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The Front Line
The Front Line: Charles D. Blanke, MD, SWOG Chair

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President Carter's Cancer Treatment Pioneer is Right Here

Aug 21, 2015 - We learned this week that former President Jimmy Carter has cancer. He has multiple brain metastases -- four spots of melanoma, each the size of the head of a pin. President Carter will receive radiation therapy and a drug pioneered by one of our very own -- a drug that's also the subject of a brand-new SWOG study.

The drug is pembrolizumab, or Keytruda, a Merck immunotherapeutic. Dr. Antoni Ribas, SWOG's melanoma chair and a long-time UCLA professor and researcher, has conducted groundbreaking work on this medication. Last year, Dr. Ribas led a global Phase III study that showed, perhaps surprisingly, perhaps not, that pembro led to better outcomes than the standard of care not only for patients with melanoma but also for patients with lung cancer. In April 2014, Dr. Ribas presented these results at the American Association for Cancer Research annual meeting, and published them in the New England Journal of Medicine. Five months later, the U.S. Food and Drug Administration approved pembro for patients with metastatic melanoma.

"It's a great new agent," says Ribas. Along with other new immunotherapy drugs, such as nivolumab, pembro works by blocking PD-1, a protein that brakes our immune response. When you take the drug, Ribas says: "It's like taking those brakes off. It lets the immune system mount a better response against cancer."

Dr. Ribas talks mechanism deftly. That's because, like many SWOG investigators, Ribas not only conducts clinical trials, but bench research. Ribas has studied the immune system for 20 years, and published papers on PD-1 and its effects in Nature and the Lancet. Now, after two years of work, he is eagerly awaiting the imminent launch of S1404, a trial led by Dr. Ken Grossmann. This SWOG trial will compare high dose interferon against pembro in patients at high risk for a recurrence of their melanoma.

The beauty of Dr. Ribas's story lies in its layers.

He embraces basic science, and brings the lessons he learns at the bench into the clinic. He also knows the power of persistence. "You used to have to hide yourself when it came to immunotherapies," he says. "They were very controversial. Now we are seeing people living a new life on this drug."

Dr. Ribas says the big message is this: Have the courage to pursue your research ideas, no matter how outlandish they may seem. One day, your pipe dream may be healing a president.


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