Immunotherapy in Cancer – Dr. Nikhil S Ghadyalpatil

As the word suggests, immunotherapy deals with the treatment of cancer and boosts the immune system. 

What is the immune system?

The immune system is the body’s fighting system that fights against various infections, bacteria, viruses and so forth to keep us healthy. 

What does the immune system consist of?

The immune system comprises some cells, some organs and some proteins. 

You may get a doubt that in that case, the immune system should also work against cancers.

But in the case of cancer, the cancer cells are the body’s own cells, it is there in the body and that is something that is not recognized by the immune system as it recognizes the foreign particles.

So what happens is, cancer gets around the immune system and disguises itself in front of the immune system and that’s how the immune system fails to recognise the cancer cells. Due to this cancer starts spreading to various organs and so on and so forth. 

What is immunotherapy?

Immunotherapy means guiding the body’s own immune system in such a way that starts acting against cancer cells thereby creating an effect. Immunotherapy is useful for most cancers if not all and it has come a long way. Immunotherapy is not for patients in the early stage, it is strictly given to patients in the advanced stage and in these patients immunotherapy can work really well so as to improve and prolong the life of the patient. 

Some important areas where immunotherapy has come a long way is lung cancers, menor mass, intestinal cancer and some blood cancers. It is surely going to stay with us and improve the lives of the patients of that matter.

What are the types of immunotherapy?

We have got immune cells that are in check all the time so that these immune cells do not harm or destroy our human body. If someone gets cancer we will want the immune system to get activated. We want those checks to be removed so that the cancer cells start getting attacked by the immune cells. One of the dominant ways we treat cancer these days is by checkpoint inhibitors, which are a kind of monoclonal antibodies or in simple terms some kind of proteins. So essentially what they do is remove the checks so that cancer starts getting flooded with the immune cells which eventually destroys the cancer cells. And that is the principle of checkpoint inhibitors. 

Then we got some oncolytic viruses, of course, they are still in an early phase. We are not using it in India as of now. What it basically does is, as the name oncolytic suggests, kill the cancer cells through viruses. What essentially happens is a virus gets integrated with the cancer cells and starts multiplying it and eventually destroys the cancer cells due to which the cancer cell dies. 

There are certain proteins that are directly used as an immune system to boost the immune system and typical examples could be kidney cancer and some melanomas.

One might have heard about Interferons or Interleukins. They are basically a kind of protein that is given as a shot to the patient which also leads to a kind of immune response for cancer to get under control. Of Course, we are not using many interferons and interleukins, however, they’ve been with us for a very long time. 

And then there are some newer technologies called Car T cells also called Chimeric antigen receptors. These are basically T lymphocytes which are programmed in such a way that they form a protein called receptor on top of it that gets hitched to the cancer cells which destroys the cancer cells. So a lot of new research and studies are coming up with exciting news about Car T cells, especially in the field of blood-related cancers. 

What about vaccines? 

There are 2 types of vaccines when we talk about cancers, one is a preventive vaccine and the other is a treatment vaccine.

There are some viruses that can be kept in check with certain vaccines called preventive vaccines. Then there are treatment vaccines which are manufactured for individual patients for their individual cells and are again injected into the patient so as to improve the immune system which can eventually start attacking the cancer cells and we start getting the response. We are very much doing this test in India, we have also done options that are available with us like immune checkpoint inhibitors which are definitely being used a lot in the current setting. We believe that the newer techniques like car T cells, which sooner or later will be available with 

us, so that it can benefit our patients in a great way.

So as I said we have more than the chemotherapy era or targeted therapy era. The current era is the era where immunotherapy and probably chemotherapy with or without targeted therapies. So it’s a more integrated way of looking and treating cancer so as to maximize the outcome of the patient’s life.