From the Guidelines
Immunotherapy is a highly effective treatment for various types of cancers, and its use is rising exponentially, with approximately 40% of patients with cancer in the United States eligible for treatment with immune checkpoint inhibitors (ICPis) 1.
Types of Immunotherapy
- Checkpoint inhibitors like pembrolizumab (Keytruda) and nivolumab (Opdivo), which block proteins that prevent immune cells from attacking cancer cells
- CAR T-cell therapy, where a patient's T-cells are modified to better recognize cancer cells
- Monoclonal antibodies such as rituximab (Rituxan) that target specific proteins on cancer cells
- Cancer vaccines that stimulate immune responses against cancer-causing viruses
Mechanism of Action
Immunotherapy works by enhancing or suppressing immune responses to target specific health conditions, and its effectiveness lies in its ability to help the body's natural defenses recognize and fight disease more effectively 1.
Side Effects
Side effects can include inflammation, fatigue, and flu-like symptoms as the immune system becomes more active, and the incidence and onset of immune-related adverse effects (irAEs) vary based on the specific therapy and patient population 1.
Treatment Regimens
Treatment regimens vary widely depending on the condition, with some requiring regular infusions every 2-3 weeks for months or years, and a high level of suspicion that any changes are treatment-related is necessary to manage immune-related adverse events effectively 1.
From the FDA Drug Label
PROVENGE is an autologous cellular immunotherapy indicated for the treatment of asymptomatic or minimally symptomatic metastatic castrate-resistant (hormone-refractory) prostate cancer. PROVENGE (sipuleucel-T) is an autologous cellular immunotherapy available as a suspension for intravenous infusion PROVENGE consists of autologous peripheral blood mononuclear cells, including antigen presenting cells (APCs), that have been activated during a defined culture period with a recombinant human protein, PAP-GM-CSF, consisting of prostatic acid phosphatase (PAP), an antigen expressed in prostate cancer tissue, linked to granulocyte-macrophage colony-stimulating factor (GM-CSF), an immune cell activator. The immunotherapy is sipuleucel-T (PROVENGE), an autologous cellular immunotherapy that consists of autologous peripheral blood mononuclear cells, including antigen presenting cells (APCs), activated with a recombinant human protein PAP-GM-CSF 2.
- The active components of PROVENGE are autologous APCs and PAP-GM-CSF.
- Key words: autologous cellular immunotherapy, sipuleucel-T, PROVENGE, antigen presenting cells, PAP-GM-CSF.
From the Research
Definition of Immunotherapy
- Immunotherapy is a treatment that uses specific components of a person's immune system to fight diseases, usually by stimulating or assisting one's immune system to attack the offending agent 3.
- It can also be referred to as biologic therapy or biotherapy, and its goal is to train the body's defense system to fight against diseases such as cancer.
Types of Immunotherapy
- Cancer immunotherapy is a new approach that has gained worldwide acceptance, and it includes using antibodies that bind to and inhibit the function of proteins expressed by cancer cells or engineering and boosting the person's own T lymphocytes to target cancer 3.
- Immunotherapy can be used in combination with other treatments, such as chemotherapy, to enhance its effectiveness 4, 5.
Examples of Immunotherapeutic Agents
- Pembrolizumab is an immune checkpoint inhibitor (programmed cell death 1) approved for use in non-small cell lung carcinoma (NSCLC) and has shown remarkable results in regression of the size of tumors in NSCLC and has shown survival advantage 6, 4, 5.
- Pembrolizumab can also be used to treat other types of cancer, such as B-cell lymphomas, and has shown promise in achieving clinical responses in patients who are refractory to or relapsed after CD19-directed CAR T-cell therapy 7.
Benefits and Challenges of Immunotherapy
- Immunotherapy has been shown to be a promising treatment strategy for various types of cancer, including NSCLC, and its benefits can overcome its risks compared to other therapies 5.
- However, immune-related adverse effects are a serious negative outcome of therapy, and the number of immune-related adverse effects with pembrolizumab has increased significantly over the recent past 6.
- The effective retained dose of pembrolizumab is a venous administration of 200 mg every 3 weeks until disease progression, intolerance or up to 24 months, and its favorable tolerance profile enables to treat fragile patients who have often no other choice than best supportive care 4.