How can my immune cells help my cancer cells at 45?

Question

Hello doctor,

I am 45 years old and was diagnosed with stage IV lung adenocarcinoma with pleural effusion about five months ago. My oncologist confirmed ROS1 rearrangement and started me on Crizotinib, which initially worked well. But recent imaging shows slight progression, and my doctor is now considering Entrectinib.

During one of my appointments, my oncologist used a phrase that I cannot stop thinking about. He said my lung cancer was essentially seducing my immune cells and turning them into helpers instead of killers.

I read about tumor-associated macrophages and regulatory T cells that apparently get recruited by the tumor to protect it instead of attacking it. My IL-6 level came back elevated on a recent cytokine panel at 38 pg/mL. My pleural fluid analysis also showed very high adenosine levels, which apparently also suppress immune activity in the tumor microenvironment.

I have mild diabetes controlled with Metformin, and I wonder if that metabolic environment makes my immune cells even more susceptible to being hijacked by the cancer. This whole concept disturbs me deeply, and I want to understand it better. Please tell me,

What happens when cancer cells induce immune cells in a 45-year-old patient like me?
Does this mean my immune cells are actively helping my lung cancer grow?
Why does this make the disease harder to control?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Normally, our immune system is supposed to identify abnormal cells and destroy them. But some cancers, especially lung adenocarcinoma at an advanced stage, develop the ability to influence nearby immune cells and change how they behave.

Instead of attacking the cancer, some of these immune cells begin to protect it. They release signals that reduce your body’s natural defense response and help the tumor survive, grow, and even spread. This is what your doctor meant by the cancer "seducing" immune cells. It is not that your immune system has failed; rather, the cancer is cleverly using it to its advantage.

This will make it even more difficult to control the disease since the tumor is not only defying the treatment but also nurturing an environment conducive to its survival. In this case, with time even though the drug used for the targeted treatment such as Crizotinib may be effective in the beginning, the tumor adapts and keeps growing in this safe environment.

Your IL-6 level being elevated does suggest that there is an active inflammatory environment, which, in this context, can support tumor growth. It does not mean your immune system is entirely working against you, but it does indicate that the balance is currently not in your favor.

The high adenosine levels in your pleural fluid also support this diagnosis. Adenosine reduces the activity of immune cells that are supposed to kill cancer cells, so it acts like a local shield for the tumor. We often see this in patients with pleural involvement.

Concerning your case of diabetes, since it is mild and under control, it will probably not act as a significant motivator in this regard. However, it may have some slight effects on your immune system, even if the effects are minor. In my experience working with cases such as yours, second-line therapies are effective.

I understand why this concept is disturbing. Many patients feel unsettled when they realize the body’s own system is being influenced in this way. But the important point is that your treatment team already understands these mechanisms, and the shift from Crizotinib to Entrectinib (an oral anticancer drug) is a logical and appropriate next step in this situation.

I hope this information helps you.

Feel free to ask further queries.

Thank you.