BY AMBER SMITH
Our immune system fights off colds. Why not cancer?
Stephen Graziano, MD. (photo by Robert Mescavage)
“Cancers develop mechanisms to get around the immune system,” explains Stephen Graziano, MD, chief of hematology/oncology at Upstate. “They express a protein on their surface which basically paralyzes the T-cells, which are the part of the immune system that’s active in the immune response.”
Immunotherapy drugs such as Keytruda and Opdivo are designed to be antibodies to that protein, “so they basically release the tumor from the immune cells, allowing them to do their job.”
It’s a concept that is more than a century old. In the last 30 or 40 years, scientists have been able to harness the body’s immune system to fight cancer, “and we’re starting to see advances that translate to patients,” Graziano says.
“It’s almost dizzying as an oncologist to keep up with the advances.”
Various immunotherapy medications are already in use for cancers of the lung, stomach, bladder, head and neck, and also for Hodgkin’s disease. In addition, Graziano says Upstate has clinical research underway that uses immunotherapy to treat patients with three stages of lung cancer, melanoma, sarcoma, cancers of the kidney, colon and head and neck.
Patients are selected for those research studies, known as clinical trials, after cells from their tumors are tested, so doctors know the likelihood the drug will work. Patients with serious autoimmune disease are not candidates for immunotherapy, since the medications could stimulate their autoimmune disease.
Also, as with any treatment, immunotherapy has potential side effects. Patients may develop fatigue, rash, diarrhea, cough or other symptoms. In those instances, immunotherapy is halted while patients receive steroid treatment.
“The nice thing about these immune therapies is they don’t have the side effects we usually associate with chemotherapy. They don’t have the nausea and vomiting, the fatigue, the hair loss, the low blood counts. Most patients feel well after they receive their treatment.”
Graziano says that in his experience, about a third of patients receiving immune therapy see a remarkable prolonged remission, about a third experience a stabilization of their disease for a period of time, and a third may see no response.
“We do have patients with advanced cancer who were on these drugs in early clinical trials for two years. And now, some patients have eight years of follow-up and are still in remission,” he says. “I think immunotherapy has great potential.”
This article appears in the summer 2018 issue of Cancer Care magazine.