Among the many researched current cancer treatment options, IMMUNOTHERAPY and CANCER VACCINES tops the list. One in the field of medical sciences my be deemed as an old-fashioned practitioner if s/he doesn’t know what immunotherapy is all about. Such fellows may not exist in Kenya with the availability of worldwide web – WWW- we’re all on the grid of information.
So, what is immunotherapy?
Immunotherapy, also called biologic therapy, According to the American Society of Clinical Oncology, ASCO, it is described as a type of cancer treatment that boosts the body’s natural defences to fight cancer. It uses substances made by the body or in a laboratory to improve or restore immune system function.
The science of immunology has been in existence from as early as 5th century BC. Today many amazing applications have saved the world from extinction through human and animal health science. Names like Robert
Koch, Louis Pasteur (Father of Immunology) cannot leave our heads. Edward Jenner eradicated smallpox through the development of vaccines in 1976. Today the world is safer an indication that VACCINES WORK!
Types of immunotherapy.
There are several types of immunotherapy, including:
- Monoclonal antibodies and tumour-agnostic therapies
- Non-specific immunotherapies
- Oncolytic virus therapy
- T-cell therapy
- Cancer vaccines
How does immunotherapy work?
- Stopping or slowing the growth of cancer cells
- Stopping cancer from spreading to other parts of the body.
- Helping the immune system work better at destroying cancer cells.
One form of immunotherapy is called an immune checkpoint inhibitor. It takes the brakes off immune cells, unlocking their ability to detect altered proteins on cancer cells in order to attack and kill these cells. These drugs include programmed death (PD-1)-inhibitors and PD-L1-inhibitors (such as pembrolizumab, atezolizumab, nivolumab), and cytotoxic T-lymphocyte antigen (CTLA)-4 inhibitors (ipilimumab).
Side effects of immunotherapy.
All drugs have side effects, including the immunotherapy drugs discussed here. Understanding the information below can help if you or a loved one does experience side effects.
These side effects are common but may not occur in all people or with all types of immunotherapies.
- Feeling tired (fatigue)
- Shortness of breath.
- Rash and/or blisters, covering less than 10% of the body.
How are the side effects of immunotherapy managed?
Severe side effects are controlled by stopping the immunotherapy and starting corticosteroids (such as prednisone), which are tapered slowly over a period of weeks. If you’ve had immunotherapy at any time in the past,
report any new symptom to your treating oncologist before self-medicating with drugs purchased over the counter. For example, if you have diarrhoea, taking loperamide (Imodium) may arrest the symptom. But it won’t address the root cause, which is inflammation of the large intestine. Uncontrolled inflammation of the intestine may lead to rupture of the intestinal wall, which can be life-threatening. Similarly, if you have a cough, consuming cough suppressants (caution for products containing codeine needs monitoring I pediatric use if it is a must,) allows lung inflammation to continue and become potentially life-threatening. Medical advice is sought to better manage the symptoms.
Antibiotics and immunotherapy.
As we begin to understand the immune system better, an important nugget of emerging information is that antibiotics may reduce the ability of immunotherapy to kill cancer by killing harmless bacteria that live in the gut. People taking immune checkpoint inhibitors who receive antibiotics are less likely to benefit from immunotherapy than those who do not. Hence, it appears important to avoid unnecessary antibiotics for minor infections, which may be prescribed for patients visiting the ER for fever, cough, or other symptoms suggestive of infections. Check with your cancer team about this.
Challenges and future trends.
- Unpredictable efficacy.
- Drug resistance.
- Cost of immunotherapy drugs re high.
- Tumour heterogenicity impedes efficacy.
- Need for more predictive biomarkers.
During recent decades, our understanding of cancer immunology has advanced dramatically. Many obstacles still impede the success of cancer immunotherapies in a wider variety of malignancies and patients. However, the rapid progress that has led to the present era of cancer immunotherapy is expected to continue vastly. Current obstacles will likely be surmounted through the implementation of available and potential solutions, including the development of more targeted cancer immunotherapies; personalized treatment with cancer immunotherapy drug combinations; cancer immunoprevention strategies; and additional important innovations.
Success of immunotherapy.
Although immunoprevention for viral-induced cancers has been successful in the setting of hepatitis B and human papillomavirus vaccination, notably, primary prevention of non-viral-induced cancers is in its conception.
A vaccine is a biological preparation that provides active acquired immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins.
A cancer vaccine is a product used to help the body fight disease. A vaccine exposes the immune system to an antigen. This triggers the immune system to recognize and destroy that antigen or related materials. There are two (2) types of cancer vaccines.
- Prevention vaccines.
The administration of preventive vaccines at pre-malignant stages of the disease holds promise, as they function before tumour-associated immune suppression is established. Accordingly, immunological and clinical studies are yielding impressive results.
Certain human cancers, notably prostate adenocarcinoma and cervical cancer, can currently be detected at very early stages of carcinogenesis. Earlier detection of these cancers, combined with existing vaccines directed against them, will soon make them targets for therapeutic vaccination in the preventive setting
This ability to detect cancer in the pre-malignant setting and being able to immunize patients at the very earliest stages of carcinogenesis, when they have fully competent immune systems, has the potential to cause a fundamental change in how therapeutic cancer vaccines are tested and used clinically.
2. Therapeutic vaccines.
Therapeutic cancer vaccines have been extensively tested in patients with advanced cancer but have had little clinical success, which has been attributed to the immunosuppressive tumour microenvironment.
Limitations of vaccines in cancer.
- Autoimmunity seems to be a major setback in this treatment option.
- The stage of cancer at which the vaccine is administered also matters a lot. At end-stage very less may be expected as the prognosis is poor.
- Underlying diseases like immunosuppressed syndromes my hinder expected outcomes of vaccines
- Prior treatments may also have an effect on vaccinations if immunity was compromised example chemotherapy.
Do vaccines work?
This question has brought a lot of controversies both in the political, medical-science and religious arena.
A story is told of Mithridates VI. He was paranoid about being poisoned and so he would take a little portion of poison throughout his life to develop immunity against It. When he was finally captured by the Romans, he attempted suicide by ingesting poison so that he could die but he could not, he was immune. SIMPLE. He was captured, of course alive.
You have your answer.
The government of Kenya supports this ideology, there’s a division of vaccines and immunizations, DVI, in the ministry of health with vision of increasing access and reducing morbidity of vaccine preventable deaths. Today in Kenya all new-born to the age of 5yrs get
immunized free of charge as a government initiative to promote immunization.
So, get out there and vaccinate your daughter against human papilloma virus, HPV, don’t let her become vulnerable, for facts will remain facts even if they’re ignored.
Anti-vaccine crusaders alive today should be thankful for those shots they got; they’d otherwise all be dead. EVIDENCE THAT VACCINES WORK!
National Cancer Institute
clinical care options http://www.nhs.uk/news/2009/09September/Pages/Cervical-cancer vaccine-QA.aspx