Cancer is the abnormal proliferation and growth of cells in a tissue or organ. The spread of cancer from the organ or tissue to distant organs is called metastasis. Metastasis is an indication of an increased stage of cancer. Cancer cells are the result of gene mutations caused by many factors. Cancer disease, which has become a major problem for humanity, will continue to threaten humanity in the future, so new and effective methods in cancer treatment must be found.
Immunotherapy is a type of treatment that allows the immune system to fight cancer cells. The immune system helps the body fight infectious diseases and other diseases. White blood cells consist of tissues and organs of the lymphatic system. Immunotherapy is a biological therapy. The substances used in biological therapy are obtained from living organisms. The first beginning of immunotherapy goes back to 1866. Starting from an observation at the beginning, scientists have come a long way since then. Immunotherapy has been widely used for about 4-5 years. Continuous immunotherapy methods are being developed for new types of cancer, currently it is possible to treat nearly twenty types of cancer with immunotherapy. There is also another type of immunotherapy for allergy sufferers.
How Does Immunotherapy Work?
The immune system recognizes the abnormal cells and immediately defends to destroy them, cancer cells are also abnormal cells but can hide from the immune system. Cancer cells contain proteins that cover the immune cells. Immunotherapy helps the immune system recognize and destroy cancer cells. Some immunotherapy drugs deliver radiotherapy and chemotherapy directly to cancer. and immunotherapy stops the cancer from growing, preventing the tumor from recurring.
What Are the Types of Immunotherapy?
Drugs that interfere with the braking mechanism of the immune system:
The immune system has a braking mechanism to prevent excessive immune response. Drugs in this group disable the braking mechanism and enable the immune system to respond strongly and T cells to fight cancer. For this, T cells are taken from the cancerous tissue; The strongest ones are selected, reproduced in vitro and given back to the patient, this is defined as T cell transfer.
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Monoclonal antibodies: These are proteins on the immune system that can bind to certain targets. These antibodies mark cancer cells and help them to be found more easily by the immune system, so they are known as targeted therapy. Monoclonal antibodies recognize specific parts of cancer cells, not healthy cells. It prevents the growth of cancer by blocking the growth sites on the surface of cancer cells. Some monoclonal antibodies are coated with radiation and given to the body so that targeted radiotherapy can be applied. Some monoclonal antibodies are loaded with cancer drugs so that they directly reach the cancer tissue.
Vaccines that cure cancer: We are all more or less aware of the existence of vaccines against bacteria and viruses that protect us from infections. Cancer vaccines do not carry weakened bacteria or viruses. They are different from vaccines that protect against cancer. HPV vaccine and hepatitis B vaccine are examples of vaccines that protect against cancer. Cancer vaccines contain antigens from the tumor surface. When they are given to the body, they enable the immune system to recognize cancer and become active. Cancer vaccines can be produced individually from your own tumor cells. A vaccine currently being administered to patients for prostate cancer extends the lifespan of patients, although it does not completely eliminate the cancer.
Oncolytic viruses: These are viruses that, when introduced into the body, do not touch normal cells but destroy cancer cells.
Immunomodulators: In general, they act by making the immune system more active.
Cytokines: Cytokines are chemicals produced by certain immune system cells; It is administered subcutaneously, intramuscularly or intravenously. Immunotherapy with cytokines has many side effects. GM-CSF, interleukins and interferons are commonly used cytokines. Cytokines contribute to the proliferation of immune system cells and act by disrupting the formation of blood vessels that feed cancer cells.
What Are the Benefits of Immunotherapy?
- Immunotherapy has fewer side effects than chemotherapy and radiotherapy. It can even be given to patients who cannot receive chemotherapy.
- It helps prolong the life of many cancer patients.
- Immunotherapy creates a cancer memory on the immune system. Thus, it can prevent the recurrence of cancer.
- It is effective on some types of cancer that are resistant to chemotherapy and radiotherapy.
- Immunotherapy can be used alone or in combination with other treatments.
- Chemotherapy and radiotherapy also damage healthy cells. Immunotherapy does not cause much damage to healthy cells.
- It is better tolerated than chemotherapy and radiotherapy.
- Less side effects are seen compared to chemotherapy and radiotherapy.
