Video Transcript
Innovations in Chemotherapy and Immunotherapy
The Head & Neck Cancer Innovations 2020 Video Series is brought to you by St Vincent’s Hospital Sydney & The Kinghorn Cancer Centre. In this episode we talk to medical oncologist and researcher, Dr Venessa Chin and medical oncologist and researcher, Dr Amy Prawira about innovations in chemotherapy and immunotherapy in the treatment of head & neck cancer patients. We also meet head & neck cancer survivor and advocate, Maureen Jansen. For more information please visit our website or our You Tube channel. The podcast versions can be found on our SoundCloud channel.
Julie McCrossin, Head & Neck Cancer Survivor
Dr Venessa Chin, Medical Oncologist & Researcher, The Kinghorn Cancer Centre & The Garvin Institute of Medical Research.
Dr Amy Prawira, Medical Oncologist & Researcher, The Kinghorn Cancer Centre.
Maureen Jansen, Head & Neck Cancer Survivor, Head and Neck Cancer Support Aotearoa.
Julie McCrossin
Hello, my name is Julie McCrossin. And it’s my great pleasure to welcome you to this video on innovations in chemotherapy and immunotherapy. And it’s part of a series of videos for head and neck cancer patients, family members, and multidisciplinary team members, all about innovations in treatment to improve survival, and, very importantly, quality of life.
Seven years ago, I was treated for stage four oropharyngeal cancer. That means cancer in my tonsils, the back of my tongue and the side of my throat. And, indeed, I had my chemotherapy in this building The Kinghorn Cancer Centre. These videos are hosted by The Kinghorn Cancer Centre and St Vincent’s Hospital Sydney. So it’s my great pleasure now to introduce the two doctors who are going to talk to us now about chemotherapy and immunotherapy.
First of all, Amy, can you introduce yourself?
Amy Prawira
Sure. Well, thanks, Julie for hosting this wonderful event. My name is Amy Prawira. I’m one of the medical oncologists here at The Kinghorn Cancer Centre. I specialize in looking after patients with head and cancer and my other specialty is early phase clinical trials. So patients with advanced malignancy,
Julie McCrossin
And we’ll hear more about clinical trials later. And could you introduce yourself Venessa?
Venessa Chin
My name is Venessa Chin. I’m also a medical oncologist here at The Kinghorn Cancer Centre and St. Vincent’s Hospital. And I also work at The Garvin Institute as a postdoctoral research officer and I focus on head and neck cancers and lung cancer.
Julie McCrossin
Can I ask you, let’s talk about chemotherapy. What is chemotherapy? How does it work?
Venessa Chin
So chemotherapy are medications, usually given through a drip or intravenously, but occasionally via tablets. And they are drugs that seek out cells in the body that are rapidly dividing. So cancer cells in general divide rapidly and they are susceptible to these drugs. And these drugs cause cell death.
Where we get the side effects is where the drugs are also targeting other cells in the body that are rapidly dividing, like the cells that lie in the bowel, or your hair or cells that line the mouth.
Julie McCrossin
Okay, so that’s why chemotherapy is good for killing cancer cells, but it may damage healthy cells in some parts of the body.
Venessa Chin
That’s right.
Julie McCrossin
I see. And what are the names of the common chemotherapy medications that are used for head and neck cancer patients?
Venessa Chin
So one of the most common drugs is called Cisplatin, or a closely-associated drug, Carboplatin. Another drug that’s commonly used is 5-Fluorouracil. There’s also a class of drugs called the Taxanes. And also the immunotherapy drugs, which I think we’ll talk about a little bit later.
Julie McCrossin
And how do you decide what chemotherapy medication to give to a head and neck cancer patient?
Venessa Chin
It depends what kind of treatment they’re having. For example, a patient who’s having combination chemotherapy and radiation, similar to you, we will nearly always use a platinum-based chemotherapy with radiation. There are some exceptions to that.
In patients who have advanced cancer, where we’re treating them with just chemotherapy alone, we commonly use, again, a platinum, but also with a second drug. And that’s commonly the 5-Fluorouracil. So it really depends on the stage of cancer. What the goals of treatment are. And also on the patient.
