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LaurenH

Cancer Immunotherapy: Where we are and where we’re heading

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Co-written by LUNGevity and Mesothelioma Cancer Alliance

A recent shift in cancer treatments from traditional, aggressive, overarching methods to targeted therapies tailored to individual patients and their medical situation has produced a resurgence of research in immunotherapy as a cancer treatment including multiple FDA approvals in the last few years. Today we are it taking a moment to reflect on how immunotherapy has progressed over the last twenty years. Immunotherapy is nothing new and has been in use for more than a century, but its potential is often seen as a mystery. While the average person might not understand the finer intricacies of these rapidly developing treatments, patients and doctors alike are reaping the benefits.

Immunotherapy is a type of treatment that is meant to boost the body’s own immune system to help identify and fight rogue pathogens and cells, including cancer cells. In some cases, treatments can help activate the body’s defenses to better equip a patient to fight off diseases more efficiently. In other instances, immunotherapy may provide the immune system with proteins it’s lacking. When cancer cells develop, they may send signals like a mask that deceives the patient’s body into recognizing them as normal, so the invading cells aren’t attacked. In other cases, a person’s immune system might notice the cancer cells are different, but still doesn’t attack them.

To help combat this, medical researchers have developed drugs called immune checkpoint inhibitors to provide T cells—specialized immune cells—the ability to identify cancer cells and attack them. For example, cancer cells produce high amounts of a protein called PD-L1. This protein binds to T cells and blocks them from launching an attack against the cancer cells Immune checkpoint inhibitors that can block this connection have helped patients fight several types of cancer, including melanoma, some types of lung cancer, and head and neck cancers.

Therapeutic cancer vaccines have also been developed in recent years in an attempt to boost the immune system to fight off infections or, like other forms of immunotherapy, attempts to spark an immune response to fight the cancer cells. The most well-known types of these vaccines are meant to prevent the HPV virus, which has been linked to several types of cancer, such as cervical and throat cancers. In most cases, however, the drugs have not been approved, although several cancer vaccines are currently being studied in clinical trials. The main drawback of these types of vaccines is that unlike regular vaccines, which train the body to attack viruses by using weakened versions of them, therapeutic cancer vaccines attempt to encourage the body’s immune system to attack a disease that’s already in the body.

Lung cancer describes many different types of cancer that start in the lung or related structures. There are two main types of lung cancer: non-small cell (NSCLC) and small cell lung cancer (SCLC). Currently, immune checkpoint inhibitors are available for a subset of advanced-stage NSCLC cancer patients. For those NSCLC patients whose tumors produce high amounts of PD-L1 protein, pembrolizumab, an immunotherapy drug federally approved to treat melanoma and non-small cell lung cancer, is available both in the first-line setting, as well as for those patients who have progressed on chemotherapy. A combination of chemotherapy and pembrolizumab has been shown to work in adenocarcinoma (a subtype of NSCLC) patients whose tumors don’t make PD-L1 protein. Two other drugs, nivolumab and atezolizumab, are available for advanced-stage NSCLC patients in the second-line setting, irrespective of how much PD-L1 protein is made by their tumors. Currently, immunotherapy either as monotherapy or in combination, are ongoing in both NSCLC and SCLC. Readout of these trials will determine standard of care of advanced-stage lung cancer patients.

For those battling mesothelioma, a rare cancer often found in the lining of the lung and directly linked to asbestos exposure, immunotherapy could be a new tool patients can use to fight their cancer and extend their lives. Currently, immunotherapy for mesothelioma is showing promise in early clinical trials, namely with pembrolizumab. If the trials continue to present promising results, the treatment could eventually be FDA-approved for mesothelioma, giving doctors and patients an opportunity to more effectively target and treat this aggressive disease.

Clinical trials are paramount to furthering our knowledge and generating the best results for current patients and those who may be at risk of developing cancer in the coming years. The advent of the National Cancer Moonshot has streamlined the clinical trial process, which according to the National Cancer Institute has drawn in about 5 percent of cancer patients into trials each year. By making it easier to find and join these important trials, hopefully more patients will get involved and eventually send the valuable information they provide as feedback to their doctors and medical researchers, which ultimately benefits current and future patients. Mesothelioma is only one cancer benefiting from more access to clinical trials, but the overall development of immunotherapy is giving the medical community hope for an eventual cure by better harnessing the body’s own defenses.

While immunotherapy is currently being used as both a stand-alone treatment and as part of a combination treatment method with surgery, radiation and/or chemotherapy, one thought is that one day it could replace traditional methods entirely. With that said, we must move along with cautious optimism—there are still many unknowns and a long road of research ahead. Some cancers and even specific patients have not responded as well to current immunotherapy treatment methods. Researchers are hoping to discover more prognostic biomarkers that will better predict which patients will respond well to the treatment based on their cancer type and own gene set. There is still much research to do on improving side effects of immunotherapy as well, which have many factors that affect severity including the patient's health and the stage and type of cancer. As more studies are conducted and research is completed, scientists and researchers hope immunotherapy becomes even more effective at treating not only lung cancer and mesothelioma, but also patients across all cancers.

Immunotherapy isn’t a miracle cure for cancers, but it’s quickly becoming a valuable tool doctors and patients can use to extend their lives and raise their quality of life. Immunotherapy as we know it is still in its infancy, but has quickly become a shining star in the medical world. Patients are already reaping some of the benefits this type of treatment provides, and for those in clinical trials, the studies are offering them something intangible: hope. That’s something everyone can use, especially during such a trying and difficult time.

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