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Cancer Immunotherapy - Types and Side Effects

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Cancer Immunotherapy - Types and Side Effects

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Cancer immunotherapy helps in the fight against cancer by utilizing and boosting the immune system. Read this article to know more.

Written by

Dr. Ramji. R. K

Medically reviewed by

Dr. Kaushal Bhavsar

Published At August 8, 2022
Reviewed AtJuly 27, 2023

Introduction:

Cancer refers to the development of abnormal cells in the body. It harms the health of an individual by causing damage to the immune system. The immune system identifies and kills the cancer cells. A strong immune response is highly necessary to fight against cancer. But the weakened immune response in people with cancer results in cancer spreading at a faster pace. The immune system alone cannot defend against cancer, so additionally, certain treatment modalities are utilized to fight against it. Immunotherapy is one such treatment modality where the immune system of an individual is utilized and stimulated to fight against cancer.

What Is Immunotherapy?

Immunotherapy is one of the cancer treatment modalities that utilize and boosts the immune system to fight against cancer. The different ways by which immunotherapy is done include;

  • By utilizing one's immune system and further it gets stimulated or boosted to fight against cancer.

  • By using laboratory-made substances like vaccines that mimic the action of the immune system and stimulate it to kill the cancer cells.

Promising results are seen in people with cancer who received immunotherapy. Immunotherapy can be used along with other treatment approaches like chemotherapy and radiation therapy. New advancements in immunotherapy are discovered by scientists to provide better cancer treatment. Not every individual is ideal to have immunotherapy as a part of their cancer treatment. Only your healthcare provider can suggest whether you can undergo immunotherapy or not.

Can All Types of Cancers Be Treated With Immunotherapy?

Immunotherapy cannot be used as a treatment approach for all cancers. It can be used in the treatment of certain cancers like,

  • Lung cancer (cancer that occurs in the lungs, especially in people who smoke).

  • Breast cancer (cancer that begins in the cells of the breast).

  • Cervical cancer (cancer that occurs in the lowermost part of the uterus, which is the cervix).

  • Skin cancer (cancer where abnormal growth of skin cells is seen).

  • Lymphoma (cancer of the lymphatic system).

  • Bladder cancer (cancer that begins in the cells of the bladder).

  • Leukemia (blood cancer).

  • Brain tumor (growth of abnormal cells in the brain is seen ).

  • Head and neck cancer (cancer that occurs in the mouth, sinuses, nose, lips, throat, larynx, and salivary glands).

  • Colorectal cancer (cancer of the colon or rectum).

What Are the Different Types of Cancer Immunotherapy?

The different types of cancer immunotherapy include,

Immune Checkpoint Inhibitors:

T-lymphocytes, or T-cells being an immune system component, identifies the abnormal( cancerous) cells in the body using their receptors (T-cell receptors). These T-cell receptors bind themselves to the abnormal cell and start signaling the T-cell to release molecules that destroy the cancer cells. T-cells also have receptors that can restrain their function other than activating T-cell receptors. Such receptors are called “checkpoints.”

Activation of these checkpoints prevents cancer cells from getting killed by T-cells. Cancer cells stop T-cell signaling by using these checkpoints. This further stops cancer cell killing by T-cells. Immune checkpoint inhibitors kill cancer cells by preventing this manipulation of cancer cells which stops T-cell signaling. Different checkpoint inhibitors are used, and many discoveries in immunotherapy treatment in immune checkpoint inhibitors are still under development. Some of the common immune checkpoint inhibitors include:

1. PD-1 Inhibitors:

These inhibitors inhibit PD-1 checkpoint protein. The different PD-1 inhibitors

include-

  • Nivolumab (Opdivo).

  • Cemiplimab (Libtayo).

  • Pembrolizumab (Keytruda).

2. PD-L1 Inhibitors (Inhibits PD-L1 protein):

  • Atezolizumab (Tecentriq).

  • Durvalumab (Imfinzi).

  • Avelumab (Bavencio).

3. CTLA-4 Inhibitor (Inhibits CTLA-4 protein):

  • Ipilimumab (Yervoy).

Adoptive Cell Therapy:

In adoptive cell therapy, one's own immune cells (T-cells) are collected and grown in the lab, and then these cells are given back to them intravenously. It is also referred to as immune cell therapy, adoptive immunotherapy, and cellular immunotherapy. The types of adoptive cell therapy include:

CAR (Chimeric Antigen Receptor) T-cell Therapy:

A treatment in which the T-cells are collected from the blood and grown in the lab and modified. The T-cells are reprogrammed, and now they produce a special receptor called chimeric antigen receptors on the T-cell surface. These receptors are then reinfused into that person's blood. It helps in treating blood cancers and certain other types of cancer.

