IMMUNOTHERAPY, THE DIRECTION OF TOMORROW’S RESEARCH
Active immunotherapy in oncology uses treatments to activate the immune system to help the body’s normal defences to fight cancer. This is a field currently in full development.
The first treatments used, such as interferon or interleukin 2, had limited efficacy and frequent side effects. New treatments have since been developed. Their goal is to obtain lasting activation of anti-cancer immunity, which is already present but that cancer knows how to circumvent or neutralize, and toinduce prolonged remissions.
This does not apply to passive immunotherapy, which uses antibodies against cancer cells.
TREATMENTS AVAILABLE AND RESEARCH
The first molecule that has demonstrated its effectiveness is ipilimumab, an antibody directed against receptors on the surface of immune cells (CTLA-4 receptors) whose role is to inhibit the immune response against cancer. By suppressing the activation of these receptors, the brake on the immune system is lifted. This molecule was approved in 2011 for patients with metastatic melanoma. It often gives prolonged regression of the disease.
Ipilimumab has been followed by other drugs, nivolumab and pembrolizumab (anti-PD-1 antibodies), which also block mechanisms that allow cancer cells to escape the immune response. Both have been shown to be effective against chemotherapy or ipilimumab in patients with metastatic melanoma. These treatments have been available since 2015.
Since then, nivolumab has also shown action in other areas such as lung cancer and kidney cancer. The regulatory procedures for approval of nivolumab in these two indications are ongoing. Meanwhile Pembrolizumab has also proved to be effective in lung cancer but will not be available for prescribing for a few more months.
IMMUNOTHERAPY, THE DIRECTION OF TOMORROW’S RESEARCH
Other molecules targeting these paths, as well as other paths of immune cells are being developed in most cancer sites.
Antoine Lacassagne Center is one of the pioneers in this branch of research and has more than 10 therapeutic trials in progress or to come, in ENT, digestive, breast, lung, bladder, kidney and other solid tumor cancers.
PRACTICAL TERMS
These medications must be prescribed by a medical specialist (medical oncologist). They are administered intravenously in hospitals , usually in day hospitals, at regular intervals, usually every 15 to 21 days.
SECONDARY EFFECTS
Overall, these new immunotherapy treatments are rather well tolerated. The side effects are variable depending on the product, but are different from those usually seen with chemotherapy or so-called “targeted” therapies.
We are talking about “immune-mediated” side effects, which mainly affect
- Skin: rash, itching
- Digestive tract: abdominal pain and diarrhea
- Endocrine system: disruption of the thyroid, hormonal system
- Liver: “hepatitis” with elevated liver enzymes
Pulmonary and renal involvement is rare.
It is therefore essential to look for these side effects consistently before each treatment injection, by a thorough clinical examination and a complete biological assessment.
