Immunotherapy
What is Immunotherapy?
Immunotherapy is a type of cancer treatment that harnesses the power of the body's immune system to recognize, attack, and destroy cancer cells. Unlike traditional cancer treatments such as chemotherapy and radiation therapy, which directly target cancer cells, immunotherapy works by stimulating the immune system's natural ability to recognize and eliminate cancer cells.
There are several different types of immunotherapy, each of which works in distinct ways to enhance the immune response against cancer:
1. Checkpoint Inhibitors: Checkpoint inhibitors are drugs that block certain proteins on immune cells called checkpoints, which cancer cells can exploit to evade detection by the immune system. By blocking these checkpoints, checkpoint inhibitors enable the immune system to recognize and attack cancer cells more effectively.
2. CAR T-cell Therapy: CAR T-cell therapy is a type of immunotherapy that involves genetically modifying a patient's own T cells (a type of immune cell) to recognize and attack cancer cells. In this approach, T cells are engineered to express chimeric antigen receptors (CARs) that target specific proteins on the surface of cancer cells, allowing them to selectively kill cancer cells while sparing healthy cells.
3. Monoclonal Antibodies: Monoclonal antibodies are laboratory-made proteins that can bind to specific targets on cancer cells, triggering an immune response against the cancer. Some monoclonal antibodies work by tagging cancer cells for destruction by the immune system, while others block signals that promote cancer cell growth and survival.
4. Cancer Vaccines: Cancer vaccines are designed to stimulate the immune system to recognize and attack cancer cells. Unlike traditional vaccines that prevent infectious diseases, cancer vaccines aim to treat existing cancer by priming the immune system to target cancer-specific antigens.
5. Adoptive Cell Therapy: Adoptive cell therapy involves harvesting immune cells, such as T cells, from a patient's blood, expanding and activating them in the laboratory, and then reinfusing them back into the patient to target and kill cancer cells.
Immunotherapy has revolutionized cancer treatment and has shown remarkable success in treating certain types of cancer, including melanoma, lung cancer, bladder cancer, and certain types of lymphoma and leukemia. It is often used in combination with other cancer treatments or as a standalone therapy, depending on the type and stage of cancer. While immunotherapy can be highly effective for some patients, it may not work for everyone, and side effects can occur, which vary depending on the type of immunotherapy used. Ongoing research continues to explore new immunotherapy approaches and expand its use across different cancer types.
Immunotherapy means a treatment plan or medicine which modify patient’s own immune system to control a disease. In broad words, use own immunity to control the disease. These diseases can be any disease, here we will discuss about Cancer Immunotherapy.
Cancer immunotherapy has a long history, but has rapidly developed since 2010. The goals of cancer immunotherapy are to kill or control cancer cells by activating, or re-activating the immune system. It triggers the body’s own immune system to fight cancer cells. Also immunotherapy can provide the body with additional components to enhance the Immune Response.
The use of immunotherapy is rapidly increasing as more immunotherapies are approved to treat the patients with many types of cancer.
Our Immune System
Our immune systems have evolved to a complex system involving Innate and Adaptive Immune Systems.
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Innate immunity means which is already present in the body. It is non specific and act against all foreign bodies, infections and on disease causing cells. It starts with physical barriers like skin, mucus, and involves non specific defence from immune cells such as neutrophils and natural killer cells.
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Adaptive immune system means which has adapted according to the disease or disease causing agent. It is most relevant in managing the immune system, addressing viral infections, and evolved to be the most important part of the immune system in terms of controlling and eliminating the cancer.
How does the immune system work??
The immune system relies on the receptor proteins on certain immune cells to detect the foreign bodies or cancer cells. At certain checkpoints, when activated or deactivated these receptors are allow to differentiate between healthy and invading cells.The checkpoints are needed to keep the immune system from attacking healthy cells.
Cancer cells don't trigger an immune response, because they are the body’s own cells that have mutated so the healthy cells no longer behave like normal cells. Because the immune system doesn’t recognize the difference,then these cancerous cells can continue to grow, divide and spread throughout the body.
How our own immunity can be used to control the cancer?
If we are able to modify or change our own immune system (the way it looks at the cancer cells), and change the response of our immune system to cancer cells, we can control or modify the growth of cancer.
Presently this is mostly done with the help of the Immune Modifying Drugs (are drugs that can modify the immune response, either by enhancing or suppressing the immune system).
How the Immunotherapy drugs are given?
These drugs are transported in normal glass vials.Firstly, they are diluted in normal saline and then infused into the veins over a period of half hour to two hours.
How does Immunotherapy work against Cancer?
The immune system detects and destroys abnormal/cancerous cells and prevent the development of new cancer cells or controls the growth of already formed abnormal cancer cells, so immune cells are usually found in and around tumors. These cells called Tumor Infiltrating Lymphocytes (TILs) and they are indicator of that the immune system is responding to the tumor. Even though the immune system can prevent or slow cancer growth, cancer cells have ways to avoid destruction by the immune system.
Example, cancer cells may have genetic changes that make them less visible to the immune system. On tumor cells or T-cells, having some surface proteins which can turn off the immune cells or these surface proteins can bind surrounding to the normal cells so that the immune system is not able to differentiate between normal cells and cancer cells. These surface proteins also interfere with the binding of our own immune cells to cancer cells and thus inhibit their killing.
Drugs used in Immunotherapy
Current Checkpoint inhibitor drugs target the PD-1 and the CTLA-4 receptors.
Common immunotherapy drugs include:
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Atezolizumab
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Avelumab
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Durvalumab
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Ipilimumab
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Nivolumab
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Pembrolizumab
Common cytokines used in cancer therapy includes:
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Interferon- alpha (IFN-alpha)
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Interleukin-2 (IL-2)
Side effects of Immunotherapy:
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Fatigue
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Rashes & Itching
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Mouth sores
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Fever & Chill
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Autoimmune disorders: It causes problem due to over activation of immune system against our own body and leading to autoimmune disease like pneumonitis, diarrhea, thyroiditis, are few of these side effects. There are usually treated with the help of steroids.
Cancers in which Immunotherapies shows promising results:
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Lung Cancer
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Kidney Cancer
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Breast Cancer
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Melanoma-type of Skin Cancer
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Hodgkin’s Lymphoma
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Head & Neck Cancer
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Leukemia
Benefits of Immunotherapy
There are many reasons that the immunotherapy is a good choice for the patients:
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Immunotherapy may work when other treatments don’t. In some cancers e.g Melanoma (type of Skin Cancer ) which don’t respond well to chemotherapy or radiation.
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It can cause fewer side effects than other treatments.This is because it targets just our immune system, not other cells in the body.
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It may help other cancer treatments work better. Other therapies like Chemotherapy, may work better if we also have immunotherapy.
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Cancer having less chances to return. When we have immunotherapy, our immune system learns to go after cancer cells. This is called immunomemory, and it could help to stay cancer-free or control cancer for a longer time.
Benefits of Immunotherapy over Chemotherapy
We must understand that surgery and chemotherapy are the back one of cancer treatment in most of the cancers. It is being supplemented by Radiotherapy and Targeted Therapy.
Immunotherapy is our new treatment against the cancer so most of the times it is either given along with chemotherapy or alone every two or three weekly. It does not cause any traditional side effects like nausea, vomiting, hair loss, fall in platelets & hemoglobin.
Risks of Immunotherapy
These treatment may cause high levels of inflammation in healthy cells and tissues. Some people develop resistance to Immunotherapy. Doctors have rarely observed severe or even fatal allergic and inflammatory reactions.
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