COMMENTARY

'False Hope' Over Immunotherapy? The Media's Misguided Effects

Kathy D. Miller, MD

Disclosures

March 05, 2018

Hi. This is Dr Kathy Miller from Indiana University, just back from vacation. I had a great time skiing. Today I want to talk about an article I saw in the New York Times while I was away. The article, "Doctors Said Immunotherapy Would Not Cure Her Cancer. They Were Wrong," by Gina Kolata,[1] one of the ace science reporters in the country, is in the February 19, 2018, issue.

This is a fascinating story of a rare type of ovarian cancer with a unique genetic aberration that makes it highly sensitive to immunotherapy. [The story is] nothing short of miraculous and the best in translational science—taking the knowledge of the biology of the patient and her tumor, applying a specific therapy, and getting a result that was better and more dramatic that anyone had reason to expect or even hope for.

Look at the headline and think about this if you are a cancer patient or the family member of a cancer patient: They said it wouldn't work; they were wrong. Would you be thinking, could that be me? Could that be my loved one? How far would you go? How far would you travel? How many people would you call? How much money would you spend to get that thing that cured these other people and just might work for you?

This is the challenge we oncologists live with in our current day of social media, regular media, fake media, wherever you get your news stories. How do we relay the legitimate enthusiasm for our ability to interrogate the biology and develop or find therapies that are very specific, with the hope that they will be much more effective and less toxic? How do we convey that legitimate hope? How do we get the support to do the proper clinical trials, to do the basic research, without [allowing our hope to morph] into hype, false hope, leading to desperate situations, bankrupt families, families with members dying halfway across the country, trying to get therapies that, in reality, have very little chance of working?

Immunotherapy has definitely changed the therapeutic landscape of some common solid tumors. But in breast cancer, we see the best, most promising data in women with triple-negative breast cancer. Response rates in patients previously treated with chemotherapy are just under 5%[2] and a bit better if this is the first therapy for patients. But nothing suggests that the responses are actually better than chemotherapy [alone]. The responses may be longer-lived in a subset of patients; there may be a long tail on that curve.

I am not suggesting that immunotherapy will not find a place in breast cancer or that we don't have a lot of work to do to figure out who would benefit. But if I told you that I have a new therapy that in previously treated patients has a response rate of 5%, ask yourself if you would be excited if I did not tell you that the treatment was immunotherapy. Then think about that headline.

Where is that balance? Should we be a bit more cautious in the stories we tell so that we can proceed quickly but also deliberately and honestly? I would love to hear your thoughts on this and other topics. I'll be back with you again soon.

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