After two bouts of chemotherapy, Michel Gueret faced another round of treatment for his lung cancer, which was back once again.
But in June of 2015 he was offered a long-shot that saved his life: try an experimental drug as part of a national clinical trial. Since joining a clinical trial at the UConn Health Center, Gueret -- a heavy smoker for much of his life -- has seen his tumors have shrunk by 80 percent. His case is far from typical, but his success illustrates the promise that drug research can hold for cancer patients.
"I was extraordinarily fortunate," Gueret said, both that his tumors began growing again just when the clinical trial was opening up, and that he was being seen at an institution that was participating in the trial. The Farmington hospital is closest to his Canton home.
Gueret, 67, recalled his doctor saying: "Well, we have two choices — we can go to a third chemotherapy that will need to be more aggressive, with more side effects, buy some time, and time measured in months, and not years... or I'm opening a clinical trial. If it works, that might be a better alternative."
Dr. Jeffrey Wasser, an assistant clinical professor of medicine at UConn, started UConn's participation testing the combination of the drug Keytruda and an experimental drug by Incyte, called Epacadostat.
Both drugs are forms of immunotherapy, which activates the body's own immune system to fight tumors.
A few months after he began, Keytruda was approved to fight certain kinds of lung cancer, after an average 4.3 month improvement in survival of patients taking part.
The averages of a few months of additional life obscure the fact that one immunotherapy drug only works for a small portion of patients — often less than 20 percent — but for them, survival can go on for years. Scientists suspect that more people will survive longer if they take two kinds of immunotherapy drugs at once.
More Patients Needed
When Gueret started in the trial at UConn's Carole and Ray Neag Comprehensive Cancer Center, it was in its earliest stage, when the companies are just trying to figure out how much the doses should be.
Now it has moved to Phase II, where the drug companies are evaluating how effective the combination is against 10 kinds of cancer. It's the third stage, when the drugs have already proven their promise in a small group, that matters most. In those clinical trials, some patients get the experimental drug and some get standard treatment. If the new drug works better, it can win Food and Drug Administration approval for sale.
As long as patients can get to Farmington, cost is not a barrier. The drug companies pay the full cost of the medicines — $12,500 a month for Keytruda, according to the Wall Street Journal — as well as the regular scans and doctor visits.
Yale-New Haven Hospital is also enrolling patients as one of the 24 sites for this national clinical trial.
Wasser is looking for patients with colrectal, renal cell, liver, gastric and esophegal cancers to join the clinical trial, as well as those with certain kinds of lymphoma.
The fact that UConn still needs to recruit more patients whose earlier treatments have failed is what motivated Gueret to come forward.
"I think there probably are a lot of people who have never even heard of these things," he said, and he hopes, by making himself an illustration, others will see if they qualify to participate.
"If the awareness is brought up a notch or two, then I may have accomplished what I wanted to do."
Lung cancer is the leading cancer killer in America, and more die of lung cancer each year than from breast, colon and prostate cancer combined.
According to The Cancer Research Institute, there are five combinations of immunotherapy drugs being tested in Phase III to see if they are better than chemotherapy for lung cancer, or if they boost chemotherapy's success.
Four of the five trials are still enrolling patients. There are trials ongoing in Norwich, Danbury and New Haven, and some are for people who have not had chemotherapy at all yet.
In the UConn study, Wasser said Gueret and a person with bladder cancer have had the best responses of the 17 who enrolled since June 2015. Five have had good enough results that they're still receiving the drugs. Some have died, though Wasser declined to say how many.
Immunotherapy Shows Promise
Wasser said that not only do some people live for years after a diagnosis of terminal cancer with the aid of immunotherapy, they also are able to do so without the kind of side effects, like vomiting and hair loss, that are common with chemotherapy.
However, immunotherapy can cause Type I diabetes, colitis and other auto-immune diseases. Gueret had joint pain, and a bout of shingles.
"Immunotherapy has been a sea change for treatment," Wasser said. But, he cautioned: "We're very early on in understanding immunotherapy."
So far, Incyte and Merck, which developed Keytruda have only decided to move on to Phase III for melanoma.
"Maybe it's not ready for prime time," Gueret said of immunotherapy, but he added: "In a few years, they can understand why it worked so well for me, and it didn't work for somebody else."
At times during his chemotherapy, Gueret thought he might die in three or four months.
"When it was clear my body started responding in a very positive way, I had to change my entire mindset," he said. "I don't think I am dying any more."
To find out what clinical trials are available in Connecticut, visit clinicaltrials.gov.