10 Facts You Must To Know About Immunotherapy Treatment

10 Facts You Must To Know About Immunotherapy Treatment

Immunotherapy harnesses your body's natural defense system, the immune system, to fight cancer. It works by either boosting its ability to recognize cancer cells or by altering its behavior to directly attack them. If immunotherapy is included in your treatment plan, understanding these 10 facts can help you to prepare effectively.

FACT #1: Cancer immunotherapy is a powerful treatment, taps into your body's natural defense system.

Our immune system, armed with killer T cells, is designed to fend off cancer cells. However, cancer can sometimes outwit our immune defenses. That's where immunotherapy treatment comes in.

A significant chunk of what we've learned about the immune system's role in cancer comes from researchers at the Cancer Research Institute (CRI). Since 1953, CRI has been the world's foremost nonprofit organization dedicated solely to advancing immunotherapy and its scientific foundations to improve cancer care.

FACT #2: In 1891, Dr. William B. Coley, the pioneer of immunotherapy treatment, made history by saving a patient with inoperable cancer.

Back in the late 1800s, surgery was pretty much the only option for cancer patients, and this troubled Dr. William B. Coley. His frustration grew, especially after he couldn't save his close friend.

In 1891, inspired by a case, Dr. Coley decided to take a bold step. He tried the unconventional approach on a man who had an advanced throat tumor and had difficulties eating. Remarkably, Dr. Coley's groundbreaking approach worked, and the patient soon returned to his normal life.

To honor him, CRI presents the annual William B. Coley Award, recognizing scientists whose work deepens our understanding of the immune system's cancer-fighting abilities and advances the development of effective immunotherapies for patients.

FACT #3: Immunotherapy treatment was named ASCO's "Advance of the Year" each of the last two years.

Immunotherapy has received high recognition from the American Society of Clinical Oncology (ASCO). In February, they named it the "Advance of the Year" once again. This groundbreaking treatment is proving its worth, offering long-term benefits to various cancer patients. In 2017 alone, eight immunotherapies gained approval, including durvalumab and avelumab, marking significant progress in the field. These achievements owe much to the dedicated work of Cancer Research Institute (CRI) scientists over decades.

Dr. Lloyd J. Old, often hailed as the "Father of Modern Tumor Immunology," played a pivotal role in advancing immunotherapy. He led CRI's scientific and medical endeavors for four decades, from 1971 to 2011. During this time, Dr. Old made critical discoveries about the connection between the immune system and cancer, laying the groundwork for the development of today's successful immunotherapies.

FACT #4: Currently, there are five types of immunotherapies available for over 20 types of cancer.

By June 2017, the U.S. FDA had approved 32 immunotherapies for various cancers, including melanoma, lung, bladder, kidney, lymphoma, leukemia, and prostate cancer. These immunotherapies bolster the immune system's cancer-fighting abilities in different ways:

Cell-Based Immunotherapies: These therapies boost patients' immune systems by introducing immune cells, like bone marrow transplants and advanced treatments like CAR T cells.

Immunomodulators: These substances can directly stimulate immune cells to combat cancer. The first immunomodulator, IFN-α, received FDA approval in 1986 for leukemia.

Vaccines: Vaccines educate and activate the immune system to target potential threats.

Antibody-Based Targeted Therapies: These therapies directly target cancer cells or other supporting elements for tumors. The first antibody, rituximab, gained approval for lymphoma treatment in 1997.

Oncolytic Viruses: These modified viruses infect cancer cells, causing them to rupture and drawing the attention of the immune system.

FACT #5: Cancer can exhaust immune cells. Checkpoint immunotherapies can wake them back up.

Sometimes, the immune system can be held back from attacking cancer, even though it has the natural ability to do so. Immune checkpoint pathways can put the brakes on anti-cancer immune cells, making them less effective against cancer. To counter this, scientists have created checkpoint inhibitor immunotherapies. These therapies block these pathways, giving a boost to the immune cells and reinvigorating their ability to fight cancer. They work particularly well against heavily mutated tumors that the immune system has already recognized.

