Cancer Immunotherapy

Cancer Immunotherapy

1. Immunotherapy Asokan R Associate Professor Dept. of Medical Surgical Nursing Kalinga Institute of Nursing Sciences KIIT Deemed to be University Bhubaneswar.

2. Outline Why Do We get Cancer? How Does the Immune System Protect Us from Cancer? Types of Immune Responses Why Does the Immune System Fail to Control Cancer Cells? Strategies to Harness the Immune System to Fight Cancer Cells Improving Antigen-Presentation to Prime More Immune Cells Immunotherapies in Oncology History of Cancer Immunotherapy I mmunotherapy uses in I ndia? How does immunotherapy work against cancer? What are the types of immunotherapy? How is immunotherapy given? How often do you receive immunotherapy? What is the current research in immunotherapy? What types of cancer can be treated with immunotherapy? What are potential risks or complications of immunotherapy? How effective is immunotherapy?

3. What is Immune system?

4. The  immune system  is a network of  biological processes  that protects an  organism  from  diseases . It detects and responds to a wide variety of  pathogens , from  viruses  to  parasitic worms , as well as  cancer cells .

5. What is Immunity?

6. I mmunity is the capability of multicellular organisms to resist harmful microorganisms. Immunity involves both specific and nonspecific components. The nonspecific components act as barriers or eliminators of a wide range of pathogens irrespective of their antigenic make-up. 

7. Why Do We get Cancer?

8. Cancer is a cellular disease resulting from the uncontrolled growth of tumor cells . A massive amount of tumor cells accumulate in one or more parts of the body or spread throughout the blood. Documentation of human cancer can be found in literature dating as far back as 3,000 years ago in Egypt, and the search for the cause never comes to an end. While inheritance and environmental factors (ultraviolet radiation, pollution, etc.) are attributed as major causes of human cancer, a recent report pointed out that random errors in replication of genetic materials (genome) in our bodies seem to play a key role in cancer generation (Tomasetti et al. 2017 ).

9. Once a genomic error happens, its consequence may or may not be harmful to our bodies and the cells harboring the error. The error or mutation (changes) in the genome can cause a normal cell to become a tumor cell. These errors in the genome are responsible for two-thirds of the mutations in human cancers (Greenman et al. 2007 ). However, not all mutations or errors in our cells will lead to cancer . We have both internal- and external-checking systems to monitor what happens to the cells in our bodies. If all these checking systems fail , tumor cells will proliferate and take control—the disease spreads throughout the body, eventually resulting in death if not treated.

10. The internal-checking system consists mainly of tumor suppressor genes that suppress the development and growth of mutant cells in a process called “ programmed cell death .” In this process, some enzymes will be activated to cut the genetic material of cells into small fragments that will stop the proliferation and survival of the cells. Basically, our cells are programmed to die if they detect any mutations within their genes that they cannot correct. If the tumor cells escape this internal check , they will face an external check that is mediated by the immune system . Our immune system has developed the ability to check for tiny changes in cells . Immune cells have very specific “eyes” to identify any subtle changes in nearby cells and will activate our immune cells accordingly.

11. How Does the Immune System Protect Us from Cancer?

12. Many of us have tumor cells in our bodies, but most of us do not develop cancer as a disease. Our immune system prevents spontaneously generated tumor cells from developing into cancers. This phenomenon has been reproduced in animal models and has prompted a theory of “ immune surveillance .” There are four pieces of evidence that support this theory that the immune system indeed responds to cancer. First , humans with genetic defects in their immune systems tend to have a higher incidence of cancer than those whose immune systems are intact. Second , humans who have their immune systems suppressed by medicine in order to avoid rejection of transplants have higher cancer generation than people with normal immune function.

13. Third , some cancer patients have “ paraneoplastic syndromes ” ( consequence of cancer in the body) that are caused by the immune system’s response to a cancer. For example, patients with lung cancer may develop disorders in the central nervous system (CNS) due to immune responses to certain proteins shared by CNS and lung cancers. Fourth , Immunotherapy regimens do not directly kill tumor cells but boost the immune system to find and destroy cancer cells. The success of this therapy provides direct evidence that we have pre-existing immune responses to cancer in our body , but at times they do not function as well as they should.

