Immunotherapy

Overview

Immunotherapy is a type of cancer treatment that locates and eliminates cancer cells by using your body’s immune system. Immunotherapy comes in a number of kinds, but all of them function through improving the ability of your immune system to fight cancer. Immunotherapy increases the ability of your immune system to identify and eliminate cancerous cells.

Healthcare providers often rely on immunotherapy as a primary treatment for various forms of metastatic cancer, where the disease has spread. Immunotherapy can be administered alone or in conjunction with targeted therapy, chemotherapy, or other cancer treatments. Different types of immunotherapy are employed to address different cancer types, leveraging the body’s immune system in distinct ways.

Immunotherapy has emerged as a highly effective treatment, potentially extending the survival of cancer patients. To broaden its applicability across different cancer types, medical researchers are actively developing novel immunotherapy treatments.

Types

The type of Immunotherapy includes the following:

• Checkpoint inhibitors: It is possible for your immune system to be overly effective in protecting yourself. Checkpoints are established by your body to prevent the overreaction of your immune system to invaders and subsequent damage to healthy cells.

T lymphocytes, or T-cells, are white blood cells that are produced in your bone marrow. T-cells combat cancer cells and keep your body free from infection. T-cell surface proteins are contacted by immune checkpoints.

T-cell signal flow is regulated by checkpoint proteins and other proteins, which instruct the cells when to turn on and off. To eliminate cancer cells, T-cells activate. They switch off to prevent harm to healthy cells.

Checkpoint inhibitors function by breaking the link between checkpoint proteins and other proteins. By breaking the link, protein cells are prevented from instructing T-cells to turn off. In this manner, T-cells continue eliminating cancerous cells.

• T-cell transfer therapy (adoptive cell therapy): The capacity of your immune system to eliminate cancerous cells is enhanced by this treatment. In a lab, healthcare providers take your immune cells and cultivate them. Providers reintroduce your cells into your body once they have grown so they can eradicate cancerous cells. The two main forms of T-cell transfer therapy are:
  • CAR T-cell therapy

The mechanism of action of chimeric antigen receptor (CAR) T-cell therapy is to enhance the cancer-fighting capabilities of your T lymphocytes, or T-cells. Your immune system tracks proteins known as antigens that are present on the surface of intruder cells to keep an eye out for invaders, such cancer cells. T-cells are necessary for your immune system to locate and eliminate invaders.

The proteins known as receptors are unique to your T-cells. Your T-cell security group utilizes their receptors to capture and block invaders when they detect antigens that indicate a threat. Plus, your T-cells have the ability to eliminate the invaders. However, antigens possess a unique defense mechanism. To elude your T-cells, they might assume a false identity. Your T-cells won’t be tricked by antigens in disguise because of CAR T-cell therapy. 

• Tumor-infiltrating lymphocyte therapy.

TIL cells can infiltrate or approach cancerous tumors, but they are outnumbered and unable to effectively combat the tumor cells. They are unable to prevent cancerous cells from transmitting signals that compromise your immune system, therefore they are unable to summon help.

TIL treatment allows the healthcare provider to develop larger and more powerful TIL cells. To stimulate the growth of TIL cells, researchers extract these cells from tumors and subject them to specific substances that encourage their proliferation. Upon returning to the cancerous tumors, the enhanced TIL cells have the ability to eliminate cancerous cells and interfere with signals that inhibit your immune system.

• Monoclonal antibodies: Your immune system’s initial line of defense against invaders includes antibodies. Proteins called antibodies combat disease by identifying invaders so your immune system can eliminate them. Lab-made antibodies that can complement your body’s natural defenses or function as their own offensive force are used in monoclonal antibody treatment for cancer.

A part of a cancerous cell may be attacked by the lab-made antibodies. They could, for instance, block proteins that are abnormal in cancer cells. Additionally, monoclonal antibodies can also specifically target cancer cells, delivering drugs, toxins, or radioactive materials that can effectively eliminate cancerous cells. (Healthcare providers view monoclonal antibody therapy as a type of targeted therapy. Targeted therapy involves the targeting of certain genes, proteins, or tissues where cancerous growths are occurring. 

• Cancer vaccines: Your body is protected against several infections by vaccinations. Certain vaccinations offer protection against viral diseases that have been connected to penile, throat, and anal cancers. One such vaccine is the human papillomavirus (HPV) vaccine. You can avoid contracting a disease that may cause cancer in the future by having these vaccinations. Cancer is not prevented by cancer vaccinations. However, cancer vaccinations prepare your body to combat cancer should it arise.

Vaccines against cancer function by assisting your immune system in recognizing antigens present in cancer cells. Cancer vaccines work by using all or a portion of cancer cells to assist your body recognize a dangerous tumor in your body, just like other vaccine types.

• Immune system modulators: Substances known as immunomodulators strengthen your body’s defenses against cancer. BCG, cytokines, and immunomodulatory medications are examples of immune system modulators.
  • Cytokines: Cytokines are proteins responsible for regulating your immune system’s reaction to invaders, including cancerous cells. They aid in regulating the growth and activity of immune cells and blood cells.

Cytokines alert your immune system to invaders like cancerous cells so that they can be dealt with. In order for immune system cells to coordinate attacks on certain cancerous targets, they facilitate communication between the cells. In addition to helping in elimination of diseased cells, cytokines also serve to prolong the life of good cells and induce death in cancerous cells.