So giving a patient two chemotherapy drugs can be intense and not everybody’s body is able to take that intense therapy. So things can be modified if a patient has certain other medical problems, like heart disease, for example. So all those things are taken into account.
Julie McCrossin
What are the potential benefits of chemotherapy for the head and neck cancer patient? But also what are some of the potential difficulties and side effects and challenges? And what can you do about them if you get them?
Venessa Chin
So benefits again depend on what the goals of treatment are. So in a patient having combination chemotherapy and radiation for a localized cancer, the addition of chemotherapy, we think makes the radiation work better. So we know that in trials that have been conducted that patients that had both therapies together had better outcomes than patients who had radiation alone. So there’s some synergy there. Okay.
In a patient with advanced cancer, we’re trying to get some control over the cancer and in a patient in whom chemotherapy works, we expect that patient to live longer than a patient that doesn’t have chemotherapy. The side effects are quite common. Okay. They really are quite common.
Julie McCrossin
Could you give them in a little list?
Venessa Chin
The most common side effect we would see would be fatigue. I would say that that’s almost universal. Okay. Nausea would be the next most common side effect, but with the improvement of nausea medication, we don’t usually get a lot of vomiting. Okay. And then beyond that there are side effects which might be a little bit more specific to the drugs that are used. So common ones would be mouth ulcers and pain in the mouth, low blood counts and sometimes diarrhea.
And I think the way to manage them effectively is to read any information that your treating team have given you. But also letting the team know if you’re getting side effects that are either severe, unexpected or not responding to any treatments that you may have been told to do. For example, if you’re getting nausea and vomiting that is not improving with nausea medication that you’ve been given, don’t wait. Don’t sit at home and suffer. There’s nearly always something that we can do to help.
Julie McCrossin
And are there longer-term side effects with some of these medications? For example, hearing loss? And if there are longer-term side effects, what can you do, if anything, to be ready for them and adapt to them effectively?
Venessa Chin
Well we can get longer term side effects, especially with the use of Cisplatin. Now, Cisplatin is an interesting drug because it is highly effective, but does have with it some significant long-term side effects. Now, I would say that there is only a minority of patients that go on to develop these in a permanent sense. Okay.
Julie McCrossin
And what are they?
Venessa Chin
So hearing loss is one, okay. Tinnitus. So sometimes tinnitus is also associated with hearing loss, but other times, it’s just more annoying but the hearing is normal.
Julie McCrossin
And what is tinnitus?
Venessa Chin
Tinnitus is ringing in the ears, or it’s not always a ringing. It’s perceived by an unwanted noise. Okay, it can be like a like a whooshing sound, or rushing sound, or that sound you get between radio stations., But a lot of people perceive it as ringing, okay. And that can be mild to severe and can cause distress in a small number of patients.
We can also get kidney impairment, okay, and also damage of the nerves in the fingers and toes. And again, those side effects do have a range of being mild to severe. Now in terms of trying to prepare or avoid those side effects, we do try and prepare patients for that possibility at the time that treatment begins and keep a close eye on those symptoms throughout the course of treatment. And treatment can be modified or even stopped if those side effects are manifesting during treatment.
There are patients, however, who get through their treatment fine and then later on down the track develop these. And responding to those is really in a supportive nature. So hearing aids, or maskers that can mask that irritating sort of noise. Supporting renal function. And also with the peripheral neuropathy, or the altered sensation in the fingers and toes, often that does improve with time. So the measures are really supportive.
Julie McCrossin
If someone is watching this and some of these side effects have turned up and it’s a few years after treatment at the cancer centre. One issue you hear patients talking about is, do I go back to my cancer doctor or do I go to my GP, my general practitioner? And are general practitioners sufficiently aware of these issues and what to do about them? What would you say?
Venessa Chin
So I would always say you need to go back to the doctors that you feel you have the best relationship with. And often, after an episode of treatment with head and neck cancer, you do have a very close relationship with your oncologist because you’ve been seeing them every three weeks for months and months. So I would say your oncologist is a good place to start.
