Immunotherapy for Cancer

Today’s health challenges demand 21st century solutions: Targeted and patient-focused treatment strategies. The Hallwang Private Oncology Clinic team is poised to discover, and design optimal solutions for all patients.

We know the three typical treatments for cancer patients –

  1. Some tumors can be surgically removed, if they are found to be operable, localized (non-metastatic).
  2. In some cases, a chemotherapy and/or
  3. Radiotherapy are recommended beforehand, after or even instead of the surgical procedure.

Often, two or even all three forms are performed and/or applied simultaneously to a patient. And we do know that method number 2 and 3 can have significant cytotoxic side effects. But what is about treatment method number 4?

4. Immunotherapy in cancer patients

Immunotherapies are treatments that affect the patient’s immune system. Research is going on for years to identify and evaluate new therapeutic methods that have the highest possible action against cancer cells. The various approaches with cancer immunotherapy do have a highly promising potential.

It is important to understand what the body’s immune system has to do with the cancer disease. The fact that the immune system can fail in its defence function against cancer cells in completely healthy individuals is not really surprising, since we do know that tumours are growing in various tissues on the basis of the body’s own cells. Thus, tumour cells carry an antigen on their surface that is perceived by the immune system as “belonging to the body”. And so these cells can grow, and form into a solid tumour, or in an advanced stage, as metastases in other tissues or organs. In this case, we are not talking about a failure of the immune system. But we need to think about how to awaken the immune system, and enable the immune system to recognize these cells and fight against them.

In the field of oncology we differentiate between active and passive immunization. With an active immunization, the patient is given cancer vaccinations that are supposed to trigger an immune response in the patient’s immune system. The immune response should ideally lead to the death of tumour cells or at least, to a delayed tumour growth. In contrast, with the passive immunization, the patient receives antibodies or antibody fragments. These should selectively bind to the tumour cells and lead to their death.

Immunotherapy is a complex field and not well understood by doctors with no expertise in immunooncology and immunotherapy. Beyond doubt, the field of immunotherapy needs to be in the hands of oncologists and scientific professionals, since there are so many biomarker constellations that need to be considered in the decision making process of whether a patient will benefit from targeted immunotherapy or not.

 

Immunotherapeutic approaches

Antibody-drug conjugates or ADCs are an important class of highly potent biopharmaceutical drugs designed as a targeted therapy for cancer treatments. Unlike chemotherapy, ADCs are intended to target and kill only cancer cells and spare healthy cells. ADCs are complex molecules composed of an antibody linked to a biologically active cytotoxic (anticancer) drug.

The development of checkpoint-blocking antibodies, such as those directed against cytoxic T-lymphocyte antigen 4 (CTLA-4) and programmes death 1 receptor /PD-1/L-1), has shown to be one of the most promising approaches to activating therapeutic antitumor immunity in the treatment of an expanding list of malignancies.

Immune checkpoints refer to a wide range of inhibitory pathways that are crucial for maintain self-tolerance and modulation of immune responses in order to minimize tissue damage. But it is now known that tumors modify certain immune-checkpoint pathways as a major mechanism of immune resistance, particularly against T cells that are specific for recognition and targeting of tumor antigens.

Many of these regulatory immune checkpoints can now be blocked by antibodies or modulated by recombinant forms of ligands and receptors. Checkpoint blocking antibodies (anti-CTLA-4 or anti-PD-1/L-1), have shown great success already in clinical studies. By blocking CTLA-4 and PD-1, these checkpoint antibodies enhance the function of T cells to fight cancer cells.

Monoclonal-antibodies are active proteins which are directed against a single epitope. A physiologically (naturally) occurring immune response against an antigen that infiltrated into the body, is polyclonal and directed against different epitopes. A trifunctional antibody is a monoclonal antibody with binding sites for two different antigens, typically CD3 and a tumour antigen, making it a type of bispecific monoclonal antibody. In addition, its intact Fc-part can bind to an Fc receptor on accessory cells like conventional monospecific antibodies. Consequently, immune cells like T cells (via CD3) and monocytes/macrophages, nature killer cells, dendritic cells or other Fc receptor expressing cells are linked to the tumour cells, leading to their elimination.

These strategies aim at inducing durable T-cell responses to tumour antigens, which are recognized by cytotoxic T lymphocytes, and belonging to the immunomodulating/educating therapies with multiple activities, i.e. including modulation of immune cell compartments, complement activation, suppression of various inflammatory mediators, including cytokines, and metalloproteinases, or effectively activates apoptosis and conquer immunosuppression.

Oncolytic virus therapy has recently been recognized as a promising new therapeutic approach for cancer treatment. An oncolytic virus is defined as a genetically engineered or naturally occurring virus that can selectively replicate in and kill cancer cells while sparing normal tissues. Oncolytic virus therapy uses the virus itself as an active drug reagent. Nowadays one also knows that some types of cancer are caused by viruses. Traditional vaccines against those viruses can prevent those types of cancer.

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So which option is the right one for the patient? One should not insist on one specific therapeutic intervention. But how to determine for the way to go?

Important: Our oncological team is happy to talk to you by phone to get a deeper understanding about your specific case, enabling to provide you with a provisional treatment plan and cost estimate. Our oncologists will provide you all the details on medications, therapeutics and treatments including underlying mechanism and side effects. After a physical examination and an in-depth discussion with you on-site, the definite treatment plan will be discussed. Please understand that complex medical processes as mentioned above can only be explained through a thorough consultation on-site.



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