14. Types of Immune Responses

15. The two types of immune responses differ in their specificity of recognition and speed of response . One is called the innate immune response , in which innate immune cells lack precise specificity in recognition of their targets but have a rapid response to them. Macrophages (large eater cells) and natural killer (NK) cells are the main innate immune cells. They recognize their targets based on the general patterns of molecules expressed by target cells or pathogens.

16. The second response is called the adaptive immune response . Adaptive immune cells have a very restricted specificity in recognition of their targets , but usually have a delayed response to their targets because they need more time to divide and produce attacking molecules. There are two major sub-populations of adaptive immune cells : T cells and B cells, also called T lymphocytes and B lymphocytes (since they were originally identified in lymph nodes). The “T” in T cells means that these cells develop in the thymus , and the “B” in B cells means they develop in bone marrow . They recognize their target cells or pathogens using receptors (eyes) that are designed only for a very specific antigen.

17. An antigen is a protein molecule or any substance capable of inducing an immune response that produces antibodies (antigen-binding proteins) or attacking molecules. As this specificity is so detailed, T cells or B cells can recognize any tiny changes in a protein molecule. In order to recognize any potentially changed proteins or pathogens , our bodies have been bestowed with 300 billion T cells and 3 billion B cells . Normally we only have a few T cells for each single antigen in our bodies, but we can have thousands of them once they are activated by antigen stimulation and undergo expansion (proliferation). Although we cannot see the expansion of T cells, we can feel them . When you feel enlarged lymph nodes in body after infection, these signs usually tell that millions of immune cells proliferated.

18. Innate Immunity to Cancer

19. The innate immune response is fast, but not restricted to specific antigens . It is still unclear how innate immune cells recognize tumor cells, but they do have the ability to kill tumor cells once they are activated by environmental cues. Macrophages and NK cells are the two major types of innate immune cells that can attack tumors. There are other innate immune cells that do not directly kill tumor cells , but can present proteins expressed by tumor cells to other immune cells to instruct them to target these tumors . For example, dendritic cells (DCs) are innate immune cells that can present tumor proteins to adaptive immune cells (like T cells) and help activate T-cell responses ; thus, the dendritic cells act as a “ bridge” between the innate immune system and the adaptive immune.

20. Macrophages are big eater cells . Macrophages are present within most tissues of our body in order to clean up dead cells and pathogens . Once activated by environmental cues (like materials released from bacteria, viruses, or dead cells), macrophages infiltrate deep into tumor tissues and destroy cells via production of toxic oxygen derivatives and tumor necrosis factor (TNF), or they directly eat the tumor cells (known as phagocytosis). In order to escape being eaten by macrophages , some tumor cells express “ don’t eat me ” signal molecules to fool macrophages and escape them. Recently, reagents have been developed to block the “don’t eat me” molecules on tumor cells. An example of a “don’t eat me” molecule is CD47 .

21. NK cells are circulating immune cells in our blood system and are believed to serve as the earliest defense against blood-borne metastatic tumor cells . Expressing something abnormal and/or failing to express something normal. NK cells are called natural killers because they do not need to be “coached” to see very specific antigens for their activation. T They respond to their target cells by searching whether something is “missing” on the cell surface . In this regard, NK cells help us clean out many cancer cells in very early stages or those cancer cells circulating in our blood where we have plenty of NK cells. Patients with metastases have abnormal NK activity , and low NK levels are predictive of eventual metastasis . Recent studies suggest that some NK cells have a “memory” capability to recognize certain tumors or pathogens.

22. First, only tumor cells with “missing” markers can be detected by NK cells. Second, there are a limited number of NK cells present in the bloodstream, as only 10% of lymphocytes are NK cells. To improve NK cell function , a cytokine called interleukine-2 has been used to activate NK cells for expansion.

