Q&A: Understanding immunotherapy for cancer treatment

You’ve probably heard of immunotherapy. But what exactly is it? And who should consider immunotherapy?

At its most basic, immunotherapy uses the body’s own natural defense system to attack diseases like cancer.

We sat down recently with Padmanee Sharma, M.D., Ph.D., co-leader of MD Anderson’s immunotherapy platform, to learn more. Here’s what she had to say.

Let’s start with the basics. What is immunotherapy?

Immunotherapy is a treatment that targets the body’s immune system to recognize and eradicate cancer.

How does it work?

When people talk about immunotherapy right now, they’re usually talking about immune checkpoint therapy. Immune checkpoint therapy comes from Jim Allison’s work with T cells. T cells are the soldiers of the immune system, the heavy lifters who do all the hard work. It takes two proteins working together to act as a signal that turns them on. But T cells are very well-regulated and they have off signals as well. After a short period of time, the signals on T cells cause them to turn off, which is normally a good thing, since it prevents the T cells from causing damage to the body.

The problem with cancer is that by the time it gets big enough for the immune system to detect, it’s also too large for the T cells to eradicate in a short period of time. The T cells can attack the cancer cells, but then the T cells turn off and don’t get a chance to finish the job. So if we block the “off” switch of T cells, they can continue to work and destroy the tumors.

What are the benefits of immunotherapy compared to more conventional treatments, such as chemotherapy and radiation?

Traditional therapy targets tumor cells, but immunotherapy targets T cells. And whereas conventional therapy treats a specific type of cancer, with immunotherapy, you can treat multiple tumor types.

Another benefit is that the immune system is always evolving and learning. It’s a living system in our bodies. So just because treatment ends, that doesn’t mean the benefits stop. Once it learns to recognize cancer in your body, the immune system will continue to target those cells if it sees them again.

Which diseases is immunotherapy working best on?

So far, immunotherapy has proven most effective in treating melanoma, both small cell lung cancer and non-small cell lung cancer, bladder cancer, kidney cancer, stomach cancer, liver cancer, head and neck cancers, and lymphoma. All of those have FDA-approved immunotherapy drugs available to treat them.

What diseases is immunotherapy showing promise for?

Ovarian cancer.

Who should consider participating in immunotherapy clinical trials?

Any cancer patient, regardless of their stage of disease, should consider enrolling in a clinical trial involving immunotherapy. We have immunotherapy clinical trials for many cancer types for patients in the early stages of cancer, for those whose cancer has metastasized, for those who have tried everything else and for those who haven’t tried anything at all yet.

These days, everyone is talking about precision medicine. Well, you don’t get much more personalized than your own immune system. The most important thing is for patients to have a conversation with their physicians to discuss their options. Their doctors are in the best position to help them navigate all the clinical trials available.

What’s new in immunotherapy research?

We still don’t understand why some patients get great responses and some don’t. So we’re going back to basic lab research. That’s what Jim Allison’s work was. He is a general researcher doing lab work. But he tried his finding first in mice, and then in patients.

It’s kind of cyclical. We take what’s been learned in lab to clinical trials, and then take the results of clinical trials back to the lab. This way, we can understand the mechanisms of resistance and develop new strategies.

Where do you see immunotherapy in 10 years?

I think it’ll be the backbone of a lot of our cancer treatments, whether used alone or in combination with more conventional treatments, such as chemo, radiation and even targeted therapy. Also, I see it being used to treat many cancer types, not just melanoma.

What advice would you offer to a patient who is considering an immunotherapy trial?

Speak with your doctor to weigh the risk/benefit ratio and to understand the toxicity and side effects, because they can be very different from those associated with more traditional therapies.

Anything else you want patients to know?

I want to encourage patients to let us collect blood samples and tumor tissues for research purposes. We need their participation to learn so we can understand cancer better. 

Editor's note: We updated the list of diseases on which immunotherapy works best and is showing the most promise on Aug. 17, 2018 to reflect additional cancers that can now be treated with FDA-approved immunotherapy drugs since this post was originally published in June 2016.

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