Some of the CAR T-cell therapies approved by FDA include:

  1. Tisagenlecleucel (Kymriah).

  2. Lisocabtagene maraleucel (Breyanzi).

  3. Idecabtagene vicleucel (Abec Ma).

  4. Axicabtagene ciloleucel (Yes Carta).

  5. Brexucabtagene autoleucel (Tecartus).

Some of the other adoptive cell therapies include NK (natural killing) cell therapy and Tumor-infiltrating lymphocytes (TILs) therapy.

Monoclonal Antibodies:

Monoclonal antibodies are antibodies developed in laboratories from their identical parent immune cells. Many monoclonal antibodies are used to treat cancers. They typically function like antibodies that bind to the cancer cells and engulf them. The other way through which it functions is by blocking the growth signals that block cancer cells' growth. It is used in treating cancers like stomach cancer, leukemia, colorectal cancer, etc. Monoclonal antibody infusion therapy is even beneficial in treating COVID-19. Some of the common examples of monoclonal antibodies used to treat cancer include:

1. Bevacizumab (Avastin).

2. Rituximab (Mabthera).

3. Trastuzumab (Herceptin).

4. Pertuzumab (Perjeta).

Cancer Vaccines:

Cancer vaccines are like typical man-made vaccines that help in the fight against cancer. It makes the immune system exposed to the antigen and makes antibodies for it, and kills it. Examples of cancer vaccines include;

  • Hepatitis B vaccines (used in liver cancer).

  • HPV (human papillomavirus) vaccine (protects from cervical and penile cancers).

  • Sipuleucel-T (Provenge) - It is used to treat prostate cancers.

  • Talimogene laherparepvec (T- VEC) - It is used to treat melanoma skin cancer.

Immunomodulators:

Cancer immunomodulators are drugs that help in treating a few cancers and other conditions like multiple myeloma. It acts by modifying the immune response either by increasing or decreasing antibody production. Examples of cancer immunomodulators include:

  • Thalidomide.

  • Lenalidomide.

  • Pomalidomide.

  • Imiquimod.

Oncolytic Viruses:

Oncolytic viruses are those viruses that specifically target and infect cancer cells. They can be used as immunotherapy. It helps in the fight against cancer in two ways;

  1. Specifically targeting and infecting cancer cells further kills cancer cells.

  2. Releasing antigens from killed cancer cells further develops immune response by recognizing the particular antigen and killing it.

Examples of oncolytic virus in cancer treatment include T-VEC (talimogene laherparepvec) in treating metastatic melanoma.

What Are the Side Effects of Immunotherapy?

The common side effects of immunotherapy include;

  • Fatigue.

  • Fever or moderate flu-like symptoms.

  • Nausea and vomiting.

  • Headache.

  • Weight loss and loss of appetite.

  • Skin rash.

  • Diarrhea.

  • Difficulty in breathing.

Severe life-threatening complications are seen in people with cancer receiving prolonged immunotherapy. Cytokine storm is one such life-threatening complication seen as a side effect of immunotherapy.

Who Is an Ideal Candidate to Receive Cancer Immunotherapy?

Not all people with cancer are ideal to receive immunotherapy. Only your healthcare provider can decide whether you are an ideal candidate to receive immunotherapy. It is decided on the following basis:

  1. Age: Age is one of the primary factors in deciding whether the candidate is ideal to receive immunotherapy or not. Immunotherapy is not usually suggested in elderly people aging more than 60. This is because immunotherapy may be ineffective at times, and it also causes difficulties for them.

  2. Stage and Type of Cancer: Your healthcare provider will decide whether immunotherapy will be effective or not based on the stage and type of cancer. In certain cases, doctors may suggest immunotherapy in the initial stages of cancer, whereas on the other hand, it may be suggested in later stages too. Immunotherapy is not given for all cancers since it has not shown any proven effects in some cancers. It is usually given in lung cancer, liver cancer, skin cancer, leukemia, etc.

  3. Genomic Testing: Genomic testing results help analyze the ideal candidate to receive immunotherapy. Your doctor will analyze the genomic test results and decide whether immunotherapy can work for you or not.

  4. Pre-existing Diseases: If the person is suffering or undergoing treatment for any pre-existing diseases, then the doctor may avoid giving immunotherapy. Immunotherapy may either be ineffective or do not provide promising results in such candidates. People who have an autoimmune disorder are not ideal for receiving immunotherapy.