23. Adaptive Immunity to Cancer

24. The adaptive response is slower, specific to certain antigens, and has memory (can provide life-long protection). Since adaptive immune cells can remember antigens from their first encounter, they can respond to antigens much faster when they encounter the same antigens again. This process is called “ immune memory ” and is the foundation of protective immunization. They need a very close cell-to-cell contact to clearly and specifically “see” their antigen on the target cells . In order to remember their target antigens, adaptive immune cells need professional antigen-presenting cells (APCs) to “teach” them how to see and how to respond. Dendritic cells are professional APCs . Dendritic cells are extend to surrounding tissues to catch proteins released from pathogens or tumors, but they cannot eat whole cells like macrophages. Once they catch proteins (antigens), they will “eat” (phagocytosis) and “digest” them using enzymes (degradation), and then “present” them in an antigen-presenting structure on their surfaces.

25. There are two types of adaptive immunity : cellular (T-cell) and humoral (B-cell) immunity. T cells consist of CD8 and CD4 T cells . CD8 T cells are also called cytotoxic T lymphocytes (CTLs). They are the primary killers of tumor cells because they can distinguish cancer cells from normal cells and directly destroy cancer cells. CTLs kill cancer cells via a quick yet well controlled cell-to-cell contact process . They start by digging a hole in the cancer cells and inject enzymes that can dissolve their inner materials.

26. As for CD4 T cells, their major function is producing soluble proteins called cytokines. These cytokines are messages sent by CD4 T cells to regulate or help the function of other immune cells during an immune response. Some cytokines are called interleukins (ILs), because they deliver messages between leukocytes (white blood cells ). CD4 T cells that use these messages to help other immune cells are called T helper cells (Th). We have several types of T helper cells according to their different production of cytokines (Th1, Th2, Th17, etc.).

27. B cells do not kill tumor cells directly , but produce antibodies as their attack molecules . Their antibodies function like “catchers” that can grasp their target antigens. There are five classes of antibodies : IgG, IgM, IgA, IgD , and IgE , based on their different chemical structures and functions. IgG is the major antibody type that crosses the placenta to provide protection for the baby . IgM is the largest antibody in our bodies . IgA can be released to our intestines to control infections in our digestion system . IgE is the major antibody to control parasites but also causes allergies . IgD functions like a receptor for the activation of B cells .

28. Each antibody can only bind to one antigen . Once antibodies bind to antigens, they either block the function of their target molecules or direct other immune cells (like macrophages and NK cells) to kill the target cells that express the antigens, a process called antibody-dependent cell-mediated cytotoxicity (ADCC). ADCC plays a key role in the treatment of human cancers , especially cancer cells in the blood.

29. Why Does the Immune System Fail to Control Cancer Cells?

30. It has been observed that in many patients, cancer cells are surrounded by immune cells in tissues or co-exist with tumor-reactive immune cells in the peripheral blood . Despite this, their cancer continues to progress and spread all over the body. We have a name for this enigma : the Hellström paradox, after Ingegerd and Karl Erik Hellström , two immunologists who first described this paradox more than 50 years ago ( Hellström et al. 1968 ). Most recently , we realized that even if there are plenty of immune cells capable of killing cancer cells , these immune cells can be killed or suppressed by cancer cells at tumor sites. The fight back from cancer cells is so powerful that many tumor vaccine therapies and T-cell transfer therapies failed to control cancer due to the barriers built up in the tumor sites . The discovery of B7-H1 (also named PD-L1) expressed by human tumor cells opened a door for us in our understanding of how tumor cells escape immune surveillance (Dong et al. 2002 ).

31. Strategies to Harness the Immune System to Fight Cancer Cells

32. Cancer immunotherapy works through the immune system to control cancer; therefore, its direct target is the immune cells rather than the tumor cells . Cancer immunotherapy is aimed at restoring or enhancing the capability of immune cells to recognize and destroy cancer cells , and the therapeutic effects will be determined by the extent to which the immune cells eliminate tumor cells. While it is unreasonable to expect the immune system to deal with large tumor masses , reducing the tumor burden seems to increase the chance of success of immunotherapy. The ideal scenario is that sufficient numbers of tumor-reactive T cells are generated by appropriate tumor-antigen stimulation, and T cells are able to move to tumor sites where they can destroy cancer cells with cytotoxic enzyme (granzyme B) or cytokines (TNF-alpha or IFN-gamma).

