Immunotherapy

The broad category of cancer medications known as immunotherapy stimulates the immune system to combat cancer cells. Cancer cells vary from healthy cells in that they do not naturally expire. They multiply like an uncontrollable copy machine that won't stop making copies.

These aberrant cells frequently transform or mutate, which helps them avoid detection by the immune system, which defends the body against infections and disease. Drugs used in cancer immunotherapy are intended to warn the immune system about these altered cells so that it can find and eliminate them.

This guide will cover the following topics to help you understand immunotherapy and when it may be used as part of a cancer treatment plan:

• How does the immune system work?
• How does immunotherapy spark the immune system to help fight cancer?
• What are some of the drugs used in immunotherapy?
• Tumor-agnostic therapies
• What are immunotherapy side effects?
• Types of immunotherapy
• What's the difference between immunotherapy and chemotherapy?
• Benefits of immunotherapy
• Risks of immunotherapy
• Are you a candidate for immunotherapy?

How does the immune system work?

Differentiating between the body's natural cells and foreign cells is one of the immune system's main tasks.

Like a police force tasked with purging the body of foreign intruders like viruses, bacteria, or fungi, the immune system is constantly on the prowl. The body's lymph nodes, which make up the majority of the immune system, act as police stations. White blood cells, such as lymphocytes like "T cells," combat cancer and infections. They are law enforcement officials. Just as a police station would radio police officers to inform them of a problem, the entire immune system is alerted by chemical signals when a foreign invader is detected.

To find the invaders, the immune system uses receptor proteins on certain immune cells. These receptors allow it to discriminate between healthy and invasive cells at specific checkpoints depending on whether they are activated or deactivated. To prevent the immune system from attacking healthy cells, checkpoints are required.

Because cancer cells are the body's own cells that have undergone mutations and no longer function as normal cells, they do not cause an immune response. These harmful cells can continue to develop, divide, and spread throughout the body because the immune system is unable to distinguish between them.

How does immunotherapy spark the immune system to help fight cancer?

Different strategies are used by immunotherapies to combat tumor cells. There are three main types of immunotherapy:

• Checkpoint inhibitors, where cancer cell signals that trick the immune system into thinking they’re healthy cells are disrupted, exposing them to attack by the immune system
• Cytokines, where protein molecules called cytokines—those that help regulate and direct the immune system—are synthesized in a laboratory and then injected into the body in much larger doses than are produced naturally
• Cancer vaccines, which may reduce the risk of cancer by attacking viruses that cause cancer, or may treat cancer by stimulating the immune system to attack cancer cells in a specific part of the body

Immunotherapy may be used alone or in combination with other cancer treatments, such as surgery, chemotherapy, radiation therapy and targeted therapy.

What are some of the drugs used in immunotherapy?

Current checkpoint inhibitor drugs target the PD-1 and the CTLA-4 receptors. Common checkpoint inhibitors include:

• Ipilimumab (Yervoy®)
• Pembrolizumab (Keytruda®)
• Nivolumab (Opdivo®)
• Sipuleucel-T (PROVENGE®)
• Atezolizumab (Tecentriq®)

Common cytokines used in cancer therapy include:

• Interleukin-2 (IL-2)
• Interferons-alpha (IFN-alpha)

New immunotherapy drugs continue to be developed.

Tumor-agnostic therapies

Immunotherapy has also been given FDA approval for the treatment of malignancies with particular genetic characteristics, independent of where in the body they originate. The following cancers may be treated with these medications, referred to as tumor-agnostic therapy:

Solid tumors with high levels of microsatellite instability (MSI-h) or a deficiency in mismatch repair (dMMR) may have unstable DNA strands or be unable to repair DNA damage.

Solid tumors with a high tumor mutation burden (TMB-h) may be more responsive to immunotherapy because these cancers have a high number of distinct gene mutations in their cells.

What are immunotherapy side effects?

Immunotherapy may cause a variety of side effects—many are flu-like symptoms—including:

• Fatigue
• Nausea or vomiting
• Mouth sores
• Diarrhea
• High blood pressure
• Fluid buildup, usually in the legs
• Fever or chills
• Pain or weakness
• Headaches
• Rashes or itching

The side effects of immunotherapy generally become less severe after the first treatment.

Throughout your treatment, your care team will provide integrative care services, including nutritional support, naturopathic support, pain management, oncology rehabilitation, behavioral health and spiritual support. These therapies may help reduce side effects and improve your overall quality of life during immunotherapy.

Types of immunotherapy

Immunotherapy aims to reset the body's immune system so that it can once more recognize and kill cancer cells. Different immunotherapies operate in a different way and each has advantages and disadvantages. The type of cancer and its stage will determine which of these treatments your care team advises.

Monoclonal or therapeutic antibodies are grown in a lab and injected into the body. Some cancer cells are marked so that the immune system can identify and eliminate them. Others use a more direct route, causing cancer cells to self-destruct or preventing their proliferation.