Healthcare providers use two different cytokines to treat cancer:

• Interferons: Your immune system fights cancer and inhibits the growth of cancer cells with the help of interferons. Healthcare providers can treat a wide range of cancer types with interferons produced in a lab.
• Interleukins: Both the immunological response and immune system cell communication are triggered by these proteins. One specific interleukin, IL-2, enhances the quantity of white blood cells in your body, including T-cells and B-cells, which play crucial roles in combating cancer. Physicians may treat cancer, particularly melanoma and kidney cancer, with lab-made interleukins, similar to how they do with interferons.

• Immunomodulatory drugs: Medications that strengthen your immune system are known as immunomodulatory medicines, or biologic response modifiers. Certain medications inhibit the growth of new blood vessels in malignant tumors. These medications may be prescribed by healthcare providers to patients with advanced stages of certain lymphoma types. Immunomodulatory medications comprise of thalidomide, lenalidomide, pomalidomide, and imiquimod. 

Lenalidomide, pomalidomide, and thalidomide induce the release of IL-2 from cells. IL-2 helps in the production of more white blood cells by your body to combat cancer. The three medications also slow the growth of cancerous tumors. They achieve this by stopping the tumors from forming the new blood vessels that they require to continue growing. Imiquimod another immunomodulatory medication, causes cells to release cytokines.

Reasons for undergoing the procedure

• Checkpoint inhibitors: Checkpoint inhibitors are commonly used by healthcare providers to treat many different types of cancers, particularly in cases of advanced cancer, metastatic cancer, non-resectable cancer, or cancer that have not responded to previous treatments. Checkpoint inhibitors may be used in conjunction with other therapies like targeted therapy or chemotherapy. 

As more and more types of cancer are discovered that can be treated with immunotherapy, the following list is likely to expand:

• Esophageal cancer.
• Head and neck cancer.
• Hepatocellular carcinoma.
• Kidney cancer.
• Bladder cancer.
• Cervical cancer.
• Melanoma.
• Mesothelioma.
• Non-small cell lung cancer.
• High risk triple-negative breast cancer.
• T-cell transfer therapy (Adoptive cell therapy)
  • CAR T-Cell therapy: Specific blood cancers, such as specific forms of leukemia, lymphoma, and multiple myeloma, are treated using CAR T-cell therapy. CAR T-cell therapy is being studied as a potential treatment for brain and breast cancer.
  • Tumor-infiltrating lymphocytes (TIL): Cancers treated by TIL: TIL therapy has not been authorized by the FDA to be used as a routine cancer treatment. TIL therapy is being investigated as a potential treatment for cholangiocarcinoma (bile duct cancer), melanoma, and cervical squamous carcinoma.
• Monoclonal antibody therapy: More than 60 distinct monoclonal antibody medications that treat a variety of cancers have received FDA approval. Common cancer forms that are treated with various monoclonal antibodies consist of:
  • Bladder cancer.
  • Breast cancer, including triple-negative breast cancer.
  • Colorectal cancer.
  • Leukemia that includes acute lymphoblastic leukemia, hairy cell leukemia, acute myeloid leukemia and chronic lymphocytic leukemia.
  • Lymphomas that includes non-Hodgkin lymphoma, cutaneous T-cell lymphoma and B-cell lymphoma.
  • Multiple myeloma.
  • Non-small cell lung cancer.
• Cancer vaccines: The FDA has sanctioned a cancer vaccine leveraging an immune cell that targets particular antigens found on prostate cancer cells.
• Immunomodulatory drugs: Immunomodulatory medications, such as pomalidomide, lenalidomide, and thalidomide, activate your immune system. These medications also prevent the formation of new blood vessels that nourish myeloma cells. It is approved to treat newly diagnosed patients with lenalidomide and thalidomide. Pomalidomide and lenidomide work well in the treatment of recurrent myeloma as well. These medications strengthen your immune system. Certain medications prevent cancerous tumors from producing the new blood vessels required for their growth. Medical professionals frequently treat metastatic cancer using these medications.

Risk

Immunotherapy is not universally applicable to all cancer types, and not all patients who respond to treatment will experience its benefits. Moreover, most immunotherapy treatments entail adverse side effects. Your healthcare provider will discuss these individualized side effects with you and provide strategies for their management if immunotherapy is deemed appropriate for your treatment plan.

Procedure

Immunotherapy is administered to patients by intravenous (IV) infusion. Immunotherapy might be given to you once a week, once a month, or in cycles. Following treatment, you take a break when receiving cyclic immunotherapy. The break in activity allows your body to create new, healthy cells.

The duration of treatment varies depending on several factors, including the type and stage of cancer, the specific immunotherapy drug administered, and your body’s response to the treatment.

Outcome

Immunotherapy offers potential benefits for cancers that have failed to respond to standard therapy or have recurred after initial treatment. It can extend lifespan by managing cancer, impeding its spread, and occasionally shrinking cancerous tumors. However, not all patients undergoing immunotherapy exhibit positive responses.

While most immunotherapy side effects are mild, some require immediate attention from a healthcare provider. If you experience side effects that are more severe than usual, it’s important to promptly contact your healthcare provider for guidance and possible intervention.