33. Successful immunity will lead to another round of immune response by releasing more tumor antigens through destruction of tumor cells. This process is called the cancer-immunity cycle (Chen and Mellman 2013 ).

34. Improving Antigen-Presentation to Prime More Immune Cells

35. Activation of the immune system to bring therapeutic benefit to cancer patients has been the subject of more than 100 years of study. Dr. Coley is believed to be the first physician to perform clinical trials in the treatment of cancer patients using dead bacteria (Coley 1906 ). His idea was that a strong immune response triggered by pathogens that can cure an infection would be able to cure a cancer as well. Thus, the so-called Coley’s toxin was originally used as a trigger of the immune system to treat human cancer. Most of his trials failed, but occasionally some of his cancer patients experienced tumor regression . From his pioneering work on cancer immunotherapy, immunologists have learned the immuno-stimulatory power of his “toxin” and dissected its effective components to discover new functions of immune adjuvants (enhancers).

36. These adjuvants have been tested to help immune responses to tumor vaccination . For example, the dead bacteria bacille Calmette- Guérin (BCG) that causes tuberculosis has been successfully used in the treatment of human bladder cancer. Some defined tumor antigens or irradiated tumor cells can be used as vaccines in combination with certain powerful adjuvants to prevent tumor growth.

37. Immunotherapies in Oncology

38. Cancer is a leading cause of death in the industrialized world second only to cardiovascular diseases. It is estimated that the number of people living with cancer is increasing. The most commonly diagnosed malignancy in women is breast cancer and that in men is prostate cancer. Lung cancer and colorectal cancer are the second and third most commonly diagnosed cancers, respectively, in both men and women (Siegel et al. 2015 ). Cancer immunotherapy aims to augment the patient’s own immune system, especially T cells, to fight cancer. In recent years cancer immunotherapy has emerged to be a promising modality in cancer treatment ( Mellman et al. 2011 ).

39. A pproved agents used in clinical practice that aim to achieve a therapeutic benefit by modulating pre-existing anti-tumor immunity.

40. History of Cancer Immunotherapy

41. The first cancer immunotherapies used nonspecific immunostimulants with then-unknown mechanisms of action that rarely limited tumor growth but provided impetus for creation of the Biologic Response Modifiers Program of the National Cancer Institute (NCI; prior to 1980s). The second generation of immunotherapies utilized well-characterized recombinant cytokines including interleukin-2 (IL-2) and interferon alpha (IFNα). These agents were associated with substantial toxicity when utilized at effective doses , but demonstrated deep responses in less than 10% of patients (prior to 1990s). Other cytokines , including IFNγ , IL-4, IL-7, IL-10, IL-12, IL-15, IL-18, IL-25, and so on, failed to provide substantive benefit , although anecdotal responses were observed. These were the first effective immunotherapies.

42. The third generation of immunotherapies utilized humanized and human monoclonal antibodies ( mAbs ) to cell surface receptor proteins present on tumor cells (human epidermal growth factor receptor 2 [ HER2 ]/Neu, epidermal growth factor receptor [ EGFR ], etc ) and were integrated into cancer care (prior to 2000s). Vaccination strategies using the available peptide, whole tumor, recombinant proteins, dendritic cells (DCs), and adjuvants were only modestly successful 100 vaccine with IL-2, anti-idiotype vaccines following effective chemotherapy, and long peptides for human papillomavirus [HPV] E6, E7 in precancerous lesions) (prior to 2000s).

43. The modern era of immunotherapy launched with the extraordinary novel efficacy to immune checkpoints in patients with lung cancer, melanoma, renal cancer, bladder cancer, and head and neck cancer (2005–current). The modern treatment of patients with cancer will integrate immunotherapy with conventional surgical, chemotherapeutic, and radiation oncologic strategies (the future).

44. Immunotherapy

45. Immunotherapy is treatment that uses a person's own immune system to fight cancer. Immunotherapy can boost or change how the immune system works so it can find and attack cancer cells.   Immunotherapy is a type of  biological therapy .

