Immunotherapy In Cancer

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Government Medical College Nagpur

• 2nd Professional MBBS, Batch -2019
• Subject Pathology
• Topic Immunotherapy in Cancer
• Presentation SDL by Shatakshi Gupta
• Roll No. - 19100, batch - A
• Guided by Dr. Jaishree Tijare Mam

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CONTENTS
Lets get ready to learn about -

• Immune system and Cancer
• Cancer Immunotherapy and its Mechanism of action
• Types of Immunotherapy approved for standard
  treatment
• Types of cancers treated with Immunotherapy
• How is Immunotherapy performed?
• Duration of the treatment
• Pros and Cons
• Sideeffects of Immunotherapy
• Effectiveness of Immunotherapy
• Current research in Immunotherapy

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• The immune system is a network of biological
  processes and consists of various organs of the
  body that provide resistance to infection and
  toxins.
• The immune system detects and destroys abnormal
  cells and most likely prevents the growth of many
  cancers.
• Immune cells are sometimes found in and around
  tumors which are tumor-infiltrating lymphocytes
  and are a sign that the immune system is
  responding to the tumor.
• The immune system is important to people with
  cancer because
• Cancer can weaken the immune system.
• Cancer treatments might weaken the immune system.
• The immune system may help to fight cancer.

IMMUNE SYSTEM AND CANCER
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IMMUNE SYSTEM AND CANCER

• 5. Even though the immune system can prevent or
  slow cancer growth, cancer cells have ways to
  avoid destruction by the immune system. As cancer
  cells may
• Have genetic changes that make them less visible
  to the immune system.
• Have proteins on their surface that turn off
  immune cells.
• Change the normal cells around the tumor so they
  interfere with how the immune system responds to
  the cancer cells.
• 6. There are various types of cancer treatments.
  Some treatments aim to use the immune system to
  fight cancer - IMMUNOTHERAPY

Chemotherapy
Surgery
Radiation Therapy
Immunotherapy
Targeted Therapy
Hormone Therapy
Stem Cell Transplant
Precision Medicine
Biomarker Testing
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CANCER IMMUNOTHERAPY AND ITS MECHANISM

• Immunotherapy is a type of cancer treatment
  that helps our immune system to fight cancer.
• It is a biological therapy  that uses
  substances made from living organisms to treat
  cancer.
• It helps the immune system to better act against
  cancer.
• It is the artificial stimulation of the immune
  system to treat cancer.
• The goal of immunotherapy is to marshal the
  specificity and long-term memory of the adaptive
  immune response to achieve durable tumor
  regression and possible cure.

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TYPES OF IMMUNOTHERAPY TREATMENTS
Types
Monoclonal Antibodies
Cell based Therapy
Cytokine Therapies
Other types 1. Cancer Vaccines 2. Immune
Checkpoint Inhibitors 3. Immune Systems
Modulators 4. Oncolytic Virus Therapy
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CELL BASED THERAPIES

• Basis Usage of cell-based vaccines.
• Source of Vaccine Cells Tumor cells or antigen
  presenting cells from patients own body.
• Cell types used as therapeutic agents NK
  cells, Cytotoxic T cells and Dendriyic cells.
• How do these treatment vaccines act ?
• Delays or stop the growth of cancer cells.
• Causes tumor shrinkage.
• Prevent cancer frpm coming back .
• Eliminates cancer cells that have not been killed
  by other forms of treatment.
• Strategies under investigation -
• 
  Increases tumour specific T- cells.
• 
  Activates innate immune responses.
• 
  Uses APCs (antigen presenting cells) to
  activate immune response.

Adoptive T cell therapy
Natural Killer cell therapy
Dendritic Cell Therapy
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Natural Killer cell therapy
Adoptive T cell therapy
Dendritic Cell Therapy
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MONOCLONAL ANTIBODIES

• Mabs are immune system proteins created in the
  lab and they have same variable end.
• They recognise molecules on the outside of cancer
  cells.
• They are designed to bind to specific targets on
  cancer cells. Some mAbs mark cancer cells so that
  they will be better seen and destroyed by the
  immune system.
• Such mAbs are a type of immunotherapy. These are
  also called therapeutic antibodies.