- Cancer growth slows or stops.
- It can prevent cancer from metastasizing.
Which types of Cancers are treated with immunotherapy?
A new generation of immunotherapies known as immune checkpoint inhibitors have been added to cancer treatments based on surgical radiotherapy and chemotherapy and targeted therapies since the 1950s.
Immunotherapy treatment is a new hope for patients. It is based on stimulating the activities of certain parts of the immune system or preventing immune-suppressing signals. Studies show that immunotherapy, which is one of the most up-to-date approaches in cancer, is effective in many types of cancer and provides complete recovery in some patients.
Immunotherapy, which was started in 2011 with the treatment of the skin cancer type melanoma and is currently under development. It is applied abroad as a treatment method in more than 20 types of cancer such as lung and kidney.
Immunotherapy, which has been used for a subgroup of breast cancer called triple negative, starting from 2018, is very effective especially in metastatic cancers.
Japanese scientist Tasuku Honjo and American scientist James P. Allison were awarded the 2018 Nobel Prize in Medicine and Physiology for their discovery of “immune checkpoint inhibitors, which enable the immune system to effectively attack cancer cells.” With this discovery, immunotherapy drugs effective against many types of cancer, especially aggressive skin cancer, malignant melanoma and lung cancer, have been developed.
As a matter of fact, the prevalence of use of immunotherapy drugs is increasing day by day in many types of cancer, and the types of cancer that the drugs affect are listed as follows:
- non-small cell lung cancer,
- small cell lung cancer,
- Skin cancers (melanoma, merkel cell carcinoma, squamous cell carcinoma)
- Genitourinary cancers (Kidney and bladder cancer)
- Some gastrointestinal cancers (esophagus, stomach, liver cancer)
- triple negative breast cancer
- Head and neck cancers
Are There Any Side Effects of Immunotherapy?
Major side effects:
- Tremor
- Weakness
- Dizziness
- Nausea or vomiting
- Muscle or joint pain
- Redness of the skin
- Fatigue
- Headache
- Shortness of breath
- Low or high blood pressure
- Heart palpitations
- Itching
- Sinus congestion
- Diarrhea
- Risk of infection
- Organ inflammation
- Pain
- Debris
- Fever
What are the side effects of cancer vaccines?
- Fever
- Tremor
- Weakness
- Dizziness
- Nausea or vomiting
- Muscle or joint pain
- Fatigue
- Headache
- Shortness of breath
- Low or high blood pressure
Frequently asked Questions
How often and for how long immunotherapy is taken depends on the type of cancer and its progression, the type of immunotherapy, how the body responds to the treatment, and the cycle of treatment to be administered. Some immunotherapies are given in cycles. The cycle includes a treatment period followed by a rest period. The rest period allows the body to recover, respond to treatment and create new healthy cells.
There are centers that perform immunotherapy in our country. It is usually part of the cancer treatment unit and can be administered as an outpatient basis for immunotherapy.
Chemotherapy acts by targeting the structures in the nucleus of the cancer cell, destroying this structure and eliminating the cancer cell. In immunotherapy treatment, the aim is to strengthen the immune system and enable the body to defeat cancer on its own.
Immunotherapy drugs are currently mostly administered in advanced stage (metastatic) cancer stages. However, it is also effective and approved in the early period in the treatment of malignant melanoma, a type of skin cancer. Studies on immunotherapy to be used in early stage tumors, before and after the operation are ongoing.
Success rates for any cancer treatment, including immunotherapy, depend on many individual factors, including the type and stage of cancer.
Immune checkpoint inhibitors, one of the types of immunotherapy, were included in the scope of reimbursement in Turkey in 2018 in patients diagnosed with metastatic malignant melanoma, advanced kidney tumors and Hodgkin lymphoma. Immunotherapies can be performed in other types of tumors in medical oncology centers with special permissions.
Some of the immunotherapy drugs are administered intravenously and the application is carried out in the hospital, while some immunotherapy drugs are in the form of tablets or capsules. There are also immunotherapy drugs that are applied to the skin in the form of a cream. Another application is to inject the drug into the urinary bladder.
In patients receiving immunotherapy, the condition of the tumor is determined by performing blood tests and radiological examinations during physician visits.