46. Cancer immunotherapy, also known as immuno-oncology , is a form of cancer treatment that uses the power of the body’s own immune system to prevent, control, and eliminate cancer. Immunotherapy can: Educate the immune system to recognize and attack specific cancer cells Boost immune cells to help them eliminate cancer Provide the body with additional components to enhance the immune response

47. Why is immunotherapy used in I ndia?

48. Immunotherapy for cancer in India can be done either by:- Stopping or halting the growth of cancer in the body. Stopping cancer from travelling to other parts of the body. Enhancing, and strengthening patient’s immune system

49. Cancer immunotherapy comes in a variety of forms , including targeted antibodies, cancer vaccines, adoptive cell transfer, tumor-infecting viruses, checkpoint inhibitors, cytokines, and adjuvants. Some immunotherapy treatments use genetic engineering to enhance immune cells’ cancer-fighting capabilities and may be referred to as gene therapies . Many immunotherapy treatments for preventing, managing, or treating different cancers can also be used in combination with surgery, chemotherapy, radiation, or targeted therapies to improve their effectiveness.

50. How does immunotherapy work against cancer?

51. Immune system can prevent or slow cancer growth . cancer cells have ways to avoid destruction by the immune system. For example, cancer cells may: Have genetic changes that make them less visible to the immune system. Have proteins on their surface that turn off immune cells. Change the normal cells around the tumor so they interfere with how the immune system responds to the cancer cells. Immunotherapy helps the immune system to better act against cancer.

52. What are the types of immunotherapy?

53. Active and Passive Immunotherapy Active Immunotherapy Inducing cellular immunity (involving cytotoxic T-cells) in a host that failed to spontaneously develop an effective response generally involves methods to enhance presentation of tumor antigens to host effector cells . Cellular immunity can be induced to specific, very well-defined antigens . Several techniques can be used to stimulate a host response; these may involve presenting peptides, DNA, or tumor cells (from the host or another patient) . T-cells as the ultimate effectors of adaptive immune response are currently used to treat patients affected by infectious diseases and certain tumors. Nonspecific Immunotherapy Interferons (IFN-α, -β, -γ) are glycoproteins that have antitumor and antiviral activity . Depending on dose, interferons may either enhance or decrease cellular and humoral immune functions . Interferons also inhibit division and certain synthetic processes in a variety of cells . Clinical trials have indicated that interferons have antitumor activity in various cancers, including hairy cell leukemia, chronic myelocytic leukemia, AIDS- associated Kaposi’s sarcoma, non-Hodgkin lymphoma (NHL), multiple myeloma, and ovarian carcinoma.

54. Three groups of immunological substances of particular interest are, I nterferon , I nterleukins and T umour necrosis factor ( TNF ).

55. Monoclonal Antibodies Many attempts have been made to develop antibodies with specific activity against a particular cancer. In animal studies, this has been possible in a number of different models, especially with several tumour types in mice . There have been three somewhat different therapeutic objectives: 1. One is to develop “ killer antibodies ” that specifically act against a particular cancer. 2. Another is to develop “ magic bullets ” where antibodies are used to carry an anticancer chemotherapeutic agent or a radio-isotope or other such agent directly to the cancer cells wherever they might be. 3. The third potential use of monoclonal antibodies is to identify the presence of cancer cells by reaction to specific antibodies .

56. The application of these principles to treatment of clinical cancers in humans has met with some encouraging results , especially in treating metastatic breast cancer. Recently developed techniques in biotechnology have made it possible to manufacture so-called monoclonal antibodies that are aimed at specific vital targets in certain cancers . These include malignant lymphoma and breast and bowel cancers . The use of these antibodies is relatively new, e.g. Mabthera for lymphoma, Herceptin in breast cancer and Erbitux for bowel cancer . In general, these antibodies are used in combination with chemotherapy . Despite their great expense, they are showing considerable effectivity , although their final role is still being evaluated .

