Dr. Adwaita Gore

DNB (Medical Oncology), DNB (Internal Medicine)
immuno therapy in mumbai

Precision Medicine and Immuno-Oncology

Our immune system is a complex network of organs, cells and molecules that protects us from foreign substances such as bacteria and viruses that can cause infection. In addition to finding and destroying foreign substances, the immune system can also locate and attack abnormal cancer cells.

There are two main parts of the immune system:

  • Innate immunity, a natural and always-present defense system, is the ability of the body to immediately protect itself against foreign organisms and toxins.
  • Adaptive immunity is a learned defense system, created in response to exposure to a specific foreign substance. The adaptive immune system works in one of two ways:
    • Humoral, also called antibody-mediated, in which B-cells (a type of white blood cell called a lymphocyte) make antibodies (specific blood proteins) that identify and destroy foreign substances.
    • Cell-mediated, in which T-cells (another type of white blood cell or lymphocyte) identify and destroy abnormal cells, including those that are cancerous.

Both an overactive and an underactive immune system can be harmful. Our growing understanding of the health benefits of a balanced immune system has led to the development of immunotherapies as a treatment approach for many types of cancer.

Immunotherapy

Immunotherapy is a breakthrough innovation in Cancer Care. Immunotherapy is the process of activating the immune cells to fight against cancer cells. It is a personalized treatment which intends to enhance the body’s defense mechanism to combat and destroy cancer cells. Immunotherapy uses the cells made by the patient’s own body, or treatments made in a laboratory to improve or restore immune system function.

The reprogramming of the immune system in a patient’s body is done through three ways, personalized to the specific cancer condition, namely – Drug therapy, Dendritic cell therapy and Cancer Vaccines. In the first type, the drugs induced boost the antibodies to destroy cancer cells. Dendritic cell therapy involves the usage of T-cells, the cells which fight infection, are removed from the blood, later modified in laboratory and injected to the patient’s body to treat cancer cells. Cancer vaccines when injected, triggers the immune system to recognize and destroy that antigen or related materials, thus killing the cancer cells and put an end to their progress.

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Cancer-Targeting Immunotherapies

The purpose of cancer-targeting immunotherapy is to modify the immune system to recognize that the cancer is foreign to the body and needs to be attacked. This can be difficult, because the differences between cancer cells and healthy cells are often quite small and hard to detect.

Additionally, white blood cells have “immune checkpoint” molecules that alert cells to either “engage and fight” or “ignore and rest” when it recognizes something in the body as being foreign. The checkpoint molecules prevent our immune system from attacking normal cells. Drugs called checkpoint inhibitors block these molecules, allowing the immune cells to start attacking cancer cells.

One type of immune checkpoint inhibitor works by interfering with a molecular “brake” known as PD-1 or PD-L1 that prevents the body’s immune system from attacking cancer cells. Drugs in this category currently approved are Nivolumab (Opdyta), Atezolizumab (Tecentriq), Pembrolizumab (Keytruda), Avelumab (Bavencio) and Durvalumab (Imfinzi).

Another type of immune checkpoint inhibitor seeks out and locks onto CTLA-4 (cytotoxic T-lymphocyte-associated protein 4), a protein that normally helps keep immune system cells (T-cells) in check. The drug Ipilimumab (Yervoy) is thought to help the immune system destroy cancer cells by blocking the action of CTLA-4.

In addition to checkpoint inhibitors, immunotherapy approaches fall into the following main categories:

  • Monoclonal antibodies are lab-generated proteins that target specific tumor antigens (substances that the immune system sees as being foreign or dangerous).
  • Therapeutic vaccines can boost the immune system and have the potential to treat cancer or prevent it from recurring (coming back) after treatment. A number of types of vaccines are being currently studied in clinical trials.
  • Adoptive T-cell transfer (also called cellular adoptive immunotherapy) is an approach in which T-cells are removed from the individual, grown to an increased number in a laboratory and infused back into the individual with the goal of improving the immune system’s anti-cancer response. One type of adoptive T-cell transfer is chimeric antigen receptor (CAR) T-cell therapy, which is used to treat certain blood cancers.

Immunotherapies can sometimes work well in combination with other treatment types, such as surgery, radiation, chemotherapy and targeted therapy (treatments designed to target the specific cell mechanisms that are important for the growth and survival of cancer cells). An example is combining immune checkpoint inhibitors with targeted therapy or traditional chemotherapy.