2023-04-24 17:03:03
L’immunotherapy is a therapeutic strategy once morest cancer. Instead of attacking tumor cells directly, it targets and mobilizes the patient’s immune system to recognize and destroy cancer cells. Indeed, over time cancer cells end up escaping the surveillance of immunity because the immunogenic tumor antigens located on their surface cease to be expressed. It is therefore understood that the tumor environment is immunosuppressive.
There are different types of immunotherapy that employ various processes to mobilize immunity. These techniques are adjuvant to other therapeutic strategies such as chemotherapyTHE targeted therapiesthe surgery or the radiotherapy.
“Today, the most common immunotherapy is taking immunomodulatory drugs such as checkpoint inhibitors, which are used in particular in cases of melanoma or to treat certain lung cancers. Immunotherapy is a strategy that does not show itself always effective. Nevertheless, it sometimes offers remission quickly to some patients”, explains Dr. Véronique Jestin Le-Tallec, medical oncologist at the institute at CHP Brest Pasteur .
Immunotherapy or chemotherapy: what are the differences?
Chemotherapy or targeted therapies directly affect the growth and proliferation of cancer cells while immunotherapy is a treatment that aims to stimulate the body’s immune defenses once morest cancer cells. We should add that immunotherapy has the advantage of generating far fewer side effects than chemotherapy. These treatments can be complementary.
What are different types of immunotherapy?
There are different types of immunotherapy that mobilize immunity differently.
Non-specific immunotherapy drugs
These drugs stimulate the overall activity of the immune system through cytokines (proteins that mediate inflammation), without specifically targeting the tumour. Among these drugs, we find:
- Interleukin 2 used once morest advanced kidney cancer;
- Interferon alpha 2b used in certain forms of leukemia, myeloma and for melanoma;
- Le vaccine you BCG ( once morest tuberculosis) used once morest bladder cancer.
Immunomodulators
These drugs reactivate the immune system globally (through the use of interferons or interleukins) or more specifically with checkpoint inhibitors (or checkpoint inhibitors). Several checkpoint inhibitors with different mechanisms of action (anti-PD-1, anti-PD-L1, anti-CTLA-4) are already used in a large number of cancers.
Therapeutic vaccines
They make it possible to stimulate and direct the immune system specifically once morest cancer cells, by presenting it with a tumor antigen capable of triggering an effective immune reaction. Vaccination triggers a “memory” immune response that should protect the patient once morest a relapse. Several therapeutic vaccines are being tested (particularly in the treatment of certain lung cancers and digestive cancers). Only one therapeutic vaccine is marketed today: the Sipuleucel‑T, once morest prostate cancer.
cell therapy
This technique consists of taking T lymphocytes from the patient’s blood and modifying them in vitro so that they express specific receptors on their surface, which recognize a tumor antigen. Once modified, these cells called CAR-T (pour Chimeric Antigen Receptor‑T Cells), are multiplied in the laboratory and reinjected in large quantities into the patient’s body to destroy cancer cells. This strategy is notably used in leukaemias in children and young adults as well as in adult lymphomas.
Virotherapy
This technique consists of using modified viruses to attack tumor cells in a targeted manner. A modified herpes virus is already licensed in the United States to treat melanoma.
What cancers are treated with immunomodulators?
Here are the different immunomodulators and their indications:
- Nivolumab (anti-PD-1) : melanoma; non-small cell lung cancer; clear cell kidney cancer; Hodgkin’s lymphoma; squamous cell cancer of the head and neck; urothelial cancer (bladder and urinary tract.
- Pembrolizumab (anti-PD-1) : melanoma; non-small cell lung cancer; Hodgkin’s lymphoma; urothelial cancer; squamous cell cancer of the head and neck; clear cell kidney cancer.
- Atezolizumab (anti-PD-L1) : urothelial cancer; non-small cell lung cancer.
- Durvalumab (anti-PD-L1) : non-small cell lung cancer.
- Avelumab (anti-PD-L1) : Merkel carcinoma; kidney cancer.
These molecules are currently indicated in advanced or metastatic cancers, with the exception of melanomas, for which an anti-PD-1 and an anti-PD-L1 are also authorized following the operation of localized tumours.
New immunomodulators are being tested
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Does immunotherapy cure cancer?
Immunotherapy would be effective in 25 to 40% of patients with cancer. The results would depend on:
- the type of tumour: immunotherapy would be effective in less than 10% of prostate or thyroid cancers, in 40 to 50% of melanomas and up to 80% of patients with Hodgkin’s disease.
- biological and genetic characteristics of the tumour: immunotherapy would be less effective on tumors with little infiltration by immune cells and those with few mutations or genetic instability.
Immunotherapy: What is the risk of side effects? How to avoid them?
Immunotherapy activates the immune system. “It is therefore likely to cause adverse effects. However, these generally remain mild to moderate compared to the usually severe side effects of chemotherapy. In addition, they are generally reversible and relieved thanks to good management” reassures Dr. Véronique Jestin Le-Tallec, medical oncologist.
These are most often autoimmune symptoms or even inflammatory pathologies. These side effects may affect the skin, colon, liver, lungs and endocrine organs (pituitary gland or thyroid). In particular, patients reported:
- a extreme tiredness ;
- weight variations;
- headaches ;
- visual disturbances;
- dizziness ;
- eye inflammation;
- bleeding;
- behavioral changes, irritability;
- memory loss;
- a decrease in libido,
- metabolic disorders: development of diabetes …;
- of the thyroid disorders: hyperthyroidism, hypothyroidism, hypophisitis… ;
- hepatic disorders: hepatitis, jaundice…;
- of the skin disorders: redness, depigmentation (vitiligo)…;
- of the lung problems: pneumonia, difficulty breathing, cough …;
- kidney and urinary disorders: less frequent urination, dark urine…;
- nervous disorders: muscle weakness, numbness or tingling in the hands, feet or face, loss of consciousness or difficulty waking up;
- of the digestive disorders: colitis, diarrhea, blood in the stool, nausea, vomiting…
Adverse effects must be identified as early as possible so that they can be treated. It is therefore essential to always inform the doctors of these manifestations as well as their possible aggravations. When the symptoms are of severe intensity or the health of an organ is compromised, the treatment can be interrupted.
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