57. Interferon It was first recognised in the 1930s that infection of animal cells with one virus would for a time “interfere” with infection by other viruses. Thirty years later , it was discovered that a protein substance was released from cells infected with a virus and this substance protects other cells against other viral infections. This interfering substance is called “interferon”. Interferon is found to be species specific. That is, interferon produced by chicken cells is protective to other chicken cells against virus infection but is not protective for cells of any other animal species . Similarly, interferon produced from human cells is protective for other human cells but not for cells of other animal species . There is evidence that it may be protective in some viral infections but is too expensive for general use. A rare form of leukaemia called “hairy cell” leukaemia is one malignancy that often does respond well to interferon treatment .

58. AIDS (acquired immune deficiency syndrome) is due to a virus infection. This condition is an infection and not a cancer , but a particular type of cancer called Kaposi ’ s sarcoma was found to develop in some of the first patients with AIDS. Over a longer term, some types of lymphoma, cancers of the cervix and some other cancers have been found to develop more commonly in AIDS patients than in the community at large. Early hopes that AIDS might respond well to interferon or any other immune treatment have so far not been fulfilled.

59. The Interleukins The interleukins are protein substances , known as cytokines, and are produced from white cells and are found to activate the immunological defense system. The first interleukins were interleukin 1 which is produced from macrophages (giant white cells) and interleukin 2 that is produced from lymphocytes (small white cells). They stimulate reproduction and activity of immune cells against a cancer to which the cells have been specifically sensitized. In experimental animals , interleukins have been shown, under certain conditions, to stimulate the animal’s natural lymphocyte activity against implanted cancers to such an extent that the cancers have been eradicated.

60. However, some cancers, including melanoma and kidney cancers , sometimes appear to have increased response when certain interleukins are used in conjunction with other treatments.

61. Tumour Necrosis Factor (TNF) TNF is a more recent cytokine protein product of immunological research . TNF does cause cancer cell destruction in some experimental models but is too toxic for direct use in human patients . However, recent work has shown that TNF enhances the anti-cancer effect of certain other chemotherapeutic agents and can be used safely and effectively when given exclusively to a limited part of the body. It can be given with safety only in a closed circuit by regional perfusion or regional infusion to treat malignancies such as melanoma and sarcoma when confined to a limb, but it cannot be used systemically with safety.

62. TNF in combination with interleukin 1 and interleukin 6 has been implicated in promoting cancer cachexia. Drugs that suppress the production of TNF, e.g. corticosteroids and thalidomide, have shown promise as agents that suppress cachexia and tumour growth, respectively. The omega-3 oils are thought to work by suppressing interleukin 6, which promotes breakdown of adipose tissue and skeletal muscle.

63. Small-Molecule Target Inhibitors Basic cancer research has identified a number of key signaling pathways that coordinate cancer cell growth . Growth signaling cytokines circulate in the blood and bind to cancer cells via special receptor molecules. Receptors become activated by the binding cytokine and send a complex series of chemical signals to the cell nucleus stimulating cell growth and division. The principle oncogene proteins responsible have been identified and successfully targeted for direct inhibition by small molecules (low molecular mass compounds) that specifically inhibit the enzyme activity that stimulates growth . Examples are imatinib mesylate (Gleevec) which inhibit the tyrosine kinases.

64. VACCINES Prophylactic vaccines have changed the natural history of many infectious diseases; consequently, the development of vaccines that could stimulate the immune system to recognize and destroy cancer cells has been a major focus of immunotherapy research for decades. Many vaccine approaches have been tried, and several have shown promise in early phase trials compared to historical controls. However, with a few notable exceptions, randomized controlled phase III trials have failed to confirm the benefit of these vaccines relative to standard therapies, observation, or placebo. Nonetheless, examination of these approaches in the light of our recent understanding of tumor immunology provides insight into the likely limitations of previous vaccine approaches that can inform current and future cancer vaccine development.

65. Autologous whole tumor cell vaccines have universally failed to show benefit in phase III trials, including studies with GVAX (a granulocyte macrophage colony-stimulating factor [GM-CSF]-transduced autologous tumor cell vaccine) given alone or in combination with other agents. Bacillus Calmette- Guérin (BCG) vaccine for adjunctive therapy for superficial bladder cancer, Sipuleucel -T is a DC vaccine for prostate cancer, GVAX is a whole-cell vaccine for prostate cancer cell lines, Gp100 vaccine is a peptide vaccine for patients with melanoma.

