How does immunotherapy work?

• The treatment stimulates the body’s natural defense systems to find and destroy cancer cells.
• Artificial drugs are created that replace damaged components of the immune system, thereby improving its function.

According to the American Cancer Society, over the past few years, tumor immunotherapy has become an integral part of treatment for some cancers. Scientists are researching new drugs and ways to stimulate the immune system.

Doctors distinguish these main types of immunotherapies for cancer:

• Monoclonal antibodies – proteins that are artificially altered to find and destroy cancer cells. Used in chronic lympholeukemia, gastric cancer.
• Checkpoint inhibitors – These drugs make cancer cells visible to the immune system. An example of such a drug is Keytruda (pembrolizumab). See clinics for treatment with Keytruda.
• Anti-cancer vaccines are drugs that work on the principle of flu shots – to induce a rapid immune system response, the patient is injected with substances that are produced by cancer cells. The most common human papillomavirus vaccines can prevent the development of rectal cancer, cervical, throat, vulva, vaginal and penile malignancies.
• Cytokines are protein molecules that stimulate the activity of the immune system and blood cells to fight cancer. They are prescribed for kidney tumors, metastatic melanoma, and, in some cases, to ease the side effects of chemotherapy.

Who would benefit from immunotherapy treatment for cancer?

Experts at the U.S. National Cancer Institute recommend immunotherapy for more than 100 different cancers in children and adults, including:

• lung cancer;
• breast cancer;
• malignant brain tumors;
• lymphoma;
• colorectal cancer;
• cancer of the stomach and pancreas;
• blood cancers.

How is immunotherapy done?

Depending on the diagnosis and the drug, immunotherapy is administered intravenously in the form of IVs or injections, in the form of tablets, cream that is rubbed into the skin or injected into the bladder through a catheter.
Some medications need to be taken continuously for a certain period of time, while others need to be taken in courses of several weeks or months.

Immunotherapy for lung cancer

The U.S. Food and Drug Administration (FDA) approved immunotherapy for the treatment of lung cancer in 2015. Over the following years, a number of studies were conducted on this therapy, which proved its effectiveness both on its own and in combination with other techniques. As a result, the FDA approved the use of immunotherapies even as a first-line treatment for lung cancer.
According to studies, after using immunotherapy, 25 patients with stage 3-4 lung cancer out of 100 live 5 years. By comparison, without immunosuppressive drugs, only 6 people pass this milestone.

Immunotherapy for breast cancer

For a long time doctors considered immunotherapy in breast cancer as insufficiently effective. But new research in the field is proving that the method still has potential.
In March 2019, the U.S. Food and Drug Administration (FDA) approved the substance atezolizumab (Tecenric), which is a checkpoint inhibitor for the treatment of triple-negative breast cancer with metastases.

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Who will benefit from cancer chemoembolization?

According to the medical portal radiologyinfo.org, doctors use chemoembolization of tumors for:

• Primary cancer of the liver and biliary tract;
• Liver metastases;
• breast cancer;
• pancreatic cancer;
• malignant tumor in the lungs;
• kidney cancer.

Depending on the number and size of tumors, transarterial embolization is used as an independent technique or in combination with surgery, radiation and chemotherapy.

How is transarterial chemoembolization performed?

Before transarterial chemoembolization, the doctor performs an X-ray examination of the tumor and the vessels that feed it. This makes it possible to plan the procedure and pave the way for the substances to be injected.
In order to make the patient feel comfortable, pain medications are given.
A catheter is inserted into an artery, most often the femoral artery. A mixture of chemopreparations and microparticles is injected through it.
After the procedure is completed, X-rays are taken again to make sure that the chemoembolization has passed accurately. The doctor removes the catheter and applies a tight dressing.
The whole procedure takes up to 90 minutes. Afterwards, the patient is monitored by doctors for about 6 more hours.

Chemoembolization with microspheres

This is an innovative cancer treatment technique that combines chemoembolization and radiotherapy. According to the American Cancer Society, during this procedure, the patient is injected not only with chemotherapy but also with special microspheres containing a radioactive substance. Once in the bloodstream, they irradiate the tumor for several days.
Chemoembolization with microspheres is safe for other tissues because doctors use a small amount of radioactive substance and inject it directly into the tumor.

Chemoembolization of a liver tumor

Chemoembolization is indicated for the treatment of a primary liver tumor and metastases from other organs. Studies have shown the method to be effective at all stages of the disease.

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How does cancer treatment with ultrasound work?

• According to the Focused Ultrasound Foundation, the principle of HIFU is similar to using a magnifying glass to focus sunlight in one spot.
• During the procedure, a special acoustic lens collects multiple intersecting ultrasound waves and directs them precisely to the target. This area is heated to about 43 degrees Celsius, resulting in the destruction of cancer cells.
• Depending on the size of the lens, the waves can affect an area 1-16 mm in diameter.
• HIFU therapy is combined with magnetic resonance imaging (MRI), which allows the waves to be directed as precisely as possible to the tumor.

