Immunotherapy as Cancer Treatment — Not Yet for Every Cancer, Every Patientby Barbara Galligan, MD, hematology, oncology
A little over two years ago, the American Society of Clinical Oncology (ASCO) in its annual report, named cancer immunotherapy the clinical cancer advance of the year.
“No recent advance has been more transformative than the rise of immunotherapy” said ASCO President Julie Vose. “These new therapies are not only transforming patient lives, they are also opening intriguing avenues for further research.”
ASCO recognized advancements in immunotherapy again in 2017 and in 2018, with the expansion of adoptive cell therapy. This recognition has driven a lot of research and development within the field of immunotherapy, with some projecting that the global immunotherapy market, valued at $60 Billion in 2016, will grow to $120 Billion by 2021.
The excitement over these treatments stems from the fact that immunotherapy can get dramatic, durable results in cancers that are difficult to treat. But the story behind immunotherapy is not simple.
Immunotherapy encompasses many different types of treatments both old and new including vaccines, antibodies, and the newer checkpoint modulators and adoptive cell therapies. What these treatments have in common is that they all harness the body’s own immune system to fight cancer.
But ramping up the body’s immune system can cause serious side effects including fatigue, pain, autoimmune diseases and organ damage. Patients undergoing immunotherapy must be monitored carefully for such side effects with regular physical exams, blood work, and scans.
Another limitation to immunotherapy is that it is not always effective. Even in best cases scenarios, only about 20% - 30% of patients receiving immunotherapy respond to treatment. That is why immunotherapy is not as widely used as radiation therapy, chemotherapy or surgery, and the Food and Drug Administration (FDA) has only approved immunotherapy for certain types of cancer.
Doctors cannot yet predict if an individual cancer patient will respond to immunotherapy because cancer is a complex set of diseases and individuals have their own unique response profiles. It can be confusing for patients when direct-to-consumer advertising campaigns for immunotherapy portray results as miraculous without discussing side effects or the chances that the treatment will not work.
For cancer patients navigating the field of immunotherapy it’s especially important to have a good relationship with an oncologist. When discussing immunotherapy with an oncologist, start by asking if the type and stage of the cancer make it eligible for treatment with immunotherapy. Ask if the goal of treatment is to eliminate the cancer, or to slow it down so that it does not spread. It’s also good to know if immunotherapy will be combined with other cancer treatments and how often treatments are given.
No treatments are without side effects, so asking about short term as well as long term side effects is important. The cost of treatment and insurance coverage are also important to consider. A frank conversation with an oncologist can help set expectations and develop the best treatment plan for the patient including monitoring for side effects and checking to see if the cancer is responding to treatment.
The field of immunotherapy is complex and, like all aspects of cancer care, there is no one-size-fits-all approach. Patients in Marin interested in discussing immunotherapy as a possible cancer treatment can find it right here in the community because together, Marin Cancer Care and Marin General Hospital offer immunotherapy as well as clinical trials in immunotherapy. When deciding if these treatments are appropriate, it is important to have a good relationship with an oncologist who can help explain the many new treatments now available to cancer patients.
Developing good communication and trust with a doctor can help patients navigate the path between older cancer therapies and newer treatments such as immunotherapy and personalized medicine. No new treatment can ever replace the healing that happens when a doctor cares for a patient as a unique individual with distinct personal characteristics, goals and plans.