However, there are some GPs who are very skilled in this area and would feel very comfortable helping with those supportive measures. So I don’t think there’s any right or wrong answer there. There are also certain supportive, skilled nurses, who might be part of the multidisciplinary team, who are also often will linked into those supportive services.
Julie McCrossin
Just before I go to the innovations that are offering some hope now, or in the future, with chemotherapy, I wanted to ask you, is there a variation between patients as to how well they respond or tolerate medications? You’ve mentioned Cisplatin, and I remember, correct me if I’m wrong, that before I had it, they put a whole lot of liquid into me through a drip.
And then I had to wee into something to prove that my kidneys were working, and I was tremendously excited to produce volumes of urine. But, I gathered, I assume they were testing my kidneys. So are the variations in how people tolerate?
Venessa Chin
So that process that you went through is a process that all patients go through having Cisplatin because Cisplatin can damage the kidneys. We try and essentially flush the kidneys before and after we administer the Cisplatin. And that has been shown to protect the kidneys. So, to answer your question, yes. There is a difference between how well patients respond. And we see that sort of more immediately in the patients with incurable cancer, where we’re giving the chemotherapy to hopefully shrink and control the tumor.
And what we know is, even with the best chemotherapy agents that we have, only about half of people will have a shrinkage of their tumor. Now in that other half, what we don’t know is why have they not had their tumor shrunk. Okay? And what we think it is, is there is just different people have different types of tumours, and those tumours are susceptible or not susceptible to specific treatments. And what we don’t have is a sophisticated way of telling people up front, what treatments might best suit them.
So that is an area in the field that needs more work. And what would be ideal is if we could do some kind of sophisticated test at diagnosis and say, yes, you need treatment X and Y, but Z is not going to help you. So we’re not there yet.
Julie McCrossin
Just before we turn to innovations, it just really strikes me listening to you, I’m a member of a number of patient Facebook sites, as many patients are. They are run by patients. And it’s very common for people to ask about particular chemotherapies, or other treatments. And really, one person’s experience may be extraordinarily different to another. And that’s just something to hold in mind if you’re a patient?
Venessa Chin
I think so. I mean, we really don’t know ahead of time, what is going to happen to any given patient. I mean, I’m sure Amy’s had the same experience. You have a patient where you think things are going to go very badly, and things go brilliantly well. And then, of course, the reverse is true.
So I think, what it’s up to the patient, with their doctor, is to decide: one, if they want to go ahead with treatment, and for the doctor to decide what is safe and reasonable. But the rest is really unknown at the start.
Julie McCrossin
Are there any innovations in chemotherapy to mention before we go to immunotherapy?
Venessa Chin
So the things that are really going on in the chemotherapy space are trying to work out, as I discussed before, whether we can predict which patients are going to benefit from which drugs. So doing work in the lab, where we can take a specimen of cancer, and grow it in a petri dish, and see whether or not we can predict whether a patient will respond to certain drugs, but in a timeframe that suits the patient.
Now, these methods are already in existence, but they take several months, which clearly does not suit a patient who’s waiting for treatment. So can these methods be sped up and be done in say a couple of weeks which would suit a patient. There are also trials looking at how we can protect the ears, particularly from drugs like Cisplatin. And I think it’s important to mention that one of the advances that has happened in the last couple of years is a significant improvement in our anti-nausea medication.
So even when I was going through my training, delivering Cisplatin was very difficult, because it’s a highly nauseating drug. And so the drugs that we have now, it’s a single tablet that’s taken on the day of treatment, and almost nobody gets nauseated enough to vomit. And people really just do feel a bit sort of yuck for a couple of days. But then it goes very quickly. And that’s been a massive improvement even in the last five years.
Julie McCrossin
That’s fantastic. Look, thank you. And I’ll just let people know we’re talking to Dr. Venessa Chin. And in a moment Dr. Amy Prawira. And we’re talking about chemotherapy and immunotherapy and clinical trials, as part of a series of videos. It’s all about innovations in the treatment for head and neck cancer patients. We’re trying to survive, better and longer, and also have a better quality of life.
Look, I want to ask you about immunotherapy. And I went, like any patient often does, to the Cancer Council to have a look at one of their booklets. And they said immunotherapy is a type of cancer treatment which assists the body’s immune system to fight cancer.
