A Legacy of Immunotherapy Advancements
For over 40 years, the Saint John’s Cancer Institute has been at the forefront of research into how tumors interact with the immune system. Co-founder Donald L. Morton, MD, was a pioneer in this field, developing methods to harness the immune system’s power to combat cancer. In the early 1970s, Dr. Morton successfully used Bacilli Calmette-Guérin (BCG), a weakened strain of the tuberculosis bacterium, to treat melanoma tumors, marking the first successful use of immunotherapy against metastatic human cancer. Combined with the exceptional quality of Saint John’s medical staff and hospital, a unique community-based cancer research and training institute was formed, outstanding in the areas of translational research and the treatment of solid tumors including surgical oncology, immunotherapy, chemotherapy, and radiation.
Immunotherapy for Melanoma Cancer
Immunotherapy is a groundbreaking approach to cancer treatment that is revolutionizing the way melanoma and other malignancies are managed. Unlike conventional treatments such as chemotherapy and radiation, immunotherapy works by harnessing the body’s natural defenses to fight melanoma that may have spread in other parts of the body. This innovative method helps the immune system recognize and attack cancer cells, which often evade detection because they share traits with healthy cells.
How Immunotherapy Works
Immunotherapy drugs activate specific molecules on the surface of immune cells, triggering an immune response. These drugs help the body circumvent the subterfuge of cancer cells, allowing the immune system to identify and destroy them. This approach has shown remarkable success in treating melanoma, particularly in advanced stages.
Immunotherapy helps the immune system overcome these challenges in several ways:
- Immune Checkpoint Inhibitors: These drugs block proteins that prevent immune cells from attacking cancer cells. By inhibiting these checkpoints, the immune system can recognize and destroy cancer cells more effectively
- T-cell Transfer Therapy: This involves extracting immune cells from the patient, enhancing their cancer-fighting abilities in a lab, and reintroducing them into the body
- Monoclonal Antibodies: Lab-created antibodies that bind to specific targets on cancer cells, marking them for destruction by the immune system
Expected Outcomes
Immunotherapy has shown promising results in treating various cancers, including melanoma, lung cancer, and bladder cancer. The expected outcomes include:
- Improved Survival Rates: Patients receiving immunotherapy often experience more prolonged survival compared to those undergoing conventional treatments
- Durable Responses: Unlike chemotherapy, which may only provide temporary relief, immunotherapy can lead to long-lasting remission
- Reduced Tumor Size: Immunotherapy can shrink tumors by enabling the immune system to target and kill cancer cells effectively
Side Effects of Immunotherapy
While immunotherapy is generally well-tolerated, it can cause side effects, some of which may be significant:
- Common Side Effects: Fatigue, skin rashes, diarrhea, nausea, and decreased thyroid hormone levels.
- Inflammation: Since immunotherapy boosts the immune system, it can lead to inflammation in various organs, such as the lungs (causing cough or shortness of breath), liver (elevated liver enzymes), and thyroid (altered hormone levels).
- Rare Occurences: In rare cases, immunotherapy can cause severe allergic reactions or inflammation-related issues.
It’s essential for patients to discuss potential side effects with their healthcare provider and to be closely monitored during treatment.
Types of Immunotherapies
- CTLA-4 Inhibitors: In 2011, the FDA approved ipilimumab, a drug that targets the CTLA-4 protein. This checkpoint molecule acts as an “off switch” for T cells, preventing them from attacking healthy cells but also blocking them from attacking tumors. Ipilimumab has been shown to extend survival in patients with metastatic melanoma, with more than 20% of patients alive three years after treatment.
- PD-1 and PD-L1 Inhibitors: Pembrolizumab and nivolumab are drugs that target PD-1 and PD-L1 proteins, which also act as immune system brakes. Pembrolizumab has produced responses in approximately one-third of patients.
- Intra-Tumoral Immunotherapy: One of the most promising areas of research involves administering treatments directly into tumors. This method allows for higher doses to be delivered specifically to the cancer while sparing the rest of the body. Intra-tumoral immunotherapy aims to kill the injected tumors and generate a broader immune response, similar to vaccination. Investigated therapies include oncolytic viruses, gene therapies, and established vaccine adjuvants.
New Treatments and Guidelines
Recent advancements in melanoma treatment include the approval of tumor-infiltrating lymphocyte (TIL) therapy, which amplifies the cancer-fighting immune cells already present in a patient’s melanoma.
Lifileucel, the first TIL therapy approved for clinical use, has shown promise in extending survival for patients with metastatic melanoma.
Additionally, new guidelines emphasize the importance of accurate staging and personalized treatment plans, incorporating sentinel lymph node biopsy and advanced imaging techniques.
Support and Care
At Saint John’s Health Center, we provide a multidisciplinary approach to patient care, involving specialists across various disciplines. These experts participate in cancer tumor boards, where they evaluate and discuss each case in detail. This collaborative effort ensures that every patient receives a comprehensive and personalized treatment plan, leveraging the collective expertise of surgeons, oncologists, radiologists, and other healthcare professionals.
Whether you’re looking for expert opinions or want to learn more about personalized clinical trials, your health and well-being are our top priorities. We’re committed to providing you with the best possible care and information.
