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Q&A: A new focus on small cell lung cancer

Dr. David MacPherson discusses the state of small cell lung cancer research, how his lab is tackling this deadly disease, and what makes him excited for the future

Feb. 7, 2019 | By Sabrina Richards / Fred Hutch News Service

Dr. David MacPherson

Dr. David MacPherson focuses his entire research program on improving our understanding of small cell lung cancer, an aggressive and deadly disease.

Photo by Robert Hood / Fred Hutch News Service

About 15 percent of lung tumors are small cell lung cancer. Treatment for this aggressive and deadly malignancy has remained nearly unchanged for decades. Recently, however, immunotherapy drugs have modestly extended patient survival. But researchers are trying to do more.

Fred Hutchinson Cancer Research Center small cell lung cancer expert Dr. David MacPherson is working to understand the biology of the disease in order to develop more effective, targeted therapies. He chatted about his most recent work, published in the journal Science Signaling, as well as the state of small cell lung cancer research and what gives him hope for the future. The interview has been edited and condensed.

Can you give us a primer on small cell lung cancer, and why more research is needed?

This is one of the most aggressive of all cancer types. It’s also about the sixth most frequent cause of cancer deaths in the U.S. But despite the high number of patients dying from small cell every year, there have been relatively few labs that have historically been studying this disease. We have a very poor understanding of the biology of small cell compared to a lot of other prevalent tumor types.

Until very recently the treatment was the same chemotherapy as it was about 30 years ago. In about two-thirds of cases, patients respond very well, but the problem is that the patient then comes back to the clinic months later with chemotherapy-resistant, recalcitrant tumors. There’s very little that can be done for those patients. The recent addition of immune checkpoint inhibitors to the chemotherapy regimen has provided some improvements in response and standard of care, but extensions in survival were modest. It’s really a tumor type where we need to do a better job in the clinic.

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Dr. Tijana Martinov named a 2019 Parker Scholar

Early-career scientist will use funding for immunotherapy research in multiple myeloma

Feb. 7, 2019 | By Kristen Woodward / Fred Hutch News Service

Dr. Tijana Martinov

Dr. Tijana Martinov

Photo courtesy of the Parker Institute for Cancer Immunotherapy

Dr. Tijana Martinov, a postdoctoral research fellow at Fred Hutchinson Cancer Research Center, has been named a Parker Scholar by the San Francisco-based Parker Institute for Cancer Immunotherapy. She is among seven early-career researchers from leading cancer research organizations throughout the U.S. to receive a total of up to $3.1 million this year from the Parker Institute in support of their immunotherapy work.

She will use the funding to design and test T cells to effectively target and destroy cancerous cells in mouse models of multiple myeloma. Multiple myeloma is a cancer of the plasma cells, a type of white blood cell, inside the bone marrow. It is the second most common blood cancer in the U.S., and it primarily strikes the elderly. Bone pain, anemia, fatigue and frequent infections are symptoms of the disease.

Ultimately, Martinov hopes to translate her findings from the lab to the clinic.

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On immunotherapy trial, long-term survivors of deadly skin cancer point to a hopeful future

Once unheard-of survival rates seen among patients with advanced Merkel cell carcinoma

Feb. 6, 2019 | By Susan Keown / Fred Hutch News Service

Cartoon diagram showing the receptors mediating the interaction between a tumor-specific T cell and a tumor cell or antigen-presenting cell. Diagram shows the T cell receptor binding to the tumor antigen presented by the MHC. Other interactions are shown between PD-1 on the T cell and PD-L1 on the other cell, and between B7 on the other cell and both CD28 and CTLA-4 on the T cell.

The trial tested a drug called pembrolizumab that interferes in one of the complex interactions between tumor-specific immune cells, or T cells (top) and tumor cells. Specifically, trial participants with advanced Merkel cell carcinoma received a drug designed to interfere in the interaction between cell components called PD-1 and PD-L1, at left, a "braking" system that tamps down the immune response.

Diagram courtesy of Dr. Paul Nghiem. Modified from Drake CG et al. Nature Reviews Clinical Oncology 2014, 11:24-37.

More than two-thirds of people with an advanced form of a rare skin cancer are on track to survive at least two years after starting an immunotherapy drug on a landmark clinical trial, researchers reported Wednesday in the Journal of Clinical Oncology.

That’s a profound shift for this deadly cancer, Merkel cell carcinoma, or MCC. Just a few years ago, patients with advanced MCC would invariably receive chemotherapy, the previous standard of care. As many as three-quarters of them would die within that two-year time frame, previous studies have shown.

The investigators are “thrilled” that so many of the trial participants are doing so well compared to what historical data would predict, said Dr. Martin “Mac” Cheever of Fred Hutchinson Cancer Research Center, one of the leaders of this first-of-its-kind study.

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