Contributing Editors:
Jennifer H Benbow, PhD
Kathryn F. Mileham, MD
Emily Baldrige, MPH
Edward S. Kim, MD
Module Overview
Advances in cancer research have provided a deeper understanding of the complex interactions that occur between the immune system and tumor cells as well as the many tumor evasion strategies. Cancer cells continue to evolve and find new ways to evade and outsmart the immune system, resulting in the continuous need for the development of novel therapeutic options focused on enhancing the functionality of the immune system and anti-tumor immunity. The greatest weapon cancer cells now use to avoid detection and thrive is the ability to alter the function and regulation of the immune system. Some cancer cells suppress factors involved in the promotion of the immune response and enhance other factors known to inhibit the immune response.
While a variety of treatment modalities are currently used to fight cancer, the aim of immunotherapy is to enhance the ability of a patient’s immune system to fight back and target the tumor cells. Immunotherapy provides an option for complex and late stage cancer patients, where other traditional therapies have demonstrated only modest at best improvements. These therapies can be classified as active — directing the patient’s immune system to interact directly with tumor cells — or passive, enhancing the anti-cancer response. Immunotherapy is not a quick fix; in some instances, these treatment options can take even longer than traditional therapies to see a response, time that that may not be an option for late stage cancer patients.
Despite the potential for prolonged time until response, immunotherapy has been shown to be an effective treatment for certain cancers where previous chemotherapy and radiation have shown little to no effect. Additionally, there is the potential that boosting a patient’s own immune system will allow it to recognize recurrent cancer cells and enhance the efficiency of the immune system to fight back against these types of cancers.
The potential exists that the opposite effect can also hold true, where cancer cells develop a resistance to the effects of immunotherapy and/or over stimulation of the immune system during prior immunotherapy results in an ineffective immune response when the tumor returns. The variation in response rates to immunotherapy can be attributed to several factors including the specificity needed to elicit the desired immune response, overcoming the evasion tactics the cancer cells are using and ensuring the activated immune cells are able to find the malignant tissues.
With the advances in immunotherapy, more and more therapies are being tested in clinical trials and approved by the FDA to treat a variety of cancers. However, the success of immunotherapies is highly dependent on the type and grade of cancer and expression of critical immunological and molecular biomarkers. While the development of new immunotherapy agents is rapidly growing, this module will provide an overview of the main categories and current status of immunotherapies.
Module Objectives
Upon completion of this module, participants should be able to understand:
- the various types of immunotherapeutic agents used in the treatment of cancer;
- the mechanism of action of these therapeutic agents; and
- the potential importance of monotherapy versus combination immunotherapy.
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