivorNet.
She often has patients request the immunotherapy drug Keytruda in response to a commercial they have seen. However, it can be an effective immunotherapy, but in certain patients it may cause severe immune-related adverse effects.
So, the important thing is to talk to your doctor if you think Keytruda could be right for you.
Contributing: SurvivorNet staff