Immunotherapy, What’s That?

After decades of attacking cancer with surgery, radiation and chemotherapy, it appears that we have a new kid on the block – immunotherapy.

Former President Jimmy Carter took a new immunotherapy drug as part of his treatment for metastatic melanoma and in December announced he no longer had any detectable cancer in his body. In March, as Carter announced that doctors were stopping his treatment, former New York City Mayor Michael Bloomberg and other philanthropists pledged $150 million for further research into cancer immunotherapy.

Just this week, Sean Parker, founding president of Facebook and the founder of the music-streaming service Napster, committed $250 million for a collaborative effort between six cancer centers nationwide.

But immunotherapy, which provokes the immune system to action so that it can recognize cancer cells and destroy them, isn’t something new. We’ve just been so busy killing off the immune system with radiation and chemotherapy the past half-century or so that the idea of stimulating it has taken a back seat.

In 1891, a young surgeon named Dr. William B. Coley was so profoundly affected by the death of one of his first patients, a teenage girl with a bone sarcoma, that he went deep into the archives at Memorial Hospital in New York (now part of Memorial Sloan Kettering Cancer Center) to see what might be an effective cancer therapy. He discovered that some cancer patients who also had developed bacterial infections saw their tumors shrink when they were treated for their infections.

Their immune systems, when provoked to attack the infection, also attacked the tumors.

Coley injected a patient who had inoperable cancer with streptococcal organisms, and the man’s tumor began to shrink. The man survived, Coley was amazed, and this first case of immunotherapy led Coley to inject bacteria or bacterial products in more than 1,000 patients over the next 40 years. He and other doctors reported great success in using “Coley’s Toxins” especially for bone and soft-tissue sarcomas, but many other doctors doubted his results because they were sporadic and seemed mysterious.

Then, thanks to Madame Marie Curie’s advances in radiation, followed by the predictable effects of chemotherapy, Coley’s Toxins and immunotherapy lost any limelight they had.

Coley’s daughter later championed his cause, getting the attention of another rising star in immunology, and she founded the Cancer Research Institute. The institute still exists today, and Coley now is considered the “Father of Immunology.” With Carter’s illness and the millions of dollars being thrown toward research in this area, immunotherapy is back in the limelight.

And it’s promising.

How it works – 

Our immune system’s job is to distinguish between normal cells and “foreign” ones, and to fight off the foreign while leaving the normal ones alone. To do this, it uses “checkpoints,” molecules on certain immune cells that need to be activated or inactivated to begin an immune response.

The immune system naturally stops and investigates at certain checkpoints in the body, explains immunologist A.J. Lanigan. When cancer is involved, the immune system doesn’t always see what’s there. Cancer hijacks certain checkpoints, and the immune system fails to respond.

Keytruda, the drug given to Carter, is known as a checkpoint inhibitor. It and other drugs like it turn the immune system loose to do its job.

“The immune system says, ‘I smell smoke, what’s going on over there?’“ Lanigan says. “Now the immune system is attacking something it could not see before.”

But checkpoint inhibitors are not the answer for everyone. So many variables exist – a patient’s genetics, location of the cancer, and type of cancer being among those.

Keytruda, for example, is known to work best for people like Carter who have melanoma of the skin.  For every 1,000 people, Lanigan explains, the drug is only given to 5%, or about 50 people. Of those 50, only 30% – or about 15 people – respond to the drug. That is 15 responses out of 50 who received it, out of the 1,000 with cancer who need help. The drug costs about $12,000 per month.

Other types of immunotherapy include cancer vaccines, monoclonal antibodies, and other nonspecific immunotherapies. Monoclonal antibodies are man-made versions of immune system proteins that can be designed to attack a specific part of a cancer cell.

Between vaccines, virotherapies, and checkpoint inhibitors, more than a dozen immunotherapies currently are being researched, says Lanigan, and all are targeted and specific, designed to help the immune system.

Chemotherapy, alternatively, sends chemicals to provide toxicity to fast growing cells. It wipes out the fast-growing cancer cells but also any fast-growing immune cells and a good portion of the immune system. And then if chemo and radiation are ineffective but and they snuff out the immune system, the cancer will come back again – with a vengeance, Lanigan says.

Parker, the Silicon Valley billionaire who lost a close friend to cancer, said this week in announcing his donation that it’s time to see better results. His donation aims to overhaul cancer research, fostering collaboration, providing the newest information technology and data processing, and making it less necessary for researchers to need to solicit grants.

“Very little progress has been made over the last several decades,” he was quoted as saying, referring to cancer drug research. “Average life expectancy has only increased three to six months with some of these drugs that cost billions to develop.”

Maybe success in this area will lead to increased awareness about the overall importance of the immune system. In a future article, we’ll discuss boosting everyone’s immune system, not just those with extra health challenges. Do you do anything to help boost your immune system? If so, what?

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