0

I have heard a lot about immunotherapy in the last 2 years. It is not used in many countries and is still under testing.

  1. What is immunotherapy? (I need a simple explanation, I am not a doctor)

  2. How much longer will the cancer patient will live if this treatement is used at any cancer stage?

  3. Why is it still not used in all countries? (I have heard that the UK will start to use it for all patients in 2 years.)

3

This is very broad as asked. I will answer with one example, there are others.

Immunotherapy gets the patient's own immune system to destroy the tumours rather than the treatment itself destroying them. This might involve making the immune system more active, or interfering with the way that tumours hide or shield themselves from the immune system. For example, Wikipedia says of Ipilimumab

T lymphocytes can recognize and destroy cancer cells. However, an inhibitory mechanism interrupts this destruction. Ipilimumab turns off this inhibitory mechanism and allows the lymphocytes to continue to destroy cancer cells.

(Lymphocytes are your own white blood cells, the same mechanism that cleans up infections in your body all the time.)

This article at cancer.gov summarizes some studies showing how Ipilimumab and other immunotherapies are changing outcomes for melanoma. You can do you own searches for other drugs and other cancers. For example Nivolumab is combined with "ipi" for melanoma. I have also seen ads on tv for Nivolumab for lung cancer.

How much longer will patients live? That depends on the cancer. Melanoma has dismal outcomes if it's Stage IV - median survival of about 6 months, less than 10% surviving 5 years - and chemotherapy doesn't help survival. (One article on how bad stage IV is with traditional treatments.) So there's plenty of room for improvement. The studies in the article above include some of that improvement. It's hard to find much on long-term odds, because they haven't been using these drugs long - ten years at most.

Why not use it everywhere? Well they literally do not know what cancers it works for (presumably not all of them) or precisely what kind of survival improvements to expect. It's a no-brainer to use it with something that has survival times of just a few months, but should you use it with something that has survival times of 2 or 3 years? Because there is a cost. First, a dollar-cost: $200,000 a year is typical. And second, the side effects are very bad. They can be fatal. And when they're not fatal, they're hospitalize-you-and-major-steroids bad, and take-a-compensating-medication-for-the-rest-of-your-life bad. The immune system can over-react causing inflammation and swelling that might damage or destroy your thyroid, pancreas, adrenal gland, or whatnot, or give you colitis. Understanding the side effects is a big part of the current studies. One study describing how people went from months of survival to years mentions "55% of patients will have high-grade adverse events" so widespread use will be held back by that.

Here's a study I'm very familiar with. It compares two dose regimens of two different immunotherapy drugs for melanoma. These regimens have already been shown to have the same response rate; the study compares the side effects. It's normal for some patients to have to stop taking the treatment because the side effects are intolerable. And a similar study (same combination of drugs, same disease) reported results where over 60% of patients getting the combination were still alive after 2 years. 65% is so much better than 10%!

There are other immunotherapy drugs, but in general you see:

  • the treatment doesn't attack the cancer; rather it enables the patients own immune system to do so
  • the improvements in survival are astonishing. People living years instead of months, and possibly decades instead of months. People becoming immediately "better" with no symptoms instead of lingering with constant side effects of chemo and radiation, or surgeries many times a year
  • the long term outcomes are not well known at all
  • the side effects are very dangerous when they happen
  • the cost is high

From a personal point of view, yesterday I said to my doctor "it feels like being around when insulin or antibiotics were first being used" and he agreed, yes it does. But that includes the part where you don't know for sure how things will turn out.

| improve this answer | |
  • So. There is no hope for finding an effective cancer cure from now till years and years. It appears from your response, that the immunotherapy will be like other cancer treatments (it may work for some, and don't for others, like chemotherapy). And we are talking about the survival rate which is the same so. – alim1990 Aug 25 '17 at 4:58
  • The survival rate is not the same. For the ones it works for, it is amazing. But yes, research is slow and things that have been killing us for centuries can't just go away in a matter of months or even years just because we wish they would. Progress is being made. Remember though, that even things we can cure still kill people today. – Kate Gregory Aug 25 '17 at 5:24
  • Thanks Kate. If you are a doctor or nurse can we go to chat and ask a question about myself. I am going to doctor but I will be glad to ask something before going – alim1990 Aug 25 '17 at 5:37
  • I am not (though I have a PhD in biomedical engineering and a personal interest in this area) but I won't be online again for a few days. – Kate Gregory Aug 25 '17 at 12:49
  • We can't give personal advice here, @droidnation. But there are advice here on how to see a doctor - what to prepare ahead of time, what to take with you, how to approach asking questions, what to tell them, even what kind of doctor to see. – DoctorWhom Aug 27 '17 at 0:55

Your Answer

By clicking “Post Your Answer”, you agree to our terms of service, privacy policy and cookie policy

Not the answer you're looking for? Browse other questions tagged or ask your own question.