CAR T-cell therapy goes by many names—including adoptive cell therapy, adoptive immunotherapy or immune cell therapy. In essence, your medical team removes white blood cells from your tumor and develops them in a lab while modifying them to boost their inherent capacity to fight cancer. To combat cancer, these cells are multiplied in big numbers and put back into the body.

Immune checkpoint inhibitors are a class of medication that eliminates bodily natural barriers that regulate your immune system. Without these organic barriers, it can react inappropriately, as in autoimmune disorders. However, these blockades or proteins are frequently used by malignancies as a form of immune system evasion. Through the use of checkpoint inhibitors, these blockades are turned off, allowing your body to react to cancer cells more forcefully.

Cancer vaccines, sometimes called immunotherapeutic or treatment vaccines, boost the immune system response when you already have cancer. They don't function as preventative immunizations like those against viruses like the flu. They prepare the body to produce antibodies that will attack cancer cells by giving immune cells a target present on cancer cells. Immune-stimulating substances are typically included in vaccines to mobilize the white blood cell army specifically against that protein target.

Cytokines are proteins created by your body during natural infections that play an important role in stimulating your immune system cells. These therapies support your body's own cytokines, which stimulate immune cells and direct them toward the tumor as their target.

Immune system modulators, sometimes called immunomodulators, are drugs that ramp up the body’s immune reaction. Immunomodulators have a variety of actions; some target the immune system specifically, while others affect the entire body.

Immunotherapy can be administered orally as pills or capsules, intravenously (IV), or topically (topically applied to the skin).

What’s the difference between immunotherapy and chemotherapy?

Chemotherapy and immunotherapy are two popular cancer therapies that use medication to inhibit or limit the growth of malignant cells. Immunotherapy, on the other hand, stimulates the immune system's capacity to recognize and combat cancer cells, whereas chemotherapy medications are employed to attack rapidly developing cells throughout the body.

Additionally, the side effects of chemotherapy and immunotherapy can vary greatly. Chemotherapy affects both rapidly growing cancerous and rapidly growing normal cells, including those lining the digestive tract and creating bone marrow. This is because chemotherapy is unable to distinguish between the cells it is targeting. This explains why side effects from chemotherapy, such as hair loss, nausea and vomiting, and changes in skin and nails, are more frequent and occasionally more severe.

Benefits of immunotherapy

In general, immunotherapies are still less frequently used to treat cancer than chemotherapy or surgery. However, these medicines are becoming a significant therapy option for some cancer types. There are still numerous immunotherapies undergoing clinical studies.

Because they leverage the body's natural ability to combat the tumor rather than injecting drugs into the body, immunotherapies have the potential to be both more thorough and less hazardous than other types of cancer treatments.

Immunotherapies are a very active area of research in cancer therapy, and new treatments continue to be approved.

Risks of immunotherapy

The risks are dependent on the immunotherapy type, the cancer kind, the stage, the patient's overall condition, and the course of current treatments. Every medication has unique side effects, and even the same treatment can have distinct effects on different patients.

When you put the immune system on "high," there are typically adverse consequences. The immune system is working as it should, so you may suffer flu-like symptoms, such as fever, chills, weakness, dizziness, nausea, muscular aches, weariness, or headache.

High levels of inflammation brought on by these treatments may result in adverse reactions like a skin rash in healthy cells and tissues. Although steroids have some of their own side effects, they may be used to alleviate the negative effects of that inflammation.

Immunotherapy resistance can appear in some patients. Rarely, serious or even fatal allergic and inflammatory reactions to various immunotherapy regimens have been seen by medical professionals.

Immunotherapy may or may not cause your body to react. Only a small percentage of those getting these treatments do so. Better knowledge of the connection between those who do respond and their motivations is a goal of research.

Ask your care team about the risks and benefits of immunotherapy for your type and stage of cancer.

Are you a candidate for immunotherapy?

Our medical professionals collaborate in multidisciplinary teams to create treatment plans that are specific to the needs of each patient with cancer. If you have a certain type of cancer, immunotherapy may be a possibility for you. Your oncologist will regularly evaluate your progress and may advise using immunotherapy in conjunction with other treatments as some cancer types may respond to the treatment more favorably than others.

Your care team will take the necessary time with you and your caregiver to discuss each choice, its possible risks and benefits, side effects, and other crucial information after they have developed a recommended treatment plan. The team will then decide which immunotherapy or other treatment options are best for you, empowering you to make well-informed choices regarding your care.

A lot of patients visit NJHOA to learn more about their cancer diagnosis or treatment options. Genomic testing, immunotherapy, targeted therapy, and clinical trials are just a few of the many diagnostic and therapeutic options available to our cancer specialists. To assist you in avoiding or managing the side effects of your cancer therapy, we also provide a team of multidisciplinary experts and a personalized approach to cancer care.