Immunotherapy

Overview

Your immune system can fight cancer with the help of an intuitive type of treatment called immunotherapy. This treatment is sometimes referred to as biologic therapy or biotherapy. Immunotherapy is currently in the spotlight as new variations become available that harness the strength of the immune system as a weapon against cancer.

The concept of using the immune system to fight cancer is not new. For centuries, doctors and researchers have understood how well-equipped the immune system is at fighting off millions of threats to our bodies from bacteria, viruses, parasites and other microorganisms on a daily basis (see Explaining the Immune System). In fact, the immune system is so powerful that the body has to suppress the full strength of the immune system most of the time so that it does not get out of control. As a result, doctors and researchers have worked hard to use the potential of the immune system to be an effective treatment for cancer. Today, medications – oral and intravenous – are available that boost the immune system so it can recognize and attack cancer.

In 1990, the U.S. Food and Drug Administration (FDA) approved the first commercial immunotherapy to treat bladder cancer. Since then, multiple immunotherapy drugs that work in a variety of ways for other cancer types have been introduced, and the immunotherapy options for treatment continue to increase as new medications and procedures are tested and approved (see Types of Cancer Immunotherapies).

When it was first introduced, immunotherapy was considered a second-line treatment, which means it was given after another option, such as surgery, chemotherapy or radiation therapy, was used. As research has progressed, many immunotherapies approved for second-line treatment are now gaining approval as a first-line treatment for many different cancers. First-line treatment is considered the standard of treatment and the best treatment for that particular type of cancer.

In addition to being given as a first-line or second-line treatment, research is showing that immunotherapy may be effective as a combination treatment with chemotherapy or radiation therapy. Research, in the form of clinical trials, is helping to determine the most effective combinations for different cancers.

None of the advancements in immunotherapy would have been possible without the use of clinical trials. Clinical trials are ongoing as researchers look for new ways to stimulate the immune system and personalize treatment for each individual. Researchers are also exploring why some immunotherapies work for certain people but not for others.

As you consider treatment options, talk with your doctor about immunotherapy and ask if you are eligible to participate in a clinical trial (see Clinical Trials).

 

The 3 E's: Cancer vs. The Body

In the 1950s, some researchers thought that in addition to protecting the body against bacteria and viruses, the immune system looked for abnormal cells and killed them before they could become tumors. This theory, called cancer immunosurveillance, was initially rejected. In the last ten years, however, studies have confirmed this is possible. Although tumors may develop in a functioning immune system, the way a tumor grows and develops is influenced by the body’s immune response. Based on this new evidence, and confirmed by studies conducted by cancer researcher Dr. Robert Schreiber, the theory has been renamed “cancer immunoediting.”

The three Es of Dr. Schreiber’s theory of cancer immunoediting are elimination, equilibrium (balance) and escape.

  1. ELIMINATION. The immune system sees and destroys cancer cells. In this phase, our bodies may be regularly introduced to cancerous changes, and our immune systems are capable of handling and eliminating them.
  2. EQUILIBRIUM. If the cancer cells are not destroyed right away, they may exist in a delicate balance between growth and control by the immune system. During equilibrium, the body’s immune system is able to keep the cancer cells in check but unable to kill them completely. In this phase, a tumor may remain dormant for an unknown length of time and evade medical testing. According to the theory, however, the constant interactions between the tumor cells and the cells of the immune system may lead to tumors that can adapt to the immune response. This means the immune system may no longer be able to find tumors and attack them. Tumors that avoid the immune response can no longer be controlled and move on to the third phase.
  3. ESCAPE. The escape phase refers to the disruption of equilibrium, which allows tumors to escape and begin growing in an environment of immune “tolerance.” It’s at this point that the symptoms of cancer begin to appear. Tumors in the escape phase use a number of methods to alter the body’s immune response in a way that allows them to grow.

 

 

A Long History

More than a century ago, Dr. William B. Coley worked with other doctors and people with cancer to study how cancer tumors reacted to bacterial infections. His treatments for people with inoperable tumors consisted of injecting a combination of bacteria directly into the tumors. Dr. Coley believed the body’s increased response to the bacteria helped fight off the cancer. The treatment shrank the tumors and sometimes even led to a cure. More recently, in the 1960s, Dr. Donald Morton experimented with a vaccine that was intended not to prevent cancer but to stimulate the body’s immune system to attack cancer cells once they had developed. Dr. Morton was at the forefront of global cancer research and treatment, with a focus on melanoma. He was an early proponent of immunotherapy, particularly cancer vaccines. His work with bacillus Calmette-Guerin (BCG) for treating melanoma led to the approval of BCG for bladder cancer, the first successful immunotherapy against a human tumor.

 

Additional Resources

 

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