And they said that one of the most widely used immunotherapies is a checkpoint inhibitor. And that some of them are funded by our Pharmaceutical Benefits Scheme, which means, you know, we get them at a very low rate of cost. Can you tell us the names of the main medications as patients would hear about them? And then which of them are available on the Pharmaceutical Benefits Scheme? For sure.
Amy Prawira
So I’ll answer your second question first. One of the immune checkpoint inhibitors, or immunotherapy, that’s currently funded by our PBS or Pharmaceutical Benefits Scheme is Nivolumab. The brand name is Opdivo. But in recent months, there has been new updates where another checkpoint inhibitor, immune checkpoint inhibitor, called Pembrolizumab, the brand name of which is Keytruda, has been shown to have activity in what we call a first-line treatment setting. Or in patients whose disease is incurable but has never had treatment before.
Now, these two drugs, obviously are drugs of the same class. So as in, they should work the same way. But we don’t really know whether one is better than the other. Essentially, personally, I do use them in the same way. But there are two options of drugs in the immune checkpoint category for patients with head and neck cancer, and one of them is available on our PBS
Julie McCrossin
So only one is available on the PBS. And that’s Opdivo.
Amy Prawira
Yes.
Julie McCrossin
Okay. Thank you. Could you give me one or two examples of patients that, obviously will protect their privacy, but of actual patients where you’ve prescribed Opdivo, so that we understand the circumstances in which a patient with head and neck cancer will get access to immunotherapy.
Amy Prawira
For sure. So I’ll talk about that in two scenarios. First are patients who obtain all of their treatment under the PBS, or standard of care in Australian standards. And the second is the other way to access immunotherapy, at different stages of your treatment, through clinical trials.
So currently, under PBS, the first-line treatment, if a patient is diagnosed with incurable disease, is chemotherapy. Either one agent or a combination of a few chemotherapy drugs together. And, if and when the cancer evolved to become resistant to that, then to go on to have Opdivo or Nivolumab as funded by PBS which is the immunotherapy. So I have prescribed Nivolumab under the PBS, you know, coverage in patients whose disease have become clever to chemo therapy
Julie McCrossin
And is it an option for all head and neck cancer patients whose chemotherapy is no longer being effective, or is it only for certain head and neck cancer patients?
Amy Prawira
So that’s a very good point. So you’re right, it is only for certain kinds of head and neck cancer. So the most common type of head and neck cancers occurs within the mouth and within the airways. So, in broad terms, these are the cancers in which immunotherapy has shown benefit.
But, like sort of, the same kind of cancer, even though they look the same under the microscope, can occur anywhere else, for example, in the sinuses, or sometimes even on the skin. They tend to be treated slightly differently. And immunotherapy is funded like for skin cancers completely separate, but for head and neck cancers outside of the mouth and the airway as well, it’s not funded under the same umbrella.
Julie McCrossin
If I’m currently a patient being treated for head and neck cancer, and I want to see if I can get access to immunotherapy through a clinical trial, what sort of patients would go through a clinical trial and what would be the benefit for the patient of taking that approach?
Amy Prawira
Currently, immunotherapy is funded by the PBS in patients whose disease have become clever to chemotherapy. But the new evidence around the world, in new clinical trials, have shown that there is some benefit to giving immunotherapy earlier on before the cancer becomes resistant to chemotherapy.
Julie McCrossin
I see. So clinical trials may offer the opportunity to get access to immunotherapy before the chemotherapy starts to fail. So what advantage may there be in getting really early access to it?
Amy Prawira
So in the recent clinical trial, they showed that if the cancer bears certain markers on their surface, patients might do a bit better when they have immunotherapy earlier on.
Julie McCrossin
So if you wanted to think of the two or three most important messages for patients listening to this, because, as you know, many patients wonder, “will immunotherapy help me?”, because there’s a bit of media coverage about it. What are the two or three most important things for patients to remember about immunotherapy right now if they are still in treatment?
