The human body is a wonderful machine with an incredible healing power we are only just fully understanding. Immuno-Oncology harnesses the immune system’s natural power to combat certain types of cancers. Also known as cancer immunotherapy, this innovative treatment could cure some cancers and give patients a new lease on life.
What is cancer immunotherapy?
Immunotherapy utilizes specific attributes of the individual’s own immune system to treat diseases like cancer. This is accomplished mainly in two ways:
- By providing the patient with immune system components that might include immune system proteins that are man-made or synthetic, and
- By stimulating the individual’s immune system to function in a more intelligent, focused, precise, and concentrated way to attack cancer cells.
Immuno-Oncology is also referred to as biotherapy or biologic therapy. As the host’s immune system attacks the cancer cells it becomes somewhat of a darwinian battle; only the strongest cells will survive.
When the immune system is weak or compromised, it is easier for the cancer cells to overcome it. Once the malignant cell population overwhelms the host’s immune system, it is more difficult to get ahead of it. Immuno-Oncologic therapies turn the immune system into a sort of mercenary, mobilizing it to not only attack the cancer when it is present, but to also retain that information so it can then continue to target any emerging copies or clones of the cancerous cells. This can lead to not only the prevention of certain cancers, but also potential cures.
Types of Immunotherapy
There are several basic types of Immuno-Oncology which can be used independently or combined. Each type utilizes certain aspects of the immune system based on the many factors that incorporate characteristics of both the host’s immune system and the cancer cells.
Cellular immunotherapy has a low toxicity level, posing a lower risk to normal tissues, but can be highly effective in eliminating the tumor completely. There are different types of cellular immunotherapies available, such as Chimeric Antigen Receptor (CAR) T-cell therapy, Tumor-Infiltrating Lymphocytes (TIL) therapy, and dendritic cell vaccines. Each one can be used to treat different types of cancers.
- CAR T-cell therapy – Uses genetically altered T cells from the patient’s blood creating specific antigen receptors. It is used to treat diffused large B-cell lymphoma, acute lymphoblastic leukemia, mantel cell lymphoma, transformed follicular lymphoma and follicular lymphoma.
- TIL therapy – Removes immune system cells, which are found inside tumors, and treats them with Interlukin-2 (IL-2). Later, they are injected back into the patient causing them to actively fight cancer. Clinical trials have begun for lung cancer, head and neck squamous cell carcinoma, melanoma, genitourinary carcinoma, kidney cancer and ovarian cancer.
- Dendritic cell vaccines – Dendritic cells are immune cells that aid the immune system in recognizing cancer cells and breaking them down into antigens in order that other T cells can detect them and start an immune reaction. By removing immune cells from the patient’s blood and exposing them to cancer cells and antigens, immune cells are transformed into dendritic cells. These dendritic cells are then injected back into the patient producing an immune response to cancer cells. One dendritic cell vaccine has been approved, sipuleucel-T (Provenge), which is used to treat some men with advanced prostate cancer.
- Monoclonal antibody therapy – Antibodies within the patient are used to assist the body in fighting cancer. This therapy is also used in fighting other diseases and infections. These proteins are products of the immune system and bind to tissues or cells via certain markers. Monoclonal antibodies assist in treatment as well as diagnosis. When used to treat cancer, they work in several ways: directly killing cancer cells, assisting the immune system in killing cancer cells, or by blocking the development of tumor blood vessels.
- Cytokine therapy – These protein molecules aid in directing and regulating the immune system. They act as messengers, so other cells know where and when to initiate an immune response. While the body naturally produces cytokines, for the purposes of cancer treatment they are synthetically replicated in a lab, then injected into the body in much larger doses than the ones that would naturally be produced.
- Immune Checkpoint Inhibitors – According to the National Cancer Institute, Immune checkpoints engage when proteins on the surface of immune cells, called T cells, recognize and bind to partner proteins on other cells, such as some tumor cells. These proteins are called immune checkpoint proteins. When the checkpoint and partner proteins bind together, they send an “off” signal to the T cells. This can prevent the immune system from destroying the cancer. Immunotherapy drugs called immune checkpoint inhibitors, work by blocking checkpoint proteins from binding with their partner proteins. This prevents the “off” signal from being sent, allowing the T cells to kill cancer cells. One such drug acts against a checkpoint protein called CTLA-4. Other immune checkpoint inhibitors act against a checkpoint protein called PD-1 or its partner protein PD-L1. Some tumors turn down the T cell response by producing lots of PD-L1. Immune checkpoint inhibitors are approved to treat some patients with a variety of cancer types, including breast, bladder, cervical, colon, head and neck, liver, lung, skin, stomach, rectal, Hodgkin lymphoma, and renal cell cancers. Immune checkpoint inhibitors drugs include:
- Yervoy (ipilimumab) [CTLA-4]
- Opdivo (nivolumab) [PD-1]
- Keytruda (pembrolizumab) [PD-1]
- Tecentriq (atezolizumab) [PD-L1]
- Bavencio (avelumab) [PD-L1]
- Imfinzi (durvalumab) [PD-L1]
- Libtayo (cemiplimab-rwlc) [PD-1]
*The drugs mentioned in this article are the ones currently approved. They are also in alphabetical order and Special Care Pharmacy Services has no preference over any treatment.
How is it administered?
The Immuno-Oncology treatment is administered in several different ways. Each is dependent upon the type of treatment, the patient, and other factors, such as health insurance coverage. Some ways are intravenous (IV), topical, subcutaneous, intravesical and oral. Some Immuno-Oncology treatments are not recommended for oral administration because the digestive process can break down or denature some of the immunologically active larger proteins rendering them inactive.
The length and frequency of the immunotherapy treatment depends on several factors including the type of cancer, how advanced the cancer is, the type of Immuno-Oncology treatment that is administered, and how the patient’s body reacts to the treatment.
What is the financial impact for the health care industry?
One challenge that Immuno-Oncology treatments face is their perceived high costs. The rising costs of healthcare expenditures, including for these types of treatment alternatives, is a very real issue that payers and patients face today. However, that does not negate the value of the treatment and the clinical benefits that cancer patients can gain from it. Value, the health improvements achieved by the patient considering the dollars invested is the true measure here, not cost. Local data presented recently at a healthcare forum in Puerto Rico, clearly demonstrated that medical management costs were materially reduced in patients suffering from lung and head and neck cancers that were treated with certain Immuno-Oncology agents.
That said, the promise of further improvements in the manufacturing and development processes for these agents could lower costs substantially in the future. For instance, by finding a better system for identifying patients who will benefit the most, overall costs for healthcare and the cost for patients will be decreased. Most health insurance plans cover immunotherapy today, but there are still out of pocket costs for the patient and other expenses typically incurred related to their illness. The healthcare industry recognizes this and is working to find ways to develop coverage policies that will meet the patients’ needs while remaining fair to all the stakeholders involved.
There is such a tremendous promise and early benefit that Immuno-Oncology offers, and the medical research community is only now fully realizing just what a profoundly positive impact it has in the lives of many cancer patients. At Special Care Pharmacy Services, we pledge to stay at the forefront of innovative Immune-Oncology therapies that will substantially add quality of life and increase survival rates of our patients. Furthermore, the medical community can always count on us as an ally in the battle against cancer. For more information on Immuno-Oncology treatment and other specialized patient care topics, please contact us at Special Care Pharmacy Services.