Who is eligible for HIFU therapy for cancer?

The U.S. Food and Drug Administration (FDA) has approved high frequency ultrasound treatment for:

• bone metastases;
• prostate cancer;
• malignant prostatic hyperplasia.

Outside the U.S., this treatment is used for:

• breast cancer;
• kidney tumors;
• liver cancer;
• pancreatic cancer;
• Malignant soft tissue tumors.

How are high frequency ultrasound treatments for cancer performed?

Depending on the type of tumor and its location, the ultrasound treatment procedure takes from 1 to several hours. All this time the patient is near a special machine. If necessary, a special probe may be brought to the tumor through natural orifices.
Some diagnoses may require several sessions.

HIFU for pancreatic cancer

According to research, HIFU therapy is effective in the later stages of pancreatic cancer. It alleviates pain and prolongs the patient’s life.
It is important to understand that this technique is only a symptomatic treatment and cannot replace other methods.

Treatment of Prostate Cancer with Ultrasound

The Focused Ultrasound Foundation recommends HIFU therapy to treat prostate cancer in its early stages or when it has relapsed, when the tumor has not begun to sprout into neighboring organs and tissues. This procedure has fewer side effects compared to surgery.
According to studies, the success rate of HIFU is 84%. This means that in 84 patients out of 100, the therapy helped get rid of the tumor.

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How does CAR-T cell therapy work?

According to the FDA, in CAR-T cell therapy, the doctor isolates T lymphocytes from the patient’s blood and injects them with the genetic code of a harmless virus. These cells are multiplied in a laboratory and then returned to the bloodstream to destroy the tumor.

Who is eligible for CAR-T treatment?

According to the American Cancer Society, CAR-T treatment is approved for certain types of lymphoma, leukemia.
Clinical trials of CAR-T therapy for lymphoma have shown the following results: in 51% of patients the tumor disappeared completely and they achieved remission (a condition in which the disease does not develop, symptoms disappear).

How does CAR-T gene therapy work?

The American Cancer Society’s experts distinguish the following steps in CAR-T therapy

T-cell harvesting.

This procedure is called leukapheresis. During it, leukocytes are taken from the patient’s blood, and the blood itself is immediately returned to the bloodstream. To do this, doctors use a special catheter with several holes to draw blood. The procedure takes 2-3 hours.

Creation of CAR-T cells

The obtained white blood cells are sent to a laboratory, where a chimeric antigen receptor is added to them. This is how CAR-T cells are made. Over the next few weeks the cells are artificially multiplied to obtain enough for the treatment.

CAR-T cells injection

A few days before the CAR-T cells are injected, the patient may receive chemotherapy. This weakens the immune system so that it will not attack the new CAR-T cells. Next, new modified white blood cells are delivered into the bloodstream using a drip.

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How does a targeted treatment work?

• Blocks or “turns off” the chemical signals that make a cell grow and divide.
• Affects a protein in the cancer cell, causing it to break down.
• Prevents the formation of new blood vessels that feed the malignant tumor.
• Activates the immune system so that it recognizes and destroys only cancer cells on its own.
• Carries toxins to malignant cells that destroy them.

Important to know! The main difference between targeted and chemotherapy, according to the American Cancer Society, is that the former destroys only malignant cells and preserves healthy cells, while the latter affects all cells. That is why the patient has almost no side effects with targeted therapy.

Who is suitable for treatment with targeted drugs?

The U.S. Food and Drug Administration (FDA) has approved targeted therapies to treat 15 types of cancer, including:

• bladder and kidney cancers;
• malignant brain tumors;
• cervical, endometrial, ovarian cancers;
• breast cancer;
• colorectal cancer;
• Endocrine and neuroendocrine tumors;
• leukemia;
• Tumors of gastrointestinal organs (esophagus, stomach, pancreas, liver);
• lymphoma;
• lung cancer;
• Thyroid malignancies;
• skin cancer;
• prostate cancer.

Specialists at the U.S. National Institute of Oncology emphasize that tumor targeting therapy is only possible if doctors find a certain mutation in cancer cells that can be targeted by the drug. For this purpose, a biopsy (obtaining and examining a tissue sample of the tumor) with immunohistochemical and genetic studies is performed.

In some cases, in order for a patient to be prescribed a targeted cancer treatment, the tumor must meet certain criteria, such as not responding to other techniques, being inoperable or having a certain degree of spread in the body (metastases). Therefore, only a doctor can prescribe such treatment after a comprehensive examination of the patient and study of his or her medical history.

How is treatment with targeted drugs?

According to the U.S. National Cancer Institute, how targeted therapy goes depends on the diagnosis, the drug prescribed and the overall condition of the patient. Some drugs need to be taken daily, once a week or once a month, while others require treatment in courses to allow the body to recover.

Medications can be taken in the form of pills, shots, or IVs.

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