Immunotherapy is a revolutionary approach to cancer treatment that harnesses the power of the body's own immune system to fight cancer. While the immune system is naturally equipped to detect and destroy abnormal cells, cancer cells have developed clever ways to evade this detection.
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Immunotherapy works by either stimulating the immune system to attack cancer cells or by providing it with the tools it needs to do so more effectively.
How the Immune System and Cancer Interact
Normally, the immune system, which is composed of white blood cells, organs, and tissues of the lymphatic system, recognizes and eliminates foreign invaders like bacteria and viruses, as well as abnormal cells that could become cancerous. However, cancer cells can:
Hide from the immune system: They can have genetic changes that make them less visible to immune cells.
Turn off immune cells: Cancer cells can have proteins on their surface that act as "checkpoints" to switch off immune cells, preventing an attack.
Change their environment: They can alter the cells around them to interfere with the immune response.
Immunotherapy is designed to overcome these obstacles and allow the immune system to recognize and destroy cancer.
Types of Immunotherapy
There are several different types of immunotherapy, each with a unique mechanism of action:
Immune Checkpoint Inhibitors: These are drugs that block the "checkpoints" on immune cells and cancer cells. By blocking these checkpoints, the "brakes" on the immune system are released, allowing immune cells (particularly T-cells) to respond more strongly to the cancer. Examples include pembrolizumab (Keytruda) and nivolumab (Opdivo).
T-Cell Transfer Therapy: This treatment boosts the natural ability of a patient's T-cells to fight cancer. In a process known as CAR T-cell therapy (Chimeric Antigen Receptor T-cell therapy), T-cells are extracted from the patient, genetically modified in a lab to better recognize cancer cells, grown in large numbers, and then infused back into the patient. The modified T-cells act as a "living drug" to find and destroy the cancer.
Monoclonal Antibodies: These are laboratory-made proteins that mimic the body's own antibodies. They are designed to bind to specific targets on cancer cells. Some monoclonal antibodies work by "flagging" cancer cells so they can be better seen and destroyed by the immune system. Others can deliver toxic substances directly to the cancer cell.
Treatment Vaccines: Unlike vaccines that prevent diseases, cancer treatment vaccines work to boost the immune system's response against existing cancer cells. They expose the immune system to certain cancer-related antigens to trigger a more robust and targeted attack.
Immunomodulators: These are a broad class of drugs that enhance the body's immune response against cancer in a more general way. They can include cytokines, which are proteins that help immune cells communicate and function.
Oncolytic Virus Therapy: This involves using a genetically modified virus that is designed to specifically infect and destroy cancer cells while leaving healthy cells unharmed. The virus also stimulates an immune response against the cancer.
Side Effects
The side effects of immunotherapy are often different from those of chemotherapy and can vary depending on the type of treatment. Because immunotherapy stimulates the immune system, many side effects are a result of the revved-up immune system attacking healthy tissues. These are often referred to as immune-related adverse events (irAEs).
Common side effects can include:
Flu-like symptoms (fever, chills, fatigue, muscle aches).
Skin reactions (rash, itching).
Gastrointestinal issues (diarrhea, colitis).
Inflammation of organs like the liver (hepatitis), lungs (pneumonitis), or heart (myocarditis).
Hormone gland problems (endocrinopathies).
Managing these side effects is a key part of immunotherapy care, and they are often treated with steroids or other immunosuppressants.
Immunotherapy and Clinical Trials
Immunotherapy has been approved by the FDA for the treatment of many different types of cancer, including melanoma, lung cancer, bladder cancer, and some blood cancers. However, not all patients respond to immunotherapy, and researchers are continually working to understand why. Many new and promising immunotherapy treatments are available only through clinical trials, which are essential for advancing the field and bringing new, potentially life-saving treatments to more patients.
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