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Monoclonal Antibody Immunotherapy
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CYTOKINE THERAPIES

• Cytokine therapy has proven to be a novel
  therapeutic approach in treating patients with
  advanced malignancies.
• Purpose It is used to manipulate the immune
  response in such a way as to generate the
  appropriate immune effector cells to eradicate
  solid tumors.
• Types diseases been treated

• Interferon Alpha

• Interleukin 2

• Hairy cell leukaemia
• Aids-related kaposis sarcoma
• Follicular lymphoma
• Chronic myeloid leukaemia
• Malignant Melanoma

• Malignant melanoma
• Renal cell carcinoma

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OTHER TYPES OF IMMUNOTHERAPY TREATMENT

• Cancer Vaccines For treatment of existing
  cancers or prevention of emergence of new
  cancers.
• Preventive Vaccines HPV vaccines and Hepatitis
  B vaccines ( cervical and liver cancers)
• Therapeutic Vaccines BCG Vaccine (early
  staged bladder cancer) , Dendritic cell based
  vaccine (prostate cancer, melanoma) .
• Immune checkpoint inhibitors
• Immune system modulators -, Enhances the
  bodys immune response against cancer.
• Oncolytic Virus Therapy - Uses viruses to
  infect and destroy cancer cells.
• Example T-Vec is approved for subsets of
  patients with melanoma.

• Blocks immune checkpoints .
• Keeps immune responses from being too strong.
• Allow immune cells to respond more strongly to
  cancer.

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TYPES OF CANCERS TREATED WITH IMMUNOTHERAPY

• Immunotherapy treatments have been approved
  or are being tested for more than 20 kinds of
  cancers
• Bladder cancer
• Brain cancer
• Breast cancer
• Cervical cancer
• Childhood cancer
• Colorectal cancer
• Esophageal cancer
• Ovarian cancer
• Pancreatic cancer
• Skin cancer
• Stomach cancer

• Head and neck cancer
• Kidney cancer
• Leukemia
• Liver cancer
• Lung cancer
• Lymphoma
• Melanoma
• Multiple myeloma
• Prostate cancer
• Sarcoma

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HOW IS IMMUNOTHERAPY PERFORMED?

• Different forms of immunotherapy may be given
  in different ways. These include
• Intravenous (IV)Goes directly into a vein.
• OralPills or  Capsules
• TopicalCream (used for very early skin cancer).
• IntravesicalGoes directly into the bladder.

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• The treatment may be given daily, weekly, monthly
  or in a cycle. Treatment length depends on
• Cancer type and stage.
• Type of immunotherapy drug.
• Our bodys response to treatment.

DURATION OF THE TREATMENT
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PROS CONS

• What Are the Benefits?

• What Are the Risks?

• Immunotherapy may work when other treatments
  dont. 
• Eg Some cancers like skin cancer dont
  respond well to radiation or chemotherapy but
  start to go away after immunotherapy.
• It can help other cancer treatments work better.
  Eg With chemotherapy
• It causes fewer side effects than other
  treatments.
• Cancer may be less likely to return after
  immunotherapy.
• The immune system learns to go after cancer cells
  if they ever come back. This is called
  immunomemory, and it could help us stay
  cancer-free for a longer time.

•  Itching, swelling, redness, or sore near the
  area of medication.
• It can harm organs and systems. 
• It isnt a quick fix. 
• It doesnt work for everyone.
• Body could get used to the treatment and
  gradually tumour may grow again.

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SIDE EFFECTS OF IMMUNOTHERAPY

• Some side effects are common with all types of
  immunotherapy. 
• Skin reactions at the needle site
• Swelling
• Soreness
• Redness
• Itchiness
• Rash
• Other side effects might include
• Swelling and weight gain from retaining fluid
• Heart palpitations
• Sinus congestion
• Diarrhea
• Risk of infection
• Organ inflammation

• Flu-like symptoms
• Fever
• Chills
• Weakness
• Dizziness
• Nausea or vomiting
• Muscle or joint aches
• Fatigue
• Headache
• Trouble breathing
• Low or high blood pressure

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EFFECTIVENESS OF IMMUNOTHERAPY

• Success rates for these cancer treatments depend
  on individual factors, including the cancer type
  and stage.
• Immunotherapy is opening the door for more
  treatment possibilities beyond chemotherapy,
  surgery and radiation.
• Lung cancer has received attention, when
  immunotherapy was combined with chemotherapy.
  Patients who received the dual therapy lived
  longer than those who received only chemotherapy.
  
• Immunotherapy can produce durable responses
  unlike chemotherapy or radiation, however, these
  occur only in around 25 patients.
• In general, immunotherapy is effective across a
  wide variety of cancers. 

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RESEARCH IN IMMUNOTHERAPY

• Finding solutions to overcome resistance to
  immunotherapy.
• Finding ways to predict which people will respond
  to treatment is a major area of research.
• Learning more about how cancer cells evade or
  suppress immune responses against them.
• Finding ways to reduce the side effects of
  treatment with immunotherapy.
• New ways to develop cancer vaccines.
• The research is leading to expand the number of
  patients who may potentially benefit from the
  treatment.

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