Amy Prawira
So I think, when it comes to immunotherapy, there is a lot of hype. Some of it are founded. Some of it are unfounded. So it’s important to know that immunotherapy doesn’t work for everybody. So even though immunotherapy there’s a lot of hype, because it has offered hope for a disease where we haven’t seen good outcomes, haven’t seen new treatment with good outcomes for years.
So there is some truth in that. But for a lot of our patients, it doesn’t work and we still need to do better. And that’s why, you know, a lot of clinical trials are looking at having more treatment, or combinations, to make sure that it works for more patients, if not the majority or all patients.
Julie McCrossin
I see, so there’s hope with immunotherapy, but still a lot more work to be done? And what work are you doing, over the next five years, because this is a program about innovation? What are the sorts of studies that you hope to be involved in? And the results you dream of having for your head and neck cancer patients?
Amy Prawira
So there are studies that we are trying to run within the institution, within the clinical trial setting, that I’m running with some of my colleagues here at The Kinghorn and at The Garvan Institute, to try to combine treatments to make the immunotherapy work better. That’s what we’re trying to get off the ground.
Julie McCrossin
Amy, thank you so much. That was just so helpful. And I want to let you know that if you’ve got any questions about immunotherapy, you can always get a brochure from Cancer Council Australia, or Cancer Council in your state and territory. Or you can ring their Information and Support Line 13 11 20. And they can send you information, offer you advice and information and refer you to other people.
But it gives me great pleasure to now introduce a second medical oncologist who’s also going to talk to us about immunotherapy. Because it’s such a complex topic and I think it’s always good to hear a number of points of view so welcome to you.
Venessa Chin
So I think immune therapy really invigorates your immune system. We know that in patients with cancer, their immune system isn’t functioning normally. Because it’s allowed the cancer to flourish, okay? And so what these immune treatments are doing are kind of ramping up or reinvigorating the immune system so that they can attack the cancer cells.
Julie McCrossin
And why aren’t they available early on for everybody if the doctor thinks it’s okay?
Venessa Chin
So at the moment, there is a slight difference between what we know works, but what is available. Okay, so as Amy said, what is available free-of-charge to patients in Australia is access to immune therapy only after chemotherapy has stopped working.
Now in a clinical trial, that was reported last year, it was shown that immune therapy, earlier on in a patient’s treatment, so as the first treatment, either by itself or in combination with chemotherapy, can be of benefit for some patients. Okay. That is not yet funded in Australia. Okay. So that patients can access immune therapy, as their first treatment. But with an out of pocket cost.
Julie McCrossin
How significant is that cost?
Venessa Chin
It’s very significant. It’s around about six and a half thousand dollars per dose. And that’s every three weeks.
Julie McCrossin
And do you have patients who are trying to get that money and keep themselves alive?
Venessa Chin
So I have had a very small number of patients fund it for themselves. Yes.
Julie McCrossin
What I’d like to do if I may is hear from each of you. What are the innovations or new treatments, novel treatments ,that are on the horizon?
Venessa Chin
So I think one of the other things that is happening is whether immune therapy can help people who are undergoing definitive radiation, or even surgery to treat their cancer. So at the moment immune therapy is mainly being used in the incurable setting. But is it helpful for patients having curable or curative treatments?
And so there are clinical trials looking at using immune therapy in patients who are having combination chemo radiation, but also around surgery. So that’s one area of really interesting research. And an area that that interests me particularly is whether we can select those people who are, or are not, going to benefit from immune therapy? Is there a more sophisticated and reliable way of doing this? The markers that we have at the moment are the best we have, but they don’t work very well.
Julie McCrossin
What proportion of patients who receive immunotherapy, immune therapy, now benefit?
Venessa Chin
So for the listed indication of people having immune therapy after chemotherapy, it’s about 20% of patients get a response, meaning that their cancer shrinks. So that’s not a very high percentage. Now in the first line setting, okay, so when people who have immune therapy as their first treatment, it’s somewhere between 40% and 47%, I think, off the top of my head, so it’s still less than half.
And bearing in mind those patients are selected by a biomarker, so a test that’s done on their tumour, okay. So in those people who have a positive test in their tumour, so that’s not everybody, of those people, it’s still less than half of people will have a response.