James P. Allison, Ph.D., was the first to identify an immune checkpoint pathway called CTLA-4 receptor. His discovery led to the development of ipilimumab, an anti-CTLA-4 checkpoint immunotherapy approved by the FDA in 2011 for melanoma. Since then, more checkpoint pathways, like the PD-1/PD-L1 pathway, have been discovered, leading to the development of additional immunotherapies. Currently, there are six FDA-approved checkpoint immunotherapies, including ipilimumab and nivolumab (used together for melanoma), pembrolizumab (for advanced lung cancer), and atezolizumab (for advanced bladder cancer in certain cases).

FACT #6: Biomarkers help immunotherapy be personalized for each patient.

Traditionally, treatments were one-size-fits-all, based on tumor location, not its unique characteristics. But now, with immunotherapy treatment, doctors use measurable biomarkers to predict the best approach.

For instance, checkpoint inhibitor immunotherapies work better for patients whose biomarkers show their immune system already recognized the tumor. If a tumor expresses a specific protein (like NY-ESO-1), doctors know that targeting it with immunotherapy can be effective.

FACT #7: Immunotherapy is making a significant difference in improving the lives of children with cancer.

For decades, children have benefited from immunotherapy through bone marrow transplants. More recently, targeted antibodies and checkpoint immunotherapies have proven successful against certain childhood cancers. Dinutuximab is now approved for neuroblastoma, and pembrolizumab for Hodgkin lymphoma in children.

Researchers are actively working to enhance bone marrow transplants and molecular-based immunotherapies. Emerging methods like CAR T cells, show great promise for children, particularly those with leukemia.

Importantly, some current treatments have severe long-term side effects for children. Immunotherapy treatment offers a potentially safer yet effective alternative for these young patients.

FACT #8: Immunotherapy achieved a groundbreaking milestone by extending the lives of patients with advanced melanoma.

When melanoma had spread to other organs, treatment options were limited. However, a groundbreaking discovery about the immune checkpoint CTLA-4 led to the development of ipilimumab, an anti-CTLA-4 checkpoint immunotherapy, which became the first treatment to demonstrate increased survival in metastatic melanoma patients through a clinical trial.

Since ipilimumab's FDA approval in 2011, other immunotherapies have been approved for melanoma, including anti-PD-1 checkpoint immunotherapies like pembrolizumab and nivolumab, as well as the oncolytic virus T-Vec. The FDA has also approved a combination of ipilimumab and nivolumab for melanoma.

Numerous patients have experienced more quality time with their families thanks to this combination immunotherapy treatment.

FACT #9: Immunotherapy treatment isn't just for humans; it works for dogs too!

Cancer is a common issue in older dogs, and the University of Pennsylvania is at the forefront of extending immunotherapy's benefits to our furry friends. The Penn Vet Cancer Center and the Mason Canine Cancer Immunotherapy Research are leading these efforts.

Dr. Mason's team has treated many dogs. For example, Lewis, a golden retriever with bone cancer: After a limb-sparing procedure, Lewis received a genetically modified bacteria similar to CRS-207, targeting a tumor-specific protein. This bacterial vaccine aims to activate his immune system against hidden metastases and provide long-term protection if cancer returns.

But vaccines are just one approach. Kobe is having his immune system engineered to produce tumor-targeting antibodies, while Harley has undergone anti-CD20 CAR T cell immunotherapy for leukemia. These treatments offer hope to dogs battling cancer.

FACT #10: Immunotherapy is the only treatment approved to combat tumors, regardless of where they originate.

On May 23, 2017, the FDA approved pembrolizumab, an anti-PD-1 checkpoint immunotherapy, without restrictions based on the tumor's location. Instead, its approval hinges on the tumor's genetic stability.

Now, individuals with metastatic cancer showing genetic instability (identified by the MSI-hi or dMMR biomarker) can receive this immunotherapy, even if other treatments haven't been effective. In the clinical trial leading to this approval, patients with fifteen different tumor types were included, and nearly 40% responded positively. These tumors are often receptive to immunotherapy because their high DNA mutation rates produce abnormal proteins (neo-antigens) that the immune system recognizes as foreign.

In some cases, immune cells have already initiated a response against these neo-antigens but become exhausted via the PD-1/PD-L1 pathway. Here, a checkpoint immunotherapy blocking this pathway can tip the balance in favor of the immune system and the patient.