Immunotherapy

Immunotherapy Overview

Our immune systems detect and destroy harmful cells daily, including bacteria, viruses, and even cancer cells. However, these same cancer cells can occasionally hide or suppress typical immune responses, allowing them to grow unchecked.

Enter immunotherapy: Unlike chemotherapy or radiation, which target cancer cells directly, immunotherapy boosts the body’s immune response through several different approaches.

In other words, immunotherapy is a cancer treatment that helps “train” your immune system to better recognize and attack cancer cells. It’s a type of biological therapy—meaning it uses substances made from living organisms—and it works in one of two ways:

• Immunotherapy can stimulate the natural defenses of your immune system so that your immune system works harder to find and attack cancer cells; or
• Immunotherapy can mimic parts of your immune system through lab-made substances that help restore or improve your immune system’s ability to find and attack cancer cells.

Because immunotherapy is an emerging science, most of its treatments for brain tumors are only available through clinical trials. As part of the cancer research process, clinical trials determine if new treatments are safe, effective, or even better than the current standard. What’s more, they can be the best option for those with difficult-to-treat tumors to improve the odds of finding an effective treatment.

Barrow Neurological Institute is proud to be one of the country’s largest sites for neurological clinical trials in partnership with the Ivy Brain Tumor Center.

The following immunotherapy approaches are currently being studied and used:

• Checkpoint inhibitors: Cancer cells sometimes use “checkpoints,” or proteins that can turn off immune cells to avoid detection by the immune system. Checkpoint inhibitors block these proteins, preventing the cancer cells from hiding. In short, checkpoint inhibitors “release the brakes” on your immune system, allowing it to recognize and target specific proteins.
• T Cell transfer therapy: This approach involves taking immune cells known as T cells—a type of white blood cell—and modifying them in a lab to recognize and destroy a specific type of cancer. These modified T cells are then infused into your body to target, attach to, and destroy the cancer cells driving tumor growth.
• Cancer vaccines: While cancer vaccines don’t prevent cancer, they do train your body to fight cancerous cells. By using dead cancer cells, pieces of protein from your tumor, or modified viruses, these vaccines teach your immune system to recognize specific cancer proteins and stimulate a response. Some cancer vaccines are preventative, such as the HPV vaccine, which reduces the risk of cervical cancer. In contrast, others are therapeutic and aim to treat an existing cancer.
• Oncolytic virus therapy: This type of immunotherapy relies on genetically modified viruses that infect and kill cancer cells without harming normal cells. With oncolytic virus therapy, the virus multiplies within cancer cells, causing them to burst and release antigens that trigger a broader immune response.
• Cytokine therapy: Cytokines are small proteins that carry messages between immune system cells to coordinate attacks on specific targets—in this case, cancerous cells. By injecting synthetic cytokines, such as interleukins or interferons, your immune system can attack these cancerous cells by boosting the activity of immune cells near your tumor.
• Monoclonal antibodies (mAbs or MoAbs): Monoclonal antibodies are lab-made proteins that can attach to specific targets on cancer cells. Once attached, they can block the growth of cancer cells, mark them for destruction by other immune cells, or destroy them directly. Monoclonal antibodies can be extremely useful in treating cancer because they can attack a particular part of a cancerous cell.

Most immunotherapy is administered through intravenous (IV) infusions, which are given daily, weekly, monthly, or cyclically. Immunotherapy can also be given orally and, in the case of skin cancer, topically if caught early. That said, the length of immunotherapy treatment will depend on your cancer type and grade, the immunotherapy being used, and your body’s response.

What kind of cancers can immunotherapy treat?

Immunotherapy can treat a variety of cancers, particularly those with higher cell mutation levels or immune system targets. The growing list of eligible cancers includes:

• Brain tumors: While immunotherapy is still considered an emerging science for brain tumors, clinical trials continue to explore options like checkpoint inhibitors, T Cell therapy, and oncolytic virus therapy; especially as a treatment for grade 4 brain tumors, such as glioblastomas.
• Head and neck cancers: Immunotherapy drugs like pembrolizumab (Keytruda) and nivolumab (Opdivo) are approved for specific head and neck cancers, particularly recurrent or metastatic cancers that do not respond to chemotherapy.
• Breast cancer: Immunotherapy has been approved for certain types of breast cancer that are less responsive to traditional therapies, such as triple-negative breast cancer, and is often combined with chemotherapy for the best outcomes.
• Hodgkin’s lymphoma: Checkpoint inhibitor drugs like pembrolizumab (Keytruda) and nivolumab (Opdivo) are especially effective for Hodgkin’s lymphoma, a cancer that affects the lymphatic system.
• Melanoma: Immunotherapy has been highly effective for melanoma, an aggressive form of skin cancer. Checkpoint inhibitor drugs like pembrolizumab (Keytruda) and nivolumab (Opdivo) have significantly improved survival rates.
• Non-Small Cell Lung Cancer (NSCLC): For advanced or metastatic NSCLCs, checkpoint inhibitors like atezolizumab (Tecentriq), pembrolizumab (Keytruda), and nivolumab (Opdivo) are often used to help the immune system better recognize cancer cells.
• Bladder cancer: Immunotherapy treatmentshave been approved for advanced or metastatic bladder cancer, particularly for those unable to undergo chemotherapy. Checkpoint inhibitor drugs, like atezolizumab (Tecentriq), pembrolizumab (Keytruda), and nivolumab (Opdivo) have shown strong results.
• Kidney cancer: Immunotherapy has become a standard for advanced kidney cancer, improving survival rates across the board. Additionally, checkpoint inhibitors like pembrolizumab (Keytruda) and nivolumab (Opdivo) can be combined with other drugs to treat advanced kidney cancers.
• Colorectal cancer: MSI-high or dMMR subset colorectal cancers have responded well to checkpoint inhibitors like pembrolizumab (Keytruda).
• Prostate cancer: Immunotherapy is sometimes used in combination with other treatments for advanced prostate cancer. The FDA-approved cancer vaccine sipuleucel-T (Provenge) has been proven to stimulate a robust immune response.
• Cervical cancer: The checkpoint inhibitor pembrolizumab (Keytruda) is approved for certain advanced or metastatic cervical cancers, especially those with high PD-L1 expressions.
• Stomach and esophageal cancers: Pembrolizumab (Keytruda) and nivolumab (Opdivo) are approved for specific advanced or metastatic stomach and esophageal cancers. As with colorectal cancer, some stomach cancers with MSI-H or dMMR features may be more likely to respond well to immunotherapy.
• Liver cancer: For advanced liver cancer, combination immunotherapies like atezolizumab (Tecentriq) with bevacizumab (Avastin) have shown promising results. Pembrolizumab (Keytruda) and nivolumab (Opdivo) are also strong options for those with progressive liver cancer.

Ultimately, immunotherapy’s success will depend on the type of cancer diagnosed, the specific characteristics of the tumor, and a person’s immune response.