Julie McCrossin
Just before I ask you some final questions, I’m thinking of rural and remote patients. Is it ever possible to have your chemotherapy or your immunotherapy in another location? Or do you always have to travel in to the primary cancer centre, where you’re receiving your treatment, even if that’s at a great distance?
Venessa Chin
I always say to my patients, it’s better to go local. Unless there is something that we can offer you in this tertiary centre that you can’t have close to home. A thing that’s important to remember is, even if your treatment is going really well, you will not feel well all the time. And having long periods of travel can become really difficult really quickly.
Julie McCrossin
And what does tertiary mean?
Venessa Chin
So tertiary usually refers to a large metropolitan hospital, okay, where we’ve got access to all the disciplines that are involved in the management of patients with head and neck cancer like surgeons medical oncology, radiation oncology, nursing. Now, the rural centres may not have access to all of those disciplines, but they will nearly always have a medical oncologist and also oncology nursing staff that are able to administer medication.
Julie McCrossin
What I want to ask you now is, what are the most common questions that you get from patients? And I’m particularly keen for you to tell me if there’s something patients often ask about that. I haven’t asked you.
Venessa Chin
I would say the most common question I get asked is can I have immune therapy? So we’ve talked about that a lot. And my standard answer is, it doesn’t help everybody. Okay. And we do all the tests that we’ve sort of alluded to during this discussion and decide whether or not it’s the best first treatment. Okay.
Also there are the constraints set by the Pharmaceutical Benefits Scheme here, which we have to acknowledge. If patients are very keen to access immune therapy as a first line treatment, then I try very hard to find them a clinical trial if that’s appropriate for them.
I think a lot of people want to know how long they’ll live. And that is a really difficult question to answer. And I think it often depends on at what point they are in their journey. Do they have a localized cancer, which they’re seeing me for? Do they have a locally advanced cancer or an incurable cancer? But I often try to give a worst-case best-case scenario, acknowledging that I am often wrong. And that that’s just a guide for them.
Julie McCrossin
Yes, because there’ll be some people listening to this, watching us today, who are thinking, if it’s incurable, why am I getting treated?
Venessa Chin
So we’re treating incurable cancers to help people live longer and better. Okay, so we know that cancers cause symptoms. They cause pain. They press on things. They make swallowing difficult. And that when chemotherapy works, it shrinks the cancer down and alleviates those symptoms.
We also know, from the trials that have been conducted before, that in patients in whom it works, they do live longer. So it is a personal choice. Not everybody wants to go through it because there are side effects. But in a best case scenario, that’s what we’re hoping to achieve
Julie McCrossin
And the key side effects?
Venessa Chin
The key side effects are the fatigue, nausea, and I think the thing that we need to also mention is the hassle. Okay, so patients are spending a lot of time at the hospital. They’ve got appointments. They’ve got blood tests. They’ve got treatment and scans. And often patients aren’t willing to go through all of that.
Julie McCrossin
Thank you so much, and Amy, what would be your key messages about immunotherapy obviously people are asking about it. What are the two or three things you want people watching this to remember?
Amy Prawira
Immunotherapy has offered hope in head and neck cancer, where we have not seen new treatments that work for a long time, for many years. So that is great in that sense, but unfortunately it doesn’t work for everybody. And we’re trying to constantly find ways, so that we have treatment that works, hopefully for the majority, if not all of our patients.
Julie McCrossin
Is there anything else I should say to our audience today, we’ve got some clinicians watching as well, what would be your message to members of multidisciplinary teams who have watched us?
Venessa Chin
I think it’s up to us as a community to raise awareness so that we can help patients but also spark research in this area. I mean, research in head and neck cancer is lagging behind some of the other solid malignancies. And without that research then, you know, nothing ever improves.
So whether that be basic science research, that we’re doing at The Garvan Institute, or whether that’s participating in a clinical trial, all those things are needed so that we can improve outcomes for cancer.
Maureen Jansen
Hello, I’m Maureen Jansen from Head and Neck Cancer Support Aotearoa. I’m here to ask a question about immunotherapy. It’s Keytruda that is approved but not funded in New Zealand. And a number of people seem to use it as a last resort. They have to use up their life insurance save to fund or give a little, And it hardly ever seems to work.
