Immunotherapy - The Future is Almost Here

by Jane Ashley

Immunotherapy…we hear that word, but many cancer patients don’t understand exactly what immunotherapy is or how it works or it’s an option for their specific cancer/situation. So let’s take a closer look at immunotherapy.

Out Of Options

The Jimmy Carter cancer story

Many of you remember that back August 20, 2015, former President Jimmy Carter announced that he had a liver tumor removed but that doctors also discovered 4 tumors in his brain. His outlook was grim, but his medical team at Emory University’s Winship Cancer Institute recommended an advanced radiation therapy for his brain tumors and Keytruda, an immunotherapy drug that had been approved in September 2014 for advanced melanoma.

In March 2016, Jimmy Carter told his Sunday school class that he didn’t need any additional immunotherapy treatments. Now, three years after that dreadful diagnosis, he is still in remission.

What exactly is immunotherapy?

In the most simplistic terms, immunotherapy helps your body use its own immune system to fight your cancer. It can use substances made by the body or made in the laboratory to boost or improve your body’s immune function. Immunotherapy is also referred to as biologic therapy.

The types of immunotherapy that are either currently available or in development now are:

• Cancer vaccines – to prevent the development of cancer. The HPV vaccine helps prevent the development of anal and gynecological cancers (cervical, vaginal and vulvar).
• Monoclonal antibodies (also called immune checkpoint inhibitors) – this is the immunotherapy that is currently available.
• Non-specific immunotherapies – Interferon and Interleukins are used to treat cancer by themselves or with or after chemotherapy or radiation.
• Oncolytic virus therapy – uses genetically modified viruses to kill cancer cells – currently approved for melanoma when it can’t be surgically removed.
• T-cell therapy – T cells are collected from a patient’s body and changed in the lab to recognize cancer cells (CAR-T therapy) – very effective in certain blood cancers. 

Science Magazine voted Cancer Immunotherapy the Science Breakthrough of the Year for 2013.

Immunotherapy currently available

So, you may have been asking yourself, “Is there a miracle drug that can help my cancer?”

The answer is, “It depends on what type of cancer you have and your genetic markers.” Let’s look at what’s available and who these currently available immunotherapies can help.

• Atezolizumab (Tecentriq). Used to treat a type bladder and urinary tract cancer called urothelial carcinoma or non-small cell lung cancer (NSCLC).
• Avelumab (Bavencio). Used to treat a skin cancer called Merkel cell carcinoma or urothelial carcinoma.
• Durvalumab (Imfinzi). Another immunotherapy to treat non-small cell lung cancer (NSCLC) or urothelial carcinoma (a type of bladder and urinary tract cancer).
• Ipilimumab (Yervoy). First immune checkpoint inhibitor approved by the FDA in 2011. Used to treat metastatic melanoma (with the BRAF V600 mutation-positive), renal cell carcinoma (in combination with nivolumab) and colorectal cancer (again in combination with nivolumab) for patients who are MSI-H or mismatch repair deficient (dMMR).
• Nivolumab (Opdivo). Used to treat metastatic melanoma (in combination with Ipilimumab) for patients who have the BRAF V600 mutation positive, metastatic non-small cell lung cancer (NSCLC), advanced renal cell cancer (often in combination with Ipilimumab), classical Hodgkin’s lymphoma (after relapse from a stem cell transplant), metastatic squamous cell carcinoma of the head and neck (SCCHN), metastatic urothelial carcinoma or certain colorectal cancer who are MSI-H or dMMR.
• Pembrolizumab (Keytruda). Used to treat advanced non-small cell lung cancer (NSCLC), classical Hodgkin’s lymphoma, advanced gastric cancer called gastroesophageal junction (GEJ) adenocarcinoma that tests positive for PD-L1, advanced melanoma, microsatellite instability-high (MSI‑H) or a mismatch repair deficient (dMMR) colorectal cancer, cervical cancer that is PD-L1 positive, head and neck squamous cell cancer (HNSCC), urothelial carcinoma and primary mediastinal B-cell lymphoma (PMBCL). Keytruda can even be used for pediatric cancers.

So…What Next?????

For the past three years, ASCO (American Society of Clinical Oncology) has declared that the Advance of the Year for 2016, 2017 and 2018 is immunotherapy. 

For 2018, ASCO proclaimed CAR-T cell therapy to be the Advance of the Year. Clinical trials are ongoing for many types of cancer. Thus far, this kind of immunotherapy has been most successful for blood cancers. Success has been achieved for:
1. Childhood acute lymphoblastic leukemia (ALL)
2. Non-Hodgkin lymphoma
3. Multiple myelomas

Car T Cell Therapy

There is much research yet to be accomplished. Some patients suffer serious side effects. Only a handful of patients with solid tumors have responded. Cost is also a factor with regimen costs approaching $375,000 for adults and $475,000 for pediatric patients.

So…What about Now?

Evidence suggests that solid tumor patients with certain genetic mutations are the best candidates for existing immunotherapy drugs like Keytruda and Opdivo. Patients who display the PD-L1 expression can benefit from Keytruda – these include some lung, head and neck, colorectal and bladder. Tumors that display MSI-H or dMMR are candidates too. Opdivo can be used in patients with the PD-L1 expression too as well as BRAF V600 mutation-positive – cancer types include colorectal, non-small cell lung cancer, renal cell cancer, hepatocellular carcinoma and squamous cell head and neck cancers. 

Benefits Of Immunotherapy

While this is a small portion of current cancer patients, many of these patients have not responded to other treatments because of their genetic mutations. For these patients, these recent immunotherapy drugs bring hope. 

Virtually every Stage IV patient should talk to their oncologist about testing their tumors for mutations if they haven’t responded to the first and second line treatments. You might not realize but the facility where your surgery was performed keeps a sample of your tumor. Knowledge is power.

Once you know your mutation status, consider an immunotherapy clinical trial. Some patients may obtain a durable remission. Patients in immunotherapy trials don’t usually suffer from the debilitating side effects that traditional chemotherapy can cause. It’s estimated that up to 90 percent of patients who are eligible for immunotherapy trials may be missing out on potentially curative treatments. 

Be proactive and advocate for yourself. Even if a current immunotherapy is not approved for the type of cancer you have, participating in a clinical trial allows you access.

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A New Kind of Therapy - 10 Things to Keep Your Mind Off Cancer 

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