  5. Organ Transplantation: Healthcare providers will inquire whether you have undergone any organ transplantation or not. Immunotherapy is not carried out in people who had organ transplantation.

Is It Safe to Get Immunotherapy?

Immunotherapy shows promising results in treating people with cancer. However, it can contribute to some side effects too. It is often considered a better approach than chemotherapy and radiation therapy for prolonged intervals. Do consult your healthcare provider to know more about immunotherapy, and he will decide whether immunotherapy will be effective, safe, or ideal for you.

Conclusion:

Immunotherapy shows promising results in the treatment of cancer. They act by stimulating or boosting the immune system to fight against cancer. Immunotherapy is not used in treating all cancer since proven effects of immunotherapy are not seen in some cancers. New advancements in immunotherapy are developed to find the best possible cancer treatment.

Frequently Asked Questions

1.

Which Type of Cancer Requires Immunotherapy?

Brain cancer.
Breast cancer.
Bladder cancer.
Ovarian cancer.
Cervical cancer.
Head and neck cancer.
Kidney, liver, and lung cancer.
Prostate cancer.
Leukemia.
Skin cancer.

2.

What Are the Types of Cancer Immunotherapy?

The main types of immunotherapy used by the professional are:
Adoptive cell therapy.
Immunomodulators.
Cancer vaccines.
Monoclonal antibodies.
Oncolytic virus.

3.

How Long Can People Survive After Immunotherapy?

Immunotherapy was provided as first-line to 13.7 % and second-line to 48. 8%, and as third-line and beyond 37.6 %. The overall survival in the patients was for 12.7 months.

4.

How Successful Is Immunotherapy in Treating Cancer?

Immunotherapy success rates depend on individual factors, including the type of cancer and its stage. In general, immunotherapy is found to be an effective treatment against many cancers. It can produce durable responses, unlike radiation or chemotherapy.

5.

Which Immunotherapy Is Commonly Used?

Monoclonal antibodies are the most common type of immunotherapy used in cancer treatment. These antibodies are made in the laboratory by researchers. They are also called naked monoclonal antibodies and work in different ways.

6.

Is It Possible to Cure Cancer With Immunotherapy?

Immunotherapy is an effective treatment against a wide variety of cancer. Some cancers are more immunogenic than others. It can produce durable responses, unlike radiation or chemotherapy. However, these happen only in around 25 % of patients.

7.

Is Chemotherapy or Immunotherapy More Effective in Treating Cancer?

The effect of chemotherapy treatment lasts only till the drugs remain in the body, whereas immunotherapy is exciting and can provide long-term protection against cancer, as it changes the ability of the immune system to recognize and remember cancer cells.

8.

In Which Type of Cancer Immunotherapy Is More Effective?

Immunotherapy gives its best results in skin cancers, lung cancers, and some types of colon cancer.

9.

How Does a Patient Feel During Immunotherapy?

Infusing immunotherapy drugs into the body of the patient through their skin can cause pain at the needle site. After the immunotherapy drug gets into the body, it can also cause inflammation, and pain in other areas of the body many days.

10.

Is Immunotherapy Effective in Pancreatic Cancer?

Based on many researches conducted, immunotherapy has been shown to be more effective in treating pancreatic cancer of all stages and severity.

11.

In Which Method Immunotherapy Is Administered for Bladder Cancer?

Intravesically is the most common way to administer immunotherapy for bladder cancer. This means the drugs are administered right into the bladder and they do not go to the rest of the patient's body.

12.

How Long Does Immunotherapy Provide Its Effect in Small Cell Lung Cancer?

After one month of the immunotherapy treatment there will be improvement in the disease and work for about 12 months.

13.

Is It Possible to Treat Breast Cancer Patients With Immunotherapy?

Immunotherapy is effective in certain breast cancer patients. Pembrolizumab is an immune checkpoint inhibitor and is approved drug for patients with early-stage triple-negative breast cancer and metastatic stage.

14.

Is Immunotherapy Effective for Colon Cancer?

Immunotherapy is more effective for colorectal (referring to both colon and rectal), especially in cases where cancer shows high microsatellite instability.

15.

How Does Immunotherapy Work on Ovarian Cancer?

Pembrolizumab is an approved immunotherapy treatment for some types of ovarian cancer. It is given through an IV for every three weeks. It allows the immune cells to recognize cancer cells and destroy them.
Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

Tags:

cancer immunotherapycancer
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