Treating cancer with immunotherapy

Callan Emery spoke to Dr Francesco Marincola Ė Chief Research Officer at Sidra in Doha and President of the Society for the Immunotherapy of Cancer (www.sitcancer.org) about immunotherapy and recent advances in its use as a treatment for cancer.

Callan Emery: In current practice, for which types of cancers has immunotherapy been shown to work as a treatment?

Dr Francesco Marincola: Currently, monoclonal antibodies are the most widely used form of cancer immunotherapy. They have been approved for use in treating several types of leukemia and lymphoma, as well as some types of breast, colorectal, head and neck cancers. Cytokines are a second type of immunotherapy, which are hormone- like molecules that regulate immune cells. Interferon and interleukin-2 are two cytokines used commonly to treat patients with melanoma and kidney cancer. Cancer vaccines have been studied for several decades, but until recently, advances in this field have been slower than for other forms of immunotherapy. For example, new vaccines against the human papilloma virus (HPV) help prevent women from getting cervical, vaginal, and vulvar cancer. Vaccines against hepatitis B virus (HBV) may lower some peopleís risk of getting liver cancer. These vaccines donít target cancer cells; they target the viruses that can cause these cancers. Adoptive t-cell therapy is an emerging type of immunotherapy in which t-cells found within a patientís tumor are Ďtrainedí to attack cancerous cells. In gene therapy, tumor cells are modified and then used to immunize cells against cancer. Both of these types of therapy have shown a high response rate in leukemia and solid tumors. Checkpoint inhibitors are another type of immunotherapy. They work by altering the way that tumor cells interact with the patientís immune system. In 2011, the US Food and Drug Administration (FDA) approved ipilimumab (Yervoy) for the treatment of melanoma, a type of skin cancer. It is also being investigated in other types of cancer.

Callan Emery: For the cancer patient, what does immunotherapy treatment involve? How is the treatment provided?

Dr Francesco Marincola: Different types of immunotherapy are used in different ways. Monoclonal antibodies are used either with standard chemotherapy or alone. They are usually administered by intravenous infusion (drip) and may be given to patients either on an inpatient or outpatient basis. The number of times a patient will receive an infusion and the dose that he or she will receive depends on the type of cancer and the patientís response to the therapy. Some monoclonal antibodies can be given by subcutaneous injection. Interferon and interleukin-2 are usually given by subcutaneous injection but can also be given by infusion. Both may be used in combination with other therapies. Adoptive t-cell therapy requires infusion of the Ďtrainedí cells.

Callan Emery: Is it used as an alternative to other forms of treatment, such as radiation, or can it be used in combination with them?

Dr Francesco Marincola: Current cancer treatments such as chemotherapy, radiation and surgery tend to destroy healthy tissue in the course of treatment. Immunotherapy can avoid this by harnessing the bodyís innate protective mechanisms to fight cancer. At present, immunotherapy is often used in combination with other treatments such as chemotherapy. For example, there is something called the abscopal effect where the use of radiation and use of checkpoint inhibitors improves treatment results. In the future, however, it may be possible to tackle cancer with immunotherapy alone.

Callan Emery: Is immunotherapy a better option than radiation or chemotherapy?

Dr Francesco Marincola: Immunotherapy will harness the bodyís innate protective mechanisms to fight cancer. In doing this it has the potential to fight cancer without causing damage to the body, which would mean effective cancer treatment with few or no side effects for patients. Side effects can be a problem with current cancer treatments (chemotherapy, radiation, surgery) that tend to destroy healthy tissue during treatment. However, we should look at immunotherapy as a complementary treatment to the existing ones as each one is more effective on certain types of cancer and in certain patients.

Callan Emery: For practicing oncologists who are used to providing traditional radiation or chemotherapy treatments what advice can you give them regarding the use of immunotherapy?

Dr Francesco Marincola: I would advise them to get up to speed as soon as possible to ensure they are able to provide their patients with the best possible treatments now and in the future. There will, of course, be a learning curve for oncologists in the region as not much is available here yet. However, thatís rapidly changing. As we saw with the Sidra-hosted Updates on Immunotherapy and Immunoscore event in January, there are hundreds of people in the region interested in learning more and who are actively involved in research on this topic. Joining professional organizations like the Society for Immunotherapy of Cancer (SITC at www.sitcancer.org) is an excellent way to keep up to date with this rapidly evolving field.

Callan Emery: Where are we, with regards current research in immunotherapy? What do you think the future holds with regards immunotherapy for cancer?

Dr Francesco Marincola: Immunotherapy has become the fourth treatment modality for patients (after radiation, surgery and chemotherapy), as it has been shown to have the potential to significantly increase survival rates. Immunotherapy is a potential gamechanger in cancer treatment, helping pave the way for more personalized medicine. However, more research will need to be done to understand why some patients respond to treatment better than others.

Callan Emery: As Chief Research Officer of Sidra Medical and Research Center, will you be continuing research in immunotherapy? In what specific areas do you envision doing this?

Dr Francesco Marincola: Yes, absolutely. Our research will focus on addressing the health challenges faced by the people of Qatar and the region, including cancer. We will work with other international institutions in the immunotherapy arena to bring personalized treatments to patients with focus on combination therapies, in particular t-cell therapy.

Date of upload: 16th May 2014

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