Immunotherapy: The Past, Present and Future
Immunotherapy is a process that uses the body's own immune system to fight off bad cells. This can happen two different ways: Either your immune system can be stimulated to work harder and smarter, or you can give your immune system synthetic proteins to help attack bad cells.
The first instance of American cancer-specific immunotherapy occurred in 1891 when William B. Coley attempted an immune-modulating therapy for sarcoma cancer. He injected streptococcal bacteria (the bug that causes “strep throat”) into the patient, in hope that doing so would result in a shrinking effect in the malignant tumor. This proved to be correct, and he continued to use this method yielding great results.
However, there were many skeptics and critics who did not believe the results. Along with the development of radiation and chemotherapy, the skepticism resulted in the discontinuation of Coley’s method. Nonetheless, after many years his ideas were brought back and have been used in the modern science of immunology. His idea that certain cancers are sensitive to an enhanced immune system stands true.
As time passed, more advancements were made in immunotherapy. In 1981, the first cancer prevention vaccine was used to help prevent liver cancer. Then, in 2001 scientists published the first draft of the Human Genome Project. While this is not specifically an immunotherapy milestone, it provided a great deal of helpful information about the human genetic makeup. It was a huge accomplishment in terms of understanding how the human body is composed. Furthermore, it deepened our understanding of how the human body can be susceptible to harmful cancer cells.
Just under one year ago, President Obama gave his final State of the Union speech, in which he announced the Cancer Moonshot. This initiative has been headed by Vice President Joe Biden and aims to make ten years’ worth of cancer research progress in just five years’ time. The hope is to find a cure for cancer during that time. While curing cancer might not come immediately, the steps in place to get there will help those battling cancer and prevent others from dealing with the pains that cancer can bring.
To accomplish this, a few key components must fall into place. First, the Cancer Moonshot is collaborative in nature, which means there must be teamwork and cooperation among a variety of government cabinets and agencies, as well as big players in pharmaceutical, academic, research, technology, insurance, and medical industries. Additionally, the initiative calls for an improvement to the access of data – in terms of organization of information, speed of access, and openness to other researchers.
Throughout 2016, big strides have been made in the field of immunotherapy, largely as a result of the Moonshot. Two immunotherapy drugs in particular have stood out, and have even been FDA approved to treat certain types of cancer. Both Keytruda and Opdivo were introduced to the FDA list of cancer immunotherapy treatments in late 2014, and have expanded their treatment reach in 2016. Keytruda was approved to treat recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) in August, and non-small cell lung cancer in October. Opdivo was approved to treat classical Hodgkin lymphoma in May, and recurrent or metastatic HNSCC in November.
These two drugs have also been used in a variety of clinical trials to treat other types of cancer. One type of cancer in particular that has seen hope is mesothelioma, a rare cancer caused by asbestos exposure. Dr. Bryan Burt, who leads the Baylor College of Medicine team dedicated to mesothelioma, has indicated that rather than administering immunotherapy drugs as standalone treatment, improvements could be made in using it is a neoadjuvant therapy – or a therapy used before surgery to treat cancer.
Dr. Burt’s team is currently conducting first-of-its-kind testing of immunotherapy as a neoadjuvant treatment. While not perfect, it’s showing hope. “Immunotherapy for mesothelioma can be considered in an early phase of development,” said Dr. Burt. “Recent human data from small clinical trials in mesothelioma patients have shown promising results.” With these types of clinical trials going on, there are great chances of finding even better treatments for mesothelioma. Patients who generally have a 12 – 21 month life expectancy can now see the potential for much longer survival with these sorts of emerging treatments.
On October 17, 2016, Vice President Biden recapped the progress of the Cancer Moonshot in his final report to President Obama. “The Cancer Moonshot is a movement that lives in communities across the United States and the world — and it will live long after we leave office,” Biden's report says. “Mr. President, we can’t afford for it not to, because the need is too great and the promise even greater.”
With the belief that the Cancer Moonshot Initiative will continue to expedite cancer research advancements, we can have hope in improvements to immunotherapy treatments. We can have hope that cancer patients will receive treatments better than they ever have before.
Emily Walsh is Community Outreach Director at the Mesothelioma Cancer Alliance.