Cancer Treatment: Immunotherapy and Immune Checkpoint Inhibitors

Cancer is a group of diseases involving abnormal or malignant cell growth with the potential to invade or spread to other parts of the body. Cancer begins in your cells, which are the building blocks of your body. Normally, your body forms new cells as you need them, replacing old cells that die. When cancer occurs, the cells begin to reproduce uncontrollably. There are more than 100 types of cancer, including breast cancer, skin cancer, lung cancer, colon cancer, prostate cancer, and lymphoma. Symptoms vary depending on the type. Cancer treatment may include chemotherapy, Immunotherapy, radiation, and/or surgery.


Immunotherapy
Immunotherapy is a treatment that uses certain parts of a person's immune system to help fight cancer. It uses substances either made by the body or in a laboratory to induce, enhance or suppress an immune response. Immunotherapies designed to induce or amplify an immune response are categorized as activation immunotherapies while immunotherapies that minimize or suppress are categorized as suppression immunotherapies. To find out more about Immunotherapy Click Here

Our immune system is an amazing piece of human biology. Our immune system helps to guard the body from infections due to bacteria, viruses, and yes, even cancer. Our immune system has a memory, too, and it can recall and know when foreign bodies, such as cancer, attempt to colonize our body. However, the immune system is not perfect in fighting these intruders, and researchers are making great progress to learn why. It appears some tumors can 'turn off' the ability of cancer-fighting cells such as T-cells (a type of white blood cell) to attack these unwelcome guests. But the new immunotherapy drug class called "Immune Checkpoint Inhibitors" is fighting back.

Cancer Types Targeted By Immunotherapy
If you've been affected by cancer -- either yourself or a family member -- take time to learn more about these breakthrough treatments. Advances are being made not only in cancers such as metastatic melanoma (skin cancer that has spread), but also non-small cell lung cancer (NSCLC), renal cell carcinoma (kidney cancer), Hodgkin's lymphoma, head and neck cancer, and bladder cancer, among others. Plus, multiple other types of cancer are under research. While not every patient will have a response, it is important to investigate your alternatives with your doctor. Joining a groundbreaking research trial might even be an option. This could give you the opportunity to use an investigational medication that is not available otherwise.

Immune Checkpoint Inhibitors
The immune system needs to be able to tell the difference between foreign invaders and heathy tissue so that our needed cells and organs are not attacked. To do this, our immune system has a set of "brakes", like a car, that can help it to stop and go. When the immune system "brakes" are "off", it attacks cells that are foreign invaders, like cancer. Our immune system is very good at this, but cancer is sneaky and can fool the "brakes" to stop. When the T-cell is stopped ("brakes" are on) it can't fight the cancer. However, a group of drugs known as Immune Checkpoint Inhibitors release the "brakes" so the T-cells can now "go" find and kill the cancer. Some of these checkpoints are called PD-1, PD-L1, and CTLA-4 receptors, which are protein receptors on cell surfaces. Drugs that target these checkpoints -- turning "off" the "brakes" -- hold great promise to fight cancer.

US FDA-Approved Immune Checkpoint Inhibitors
Yervoy (ipilimumab) from Bristol Myers Squibb, targets CTLA-4 and is used for advanced melanoma (skin cancer)
Keytruda (pembrolizumab) from Merck, targets PD-1 and is used for advanced melanoma, non-small cell lung cancer (NSCLC), and head and neck cancer
Opdivo (nivolumab) from Bristol-Myers Squibb, targets PD-1 and is used for advanced melanoma, advanced NSCLC, advanced renal cell cancer, Hodgkin's Lymphoma, and squamous cell carcinoma of the head and neck
Tecentriq (atezolizumab) from Genentech, targets PD-L1 and is used for advanced bladder cancer and NSCLC.

Quite often these drugs are used after traditional cancer treatment has failed, but as research advances they may be used first-line. 

How Well Do Checkpoint Inhibitors Work?
Some, but not all people, can have a positive response with checkpoint inhibitors. How well they work for an individual patient will be based on many factors: the type of cancer, whether they express certain genetic markers on their tumors, their overall health at the time of treatment, previous treatments, and their ability to tolerate the side effects of the medication. In some patients, tumors have regressed and disappeared with checkpoint inhibitors. But this does not necessarily mean they are "cured", that the cancer won't return, or that everyone will respond. For example, of those people who received Keytruda in one clinical trial for melanoma, roughly 24 percent had their tumors shrink (partially or fully) lasting at least 1.4 to 8.5 months, and continued beyond this period in most patients. Unfortunately, this means that 76 percent of patients did not respond to the treatment. But this can be variable -- cancer treatment is very individual. It's important to discuss your expected treatment outcomes with your doctor.


Other Types of Cancer Immunotherapy
Research is very active in the area of cancer immunotherapy treatments. Immune checkpoint inhibitors are only one type of immunotherapy for treating cancer. Many other types of immunotherapy exist, some still under research in clinical trials and not yet approved:

• Monoclonal Antibodies
• Cancer Vaccines
• Cytokines
• Other monoclonal antibodies
• Oncolytic viruses
• Chimeric antigen receptor (CAR) T-cell therapy 

Reference: Drugs.com

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