StemCell Therapy

Q: What is immunotherapy, and what kinds of cancer can it treat?

A: Immunotherapy is a cancer treatment that activates a patients immune system to identify and destroy diseases such as cancer.

Immunotherapy is the future of cancer care, said Dr. Theodoros Teknos, president and scientific director of the University Hospitals Seidman Cancer Center and deputy director of the Case Comprehensive Cancer Center.

This type of treatment is being used to fight a number of cancers of the blood and solid organs such as the liver, spleen, kidneys, adrenals, pancreas, ovaries and uterus. It has been shown most effective in lymphomas, leukemias, melanoma and lung cancer, Teknos said.

The Cleveland Clinic annually treats a few dozen patients with immunotherapy vaccines, the health system said.

Some patients who undergo immunotherapy treatments see their cancerous tumors disappear, said Dr. Dale Shepard, medical oncologist at the Cleveland Clinics Taussig Cancer Center.

A 2019 clinical trial suggested that immunotherapy could give some men with advanced prostate cancer who have exhausted all other treatment options two years or more of life.

UH and the Cleveland Clinic are using these therapies to treat cancer and conducting clinical trials of new immunotherapies. MetroHealth System is holding clinical trials of a new form of immunotherapy for women with recurrent cervical cancer.

UH is the only Midwest site taking part in a new clinical trial investigating the use of immunotherapy on glioblastoma, a type of brain cancer. The trial uses a modified polio virus to target tumor cells and kill them directly, and create an anti-tumor immune response to kill additional tumors.

This is the hottest area of research, Teknos said.

A patients age has no bearing on how well immunotherapy will work, Shepard said. He gave the example of former President Jimmy Carter, who at age 95 is being treated with immunotherapy.

Immunotherapy holds great promise, but it has limitations. The treatments can be used for only some types of cancer, and can come with severe side effects. Costs also can spiral north of $100,000.

Here are some often-used types of immunotherapy:

Immune checkpoint inhibitors

Cancer cells secrete a protein that turns off the immune system. Checkpoint drugs allow the bodys immune system to identify cancer cells and fight them, Teknos said.

Checkpoint inhibitors take the tumors Invisibility Cloak off, UHs Teknos said, using a Harry Potter reference.

Checkpoint inhibitors currently on the market include the brands Keytruda (Pembrolizumab) and Opdivo (Nivolumab).

Checkpoint inhibitors hold the potential for very, very good and long-lasting responses, Shepard said. Chemotherapy typically will not do that.

CAR-T cell therapy

Bodies fight infection using a type of immune cell called T cells. CAR-T-cell therapy works by removing T-cells from a patients blood and modifying them in a laboratory to chimeric antigen receptors (CAR). These altered T-cells are returned to the patients body, where they recognize and destroy cancer cells.

They go out and seek tumors, Shepard said.

Cancer vaccines

Some types of anti-cancer vaccines target specific proteins found on cancer tumors. This type of anti-cancer vaccine has to be specially tailored for a specific patient.

FDA-approved vaccines include Provenge (sipuleucel-T), which is infused through an IV, for prostate cancer, the Clinic said. Another anti-cancer vaccine is talimogene laherparepvec (T-VEC) for melanoma; it is injected into the tumor.

Other anti-cancer vaccines utilize viruses that grow inside tumors and cause the cancerous cells to break apart. This allows the bodys immune system to recognize and destroy cancer cells.

There are serious risks

Immunotherapy isnt always successful. Some patients see their tumors shrink, but others see no response, or their tumor increases in size, Shepard said.

We dont know how to tell whos who, Shepard said.

Theres evidence that in some cases, ramped-up immune systems created by these therapies attack healthy organs, according to a 2016 New York Times article.

Studies suggest that severe reactions occur nearly 20% of the time with certain drugs, and in more than half of patients when some drugs are used in combination.

Patient deaths led Seattle-based Juno Theraputics to permanently shut down its clinical trial of an immunotherapy to treat acute lymphoblasic leukemia in adults, according to a 2017 Seattle Times article. Five patients in the trials died, but the fifth death could not be tied to the trial. Juno Theraputics did not respond to requests for comment.

Expensive care

Because immunotherapy treatments are time-consuming to make, and sometimes must be personalized for individual patients, they often cost more than $100,000 per patient.

When the therapies are used in combination, costs can double or triple, according to the online publication Vox. For example, CAR-T is $350,000 to $500,000 per treatment, Teknos said.

Private health insurance companies sometimes wont cover immunotherapy costs, even if a physician recommends the treatment, according to Vox. Copays are so high that they put the treatment out of reach for most people, the article said.

Medicare doesnt cover the costs of Keytruda or Optivo, according to GoodRx.

When immunotherapy is given to a hospital inpatient, it is included under the diagnosis-related group payment system used to determine hospital payments, a Medicare spokesman said. Local Medicare administrators determine Medicare coverage for outpatient immunotherapy treatments.

Further reading

More detail about Medicare coverage of immunotherapy

The Society for Immunotherapy of Cancer (SITC)

This professional society for the advancement of immunotherapy offers a 40-page booklet free to download.

Cancer.Net

Additional information on immunotherapy in each cancer-specific section.

GoodRx lists patient assistance programs for Opdivo.

ResearchMatch

This is an NIH-funded free registry for people trying to find research studies to join.

Recent Health Matters columns by Julie Washington:

Hospitals say leave meds at home; readers say otherwise

Where to get help paying your medical bill

Tips for a smooth transition to a skilled nursing facility

Local celebrities share their healthy 2020 resolutions: Health Matters

Creating healthy habits for 2020: Health Matters

Shingles vaccine and virus: What you need to know: Health Matters

In her column, patient advocacy writer Julie Washington will answer readers questions about navigating health-care systems. (She will not address individual treatments.) Your comments may be published in a future story or column. Send questions and comments for publication including your name, city and daytime phone number to jwashington@plaind.com. You can also find Julie on Twitter @JulieEWash.

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Immunotherapy called the future of cancer care, but not without risks, costs: Health Matters - cleveland.com

This entry was posted on January 30, 2020 at 3:42 pm and is filed under Immune System. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed. |