What Is Immunotherapy?

If you have been paying any attention to cancer news in the last few years, you've probably heard a few prominent things. Joe Biden's cancer initiative in honor of his son Beau. Celebrities waging their own battles, including Julia-Louis Dreyfus’ ongoing one with breast cancer. A former president, in his 90’s, tells the world his metastatic melanoma is gone - while teaching Sunday School.

And immunotherapy. It is the most-talked-about cancer treatment since, well…since before I got cancer, at least (in 2012). It saved President Carter's life. It’s getting FDA breakthrough designations and accelerated approvals for all kinds of different indications. But what IS it? And why should you know about it?

What is immunotherapy?

Chances are, if you are on SkinCancer.net, you either have some form of skin cancer, or know someone who does. So the chances are also strong that somewhere along this path you have head of an immunotherapy or know there's something out there that works with your immune system to beat cancer.

Immunotherapy, and the cancer research into it (called immuno-oncology, or I/O), is a broad catch-all for any drug or other treatment that aims to enable your immune system to fight disease - in this case, cancer.  It's a bit of the opposite of chemotherapy, which will kill both good and bad cells. Immunotherapy aims to "unlock the brakes" on the immune system, simply enabling it to do what it was designed to do, clear out junk cells from our body.

Sounds easy, right? Just let the body take care of its own business with a little pharmacologic enhancement, like a couple of post-grads popped a few cells on a microscope slide one day and realized, "Hey, I think we can get rid of all those really awful cancer cells if we maybe mess with the immune system just a LITTLE bit…”. Yea, well, it’s not quite that simple.

Modern cancer treatment

It has its roots almost a century ago, when William Coley used an immune response to treat some cancers. But it has only been in the last couple of decades that immunotherapies have gotten any kind of traction in the research world, and only the within the last few years that it went from an outlier treatment to being the most promising treatment possibility in years. Immunotherapy in modern cancer treatment has prominent roots in melanoma; this short walk-through of its history shows how “checkpoint inhibitor” drugs targeting anti-CTLA-4 (ipilimumab) and anti-PD-1 (nivolumab and pembrolizumab) have begun to pave the way for a change in cancer treatments that one day may alter the entire landscape of oncology. There are other types of immunotherapies, including vaccines, oncolytic viruses, and T Cell therapies.

Not a cure-all

What it is NOT is a silver bullet. It cannot work as a cure-all; even the most promising of results still offer response rates of 40% or less. While side effects differ from traditional chemo and are often less serious or frequent in occurrence, they still exist and patients considering immunotherapy need to be vigilant in monitoring their immune reaction, particularly in the initial doses. Immunotherapy fundamentally alters the chemical and biological checks and balances that your body uses to keep itself functional. There are going to be consequences; thankfully, most of them are either very rare or very manageable.

Immunotherapy and melanoma

Fortunately for melanoma patients, we are on the cutting edge of these cancer treatments. There have been eleven new therapies developed in the last decade for melanoma using immunotherapy or its cousin, targeted therapy (either alone, or in combination). The question of what to use, and in what order, is still being discussed; what is important is that the once-limited options for treatment have been expanded tremendously in the last decade.  The most-hyped immunotherapies mentioned above have other spawned other approved treatments and new investigation drugs/combinations that, hopefully, will increase response rates as researchers find the right treatments for individual patients.

What to know – the bottom line

Fully understanding the mechanisms behind each different type of immunotherapy isn’t necessary; however, any newly-diagnosed patient should have some idea of what approved treatments exist for their stage of the disease, and be able to ask questions about possible new drugs and/or combinations in trial.

You should know that immunotherapies show extreme promise in getting responses lasting a long time. You should know that you are messing with a complex bio-chemical machine – your body – that has evolved over thousands of years, and that there will be potential for some unpleasant side effects. Be proactive in understanding your treatment options, be prepared to handle any adverse effects from the chosen medication, and be healthy – let’s give that immune system a shot to do what it does best.