We are hearing a lot about cancer immunotherapy these days. Though modern approaches and technology are now helping to revolutionize cancer care, this specialized field dates back over a century.
What decision-making power do we hold to influence an immune-therapeutic response in order to avoid, manage, or treat a cancer diagnosis? And what role may this play specific to long-term survival?
The father of immunotherapy, Dr. William Coley, was a surgeon at the acclaimed Memorial Sloan Kettering Cancer Center. In the early 1890s, Coley experimented with bacterial toxins with mixed success.
Currently, the discovery of new anticancer drugs is growing apace. But the promise of precision medicine, and especially immunotherapy agents, is oncology’s Holy Grail.
In the U.S. alone, the immunotherapy market is set to grow to $101.6 billion in 2023; that’s from $36.8 billion in 2016. This means that more types of cancer, affecting myriad patients, will soon be matched with these novel treatments.
By far the biggest buzz in ‘liquid’ tumors—leukemia and lymphoma—is CAR-T cell therapy. CAR-T involves the process of genetically modifying (gene editing) T-cells—essentially the reprogramming of heat-seeking cruise missiles to home-in on cancer cells. Price tag: $475K+ per patient.
Immunotherapies are also used for a number of ‘solid’ tumors, including melanoma, and cancers of the kidney and bladder.
Whereas drugs such as chemotherapy compromise the immune system with their indiscriminate ‘buckshot-like’ approach in killing good cells along with bad (cancerous) cells—resulting in nausea, fatigue, neuropathy—immunotherapies are targeted, and tend to cause less ‘collateral’ damage.
Though targeted therapies typically cause less deleterious side effects compared to many conventional agents, they are not without risks and complications; it will be years before we learn the long-term adverse effects of immunotherapies and other novel agents.
And, interestingly, immunotherapies are also being used in concert with chemotherapies for a so-called one-two punch.
The Original Cancer Immunotherapy: Behavior
Our original, innate immunotherapy is our behavior; specifically, the lifestyle choices that support our immune system.
A personalized approach to activate our innate immune function, while no absolute guarantee against cancer, can be unleashed in the name of cancer prevention. This can be accessed by adhering to the core tenets of integrative oncology and smart lifestyle choices: focused quality nutrition, physical activity, stress reduction, restful sleep, and plentiful hydration with clean water.
Behavioral change is available to most of us. Engaged by making smart choices, it’s found in our grocery cart, on our plate, in our neighborhood apothecary, at our closest hiking trail, and in our local gym.
Unleashing the human body and brain’s natural immunotherapy properties is further activated and modulated through dogged attention to the air we breathe, and keen awareness of the chemicals that surround us: industrial pollutants, toxins in our cosmetic cabinets, in our cleaning supply closets, and even in our toiletry bags.
Current Reality of Precision Medicine and Immunotherapies
The Human Genome Project was completed in April 2003—almost 15 years ago. While it has help usher in more tests and assays to inform precision approaches to therapy—based on a patient’s unique tumor mutations—these discoveries are still only available to a small subset of cancer patients.
This means that most patients will undergo standard care as recommended within the NCCN clinical practice guidelines, without new targeted therapies. When you view, hear, or read advertisements from various cancer centers about all things ‘precision medicine’, and their innovative, leading edge approaches, be sure to ask how these things may be accessed or otherwise relate to your unique situation.
The Future? Our Own Stem Cells as Cancer Immunotherapy
Another approach to immunotherapy received public attention just two weeks ago, as investigators at Stanford University School of Medicine released a study on injecting pluripotent stem cells into the body that may cause the immune system to destroy cancer cells, or even prevent cancer (i.e. a vaccine characteristic).
The researchers hypothesized that pluripotent stem cells are similar to cancer cells in that they are both developmentally immature cells.
These pluripotent stem cells were captured from the host donor’s own tissue. This experiment was done on mice, not humans. The arm of the study that showed the most remarkable outcomes combined pluripotent stem cells and an adjuvant agent to stimulate the immune system.
Out of the ten mice injected with human breast cancer cells, seven had reductions in tumor size. In two mice the tumors disappeared completely, and they went on to live a year or longer after they were injected with the cancer tumors; that’s a long time in mouse-years.
Again, this was a small study on mice, not a randomized, controlled, double-blind trial on a large number of humans—the gold standard for biomedical research. The big takeaway here is that cancer immunotherapy will take many shapes and forms over the coming years and decades.
Bioinformatics… and What We Don’t Know
The umbrella of precision medicine covers an array of targeted agents, available across a number of cancer types that have specific genetic mutations, deletions, biomarkers, and hormones. Many work synergistically with immunotherapies. They include tyrosine kinase inhibitors, checkpoint inhibitors, hormone blockers, and monoclonal antibodies.
The obstacle to translating more data to precision clinical care at the bedside is not necessarily a deficit of data, or small or large molecule chemicals—it’s an information technology deficit. We just don’t know what all the big data means… and, therefore, we’re not sure what to do with it.
Progress requires the art and science of matching specific mutations, chromosome deletions, and biomarkers, with the best drug agents. The information technology deficit will not be solved quickly; it will take years, if not decades, to replace common chemotherapeutic drugs with targeted and personalized, precision agents. So…
Grab the Immunotherapy in Front of You
As the promise of precision medicine unfolds before us, and the use of thirty, forty, and fifty-year-old chemotherapeutics are discontinued over time—years or decades—you control many levers to position your mind and body to be its healthiest self—and to unleash your innate healing capacity. Place your hands on those levers and start doing the immunotherapy work that needs doing.
For a highly personal, honest, and practically real-time CAR-T patient experience, sign up for CLL survivor Dr. Brian Koffman’s blog as he embarks on his CAR-T journey as subject #36 in a trial at Seattle Cancer Care Alliance. Koffman, a friend and colleague, is the co-founder of the CLL Society, arguably the best source of information specific to CLL and SLL.
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