Immunotherapy is revolutionizing cancer treatment

In the past 50 years, understanding of cancer has advanced considerably, and treatments are far more effective. Thanks to new and innovative therapies, being diagnosed with cancer today is no longer a death sentence.

Some cancers that were once terminal in every case are now generally treatable. For example, childhood leukemia, testicular cancer, and Hodgkin’s disease — previously fatal — are now generally curable through chemotherapy. In 1968, a child with acute lymphoblastic leukemia (ALL) had a diagnosis that was almost uniformly fatal. Today’s best treatments provide cure rates approaching 90% for ALL.

The development of successful treatments has followed our understanding of the biology of the disease, attained through incremental advances and occasional moments of great insight. These advances paved the way for innovative cancer treatments including chemotherapy, radiation therapy, and targeted therapy, among others.

Today, a new era in medicine is revolutionizing how we diagnose, treat and hopefully one day cure the many diseases that make up cancer. The pipeline has never been more promising with 79% of medicines in development for cancer having the potential to be first-in-class treatments. More than 70% of cancer medicines in the pipeline also have the potential to be personalized medicines.

The latest and most exciting development in our search for a cure for cancer is in the growing field of cancer immunotherapy. Also known as immuno-oncology, cancer immunotherapy is a form of cancer treatment that uses the power of the body’s own immune system to prevent, control, and eliminate cancer.

According to the American Cancer Society (ACS), immunotherapy involves: 1.) stimulating, or boosting, the natural defenses of your immune system so it works harder or smarter to find and attack cancer cells; or, 2.) making substances in a laboratory that are just like immune system components, and using them to help restore or improve how your immune system works to find and attack cancer cells.

A class of immunotherapies have already achieved US Food and Drug Administration (FDA) approval in a range of cancers, including certain types of melanoma, non-small cell lung cancer, renal cell carcinoma, bladder cancer, head and neck cancer, liver cancer, and classic Hodgkin’s lymphoma. The first generation of immuno-oncology drugs are poised to become the standard of care across multiple tumor types in advanced disease, and are already being followed with other immune-activating agents.

Another immunotherapy approach is called adoptive cell transfer (ACT) which collects and uses a patients’ own immune cells to treat their cancer. One of the more advanced forms of ACT is CAR T-cell therapy. CAR stands for chimeric antigen receptor. CAR T-cell therapy employs the use of T-cells, which play a critical role in orchestrating the immune response and killing cells infected by pathogens.

In CAR T-cell therapy, some T-cells are taken from a patient’s blood and mixed with a special virus that makes the T-cells learn how to attach to tumor cells. The cells are then given back to the patient so they can find, attach to, and kill the cancer, the ACS explains. With the potential for this treatment to be effective against a wide variety of aggressive cancers, expectations and hopes are running high.

CAR T-cell therapy is just one of several main types of cancer immunotherapy, according to the ACS. Checkpoint inhibitors are drugs that basically take the “brakes” off the immune system, which helps it recognize and attack cancer cells. Cytokines (small proteins that carry messages between cells) stimulate the immune cells to attack cancer.

Immunomodulators are a group of drugs that generally boosts parts of the immune system to treat certain types of cancer. Cancer vaccines trigger an immune response to help prevent or treat cancer. Monoclonal antibodies (mAbs) are man-made versions of immune system proteins that can be very useful in treating cancer because they can be designed to attack a very specific part of a cancer cell.

Oncolytic viruses are lab-modified viruses designed to infect and kill certain tumor cells. Oncolytic viral therapies zero in on cancer cells, replicate, and cause them to rupture. They have been recognized as a promising new treatment, with the potential to be a standard therapeutic option for all cancer patients.

Some immunotherapy treatments use genetic engineering to enhance immune cells’ cancer-fighting capabilities and may be referred to as gene therapies. The gene editing technology CRISPR/Cas9 allows researchers to manipulate cancer cell function.

The first clinical trial involving CRISPR, a family of DNA sequences in bacteria and archaea, started in 2016. Today there are over 20 human trials underway. One of these trials will feature the first-ever attempt to edit cells inside the body, with the aim of targeting and destroying the genes of HPV that cause tumor growth.

The global prevalence of cancer is increasing rapidly, presenting an especially heavy burden for people in low and middle-income countries (LMICs). Collaborative and innovative thinking is now needed to expand access to cutting-edge cancer therapies, including immunotherapy. To this end, the research-based pharmaceutical industry is committed to facilitating public and private sector partnerships for better access to quality cancer care.

Teodoro B. Padilla is the executive director of Pharmaceutical and Healthcare Association of the Philippines (PHAP).PHAP represents the biopharmaceutical medicines and vaccines industry in the country. Its members are in the forefront of research and development efforts for COVID-19 and other diseases that affect Filipinos.