66. Several types of immunotherapy are used to treat cancer. These include: Immune checkpoint inhibitors , which are drugs that block immune checkpoints . These checkpoints are a normal part of the immune system and keep immune responses from being too strong . By blocking them, these drugs allow immune cells to respond more strongly to cancer. T-cell transfer therapy , which is a treatment that boosts the natural ability of your  T cells  to fight cancer . T-cell transfer therapy may also be called adoptive cell therapy, adoptive immunotherapy, or immune cell therapy.

67. How is immunotherapy given?

68. Different forms of immunotherapy may be given in different ways. These include: Intravenous (IV) The immunotherapy goes directly into a  vein . Oral The immunotherapy comes in pills or  capsules  that swallow. Topical The immunotherapy comes in a cream that rub into skin. This type of immunotherapy can be used for very early skin cancer. Intravesical The immunotherapy goes directly into the bladder.

69. How often do you receive immunotherapy?

70. Immunotherapy depends on: T ype of cancer and how advanced it is The type of immunotherapy get How body reacts to treatment May have treatment every day, week, or month. Some types of immunotherapy given in cycles. A cycle is a period of treatment followed by a period of rest. The rest period gives body a chance to recover, respond to the immunotherapy, and build new healthy cells.

71. What is the current research in immunotherapy?

72. Researchers are focusing on several major areas to improve immunotherapy, including: Finding solutions for resistance. Researchers are testing combinations of immune checkpoint inhibitors and other types of immunotherapy, targeted therapy, and radiation therapy to overcome resistance to immunotherapy. Finding ways to predict responses to immunotherapy. Only a small portion of people who receive immunotherapy will respond to the treatment. Finding ways to predict which people will respond to treatment is a major area of research. Learning more about how cancer cells evade or suppress immune responses against them. A better understanding of how cancer cells get around the immune system could lead to the development of new drugs that block those processes. How to  reduce the side effects  of treatment with immunotherapy.

73. What types of cancer can be treated with immunotherapy?

74. Immunotherapy has proven beneficial in the treatment of most cancer types . The various common types of cancer that can be treated with immunotherapy include lung cancer, some skin cancers (particularly melanoma),  kidney cancer , bladder cancer, head and neck cancers,  lymphoma . Not as widely used as radiation therapy, surgery or chemotherapy, some studies indicate that immunotherapy has shown 20-30% positive results on the patients . Doctors advise for this treatment when the patient’s body fails the first and second-line treatments .

75. What are potential risks or complications of immunotherapy?

76. Side effects from immunotherapy vary depending on the drug and cancer types. Infusion-related reactions. Diarrhea or colitis. Bone or  muscle pain . Fatigue . Flu-like symptoms, such as  fever  and chills. Headaches . Loss of appetite. Mouth sores. Skin rash. Shortness of breath or pneumonitis.

77. How effective is immunotherapy?

78. Success rates for any cancer treatment, including immunotherapy, depend on individual factors, including the cancer type and stage. In general, immunotherapy is effective against many cancers . While some cancers are more immunogenic than others, in general, immunotherapy is effective across a wide variety of cancers. Immunotherapy can produce durable responses unlike chemotherapy or radiation, however, these occur only in around 25% patients . Some research suggests that the immune system may remember cancer cells after immunotherapy ends.

79. Essential Nursing Diagnoses Pain Hyperthermia Imbalanced nutrition less than body requirement Fatigue Disturbed thought processes Risk for Impaired Skin Integrity Risk for fluid Volume Deficit Risk for Infection & injury

80. Conclusion

81. Perhaps the greatest hopes for the future are in the fields of immunotherapy , genetic engineering and molecular biology . Related research indicates that tumour antibodies may not only reveal early evidence of cancer but may be used in treatment either in a direct attack upon cancer cells or by carrying cytotoxic chemical agents specifi cally to the cancer cells. In time, a more reliable means of stimulating the immune defence system to eradicate cancer cells may also emerge from these studies.

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83. 12. https://en.wikipedia.org/wiki/Immune_system