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In a Heartbeat

Immunotherapy drug Opdivo might be effective for esophageal cancer

| Tuesday, Sept. 19, 2017, 11:45 a.m.
Dr. Blair Jobe
Dr. Blair Jobe

Allegheny Health Network and Johns Hopkins have launched a clinical trial to find out whether Opdivo, a popular immunotherapy drug, might be an effective treatment for esophageal cancer. Esophageal cancer is a deadly form of the disease with few treatment options that is projected to be diagnosed in about 17,000 new people in the United States this year. Dr. Blair Jobe, chairman of Allegheny Health Network's Esophageal and Lung Institute, provides details below.

What makes esophageal cancer particularly deadly?

Esophageal adenocarcinoma (EAC) is an aggressive cancer that is typically diagnosed in its later stages. By that time, the 5-year survival rate is less than 5 percent, with a median survival of six months. Current treatment strategies, usually chemotherapy followed by surgery, are of limited benefit, and advancements are desperately needed. What's more, EAC is on the increase, particularly in the northeastern Great Lakes region that includes Pennsylvania. It currently represents the sixth leading cause of cancer death worldwide.

How did Opdivo emerge as a potential esophageal cancer treatment?

Some patients with lung cancer and melanoma have seen dramatic results with Opdivo (nivolumab), but response in esophageal cancer so far has been minimal. Our research team at Allegheny Health Network and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins looked at how the immune microenvironment changes during chemotherapy and radiation, examining tissue samples from 31 esophageal cancer patients and in an animal model of the disease. We know that Opdivo can benefit patients with high levels of PD L-1, a protein that regulates a tumor's response to a patient's immune system. Our research found that PD-L1 expression levels were highest immediately after radiation treatment. We hope that the human body's dormant immune defenses can be tricked into recognizing and killing esophageal cancer cells when combined with chemo-radiation.

When might researchers know whether the drug is an effective treatment for esophageal cancer?

AHN and Johns Hopkins are launching a Phase 1B clinical trial which will enroll 32 patients over two years, evaluating Opdivo's safety, response rates and progression-free survival in locally advanced cancer cases. If successful, it will be followed by a global Phase III registration trial comparing the efficacy of Opdivo combined with chemo-radiation to our current standard of care.

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