But lately, I’ve met a couple of people for whom it has been successful. And I’m asking if there are factors from the biomarkers that indicate a successful treatment with Keytruda? Is it something to do with where and how the cancers spreads? Is it to do with how well defined a cancer is? Or combinations? Thank you.
Julie McCrossin
Maureen, thank you so much for that question. And I also just want to say a special hello to everybody in Aotearoa New Zealand, who are with head and neck cancer or members of multidisciplinary teams. And thank you so much for joining us for this series of videos.
If I could come to you, Venessa, how would you respond to Maureen’s question and also if you could explain terms like biomarkers and so on?
Venessa Chin
So I guess we can start with a term biomarker. That’s really an indication in someone’s body, either an indication from their tumour or their blood, that they might benefit from a certain treatment, okay. And we use them across all types of fields in oncology and they differ depending on the type of cancer we’re talking about.
But I think the biomarker that she’s referring to is a biomarker called tumor proportions score, okay? And we look at the cells in a biopsy and we do a special stain on those cells. And if they stain strongly for this marker, then that has been shown in trials to predict for patients who are more likely to get benefit from immune therapy.
It is far from perfect. And that was, I think, what Maureen is alluding to. Are there more specific ways to identify patients who might benefit, or not benefit, from immune therapy? And the short answer is not really. There are a lot of theories and there is a lot of research going into this because this is something that’s applicable, not only to patients with head and neck cancer, but all cancers where we use immune therapy.
And really there are not reliable characteristics, in either the patient or the tumour, that tell us that someone is going to respond or not respond. So that is the frustrating thing about immune therapy
Julie McCrossin
And Maureen has clearly known people for whom it hasn’t had any benefit, and she’s known people it really has. And that’s really the pattern we’ve been discussing in our interview. It must be very difficult for the people in New Zealand, when it’s not funded by the government, as to whether you try to pay for your own Keytruda or not? I mean, there’s, it’s really like rolling a dice is at that?
Venessa Chin
So I think one of the things to keep in mind is that what we’re doing is assessing things as we go. Okay, So what I’ll often say to people, if they decide to pay for Keytruda, or any other drug, out of pocket, is that we’ll give a certain number of doses and then reassess. Okay.
And so that what I often talk to them about is the minimum you’re going to spend and then the maximum you’re going to spend. And so that you have to be willing to at least spend that minimum amount. But, In a best case scenario, if we keep treating, you have to be willing to spend more to stay on that treatment.
And I think what’s important to note is, even if you’re on a treatment that’s working, if you can’t afford to pay it, then we can’t give you the drug. So we don’t have any sort of special powers in that sense to give people drugs that they can’t afford to pay for. So it’s an interesting part of medicine and an interesting part of oncology talking about financial toxicities of drugs. And it’s a really difficult area and it can be very difficult for patients.
So I often say to people, if you can do this without re-mortgaging the house, then we can consider it. But if you’re looking at going into serious debt to pay for a drug, I don’t support that. I don’t think that helps anybody.
Julie McCrossin
Would you deny it to someone if they chose to mortgage their house?
Venessa Chin
I would never deny them but I would seriously get them to reconsider. I have had a few people that have gotten into strife and it is not a good situation to be in.
Julie McCrossin
Look, I’d like to say to both of you on behalf of everybody, thank you for giving us this time today here at The Kinghorn Cancer Centre. I’ve been talking to Dr Venessa Chin and Dr Amy Prawira. We’re in The Kinghorn Cancer Centre. This series of videos on innovations in treatment for head and neck cancer is hosted by St Vincent’s Hospital Sydney and The Kinghorn Cancer Centre.
I’m Julie McCrossin. And thank you so much for watching and remember, if you have any questions, or you’d like to talk to somebody, if you’re in Australia ring Cancer Council Information and Support Line 13 11 20 – 13 11 20.
There are clinicians on the end and they’re friendly and they are very helpful. And also there is a website that’s all about head and neck cancer. That will be of value anywhere in the world. It’s called https://beyondfive.org.au. And whatever screen you’re watching this on, we’ll have that written down. Thank you.
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