Can someone explain immunotherapy?

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Hey all, in my continued quest for information for my mom, i'm trying to understand just what immunotherapy is, how it works, what it does, etc.  Someone suggested we look at keytruda immunotherapy.  i haven't the faintest idea what it is.  We do have a consult with the medical oncologist next Tuesday and i will certainly be asking him these questions, but i like to go into these appointment wiith SOME sort of information. Anything anyone can share about this would be much appreciated.

Thank you!

~ accordiongirl

Comments

  • Nancy24
    Nancy24 Member Posts: 72 Member
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    Keytruda

    My brother had stage 3 melanoma and was treated with Keytruda at MD Anderson. The cancer is gone. Immunotherapy boosts your own immune system to locate and attack the cancer cells. Chemotherapy works by stopping or blocking cells from growing. Immunotherapy may or may not work, depending upon the specific cancer (and stage) that you have. 

    Nancy

  • wbcgaruss
    wbcgaruss Member Posts: 2,305 Member
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    Articles

    There are plenty of articles on the net just search immunotherapy but here is an article from the National Cancer Institute that seems to explain it pretty well---

    https://www.cancer.gov/about-cancer/treatment/types/immunotherapy

    Hope this helps some-Take care.

  • corleone
    corleone Member Posts: 312 Member
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    There are many types of

    There are many types of immune-oncology compounds, some approved by FDA, many others in clinical trials.

    Most known (that you will most likely hear of) are the so-called checkpoint inhibitors, which increase the immune response by stopping white blood cells (T cells) from being suppressed. There are different compounds (antibodies), classified based on the molecule it targets on the surface of the T cells: Some examples are ipilimumab (Yervoy) which targets CTLA-4. Other target a checkpoint protein called PD-1 or one of its ligands, PD-L1 For example, nivolumab (Opdivo), pembrolizumab (Keytruda), atezolizumab (Tecentriq). The issue right now is that only around 20% of treated patients respond (in which case it is obtained partial or complete remission); the exact reason for that is not known. There are many clinical trials that study the blood and tissue biomarkers, to determine what can be used to predict the answer. These check point inhibitors are even used in combination, like anti CTLA-4 plus a PD-(L)1 inhibitor, most likely to succeed. These are well tolerated, the most common side effects are immune mediated reactions that can be easily recognized and treated (in large, specialized centers).
    As well as checkpoint inhibitors, two other immunotherapy approaches have produced exciting clinical trials results (that unfortunately are not used now for H&N cancers, but their use will extend to other cancer types): CAR-modified T cell therapy (used for hematological cancers) and TILs (tumor infiltrating lymphocytes) (used for malignant melanoma). Both rely on reprogramming the patient’s own white blood cells.

    Also included in this large basket of immunotherapies are cancer treatment vaccines – treatments that increase the “visibility” of the patient’s cancer cells to their immune system.

  • accordiongirl
    accordiongirl Member Posts: 63
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    corleone said:

    There are many types of

    There are many types of immune-oncology compounds, some approved by FDA, many others in clinical trials.

    Most known (that you will most likely hear of) are the so-called checkpoint inhibitors, which increase the immune response by stopping white blood cells (T cells) from being suppressed. There are different compounds (antibodies), classified based on the molecule it targets on the surface of the T cells: Some examples are ipilimumab (Yervoy) which targets CTLA-4. Other target a checkpoint protein called PD-1 or one of its ligands, PD-L1 For example, nivolumab (Opdivo), pembrolizumab (Keytruda), atezolizumab (Tecentriq). The issue right now is that only around 20% of treated patients respond (in which case it is obtained partial or complete remission); the exact reason for that is not known. There are many clinical trials that study the blood and tissue biomarkers, to determine what can be used to predict the answer. These check point inhibitors are even used in combination, like anti CTLA-4 plus a PD-(L)1 inhibitor, most likely to succeed. These are well tolerated, the most common side effects are immune mediated reactions that can be easily recognized and treated (in large, specialized centers).
    As well as checkpoint inhibitors, two other immunotherapy approaches have produced exciting clinical trials results (that unfortunately are not used now for H&N cancers, but their use will extend to other cancer types): CAR-modified T cell therapy (used for hematological cancers) and TILs (tumor infiltrating lymphocytes) (used for malignant melanoma). Both rely on reprogramming the patient’s own white blood cells.

    Also included in this large basket of immunotherapies are cancer treatment vaccines – treatments that increase the “visibility” of the patient’s cancer cells to their immune system.

    Thank you!!

    Corleone - yours was a very detailed, yet relatively easy to follow explanation.  i'm wondering how these therapies are determined (which one works for which patient, etc) and also how they're administered - is it a pill, a shot, an IV drip, etc.   Do patients typically stay on it for weeks, months, years?  Is it something that causes awful side effects?  Sorry for all the questions - just trying to understand and looking at it online overwhelms me.  i appreciate your straightforward explanations.

    Thank you!

    ~ accordiongirl

  • corleone
    corleone Member Posts: 312 Member
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    Thank you!!

    Corleone - yours was a very detailed, yet relatively easy to follow explanation.  i'm wondering how these therapies are determined (which one works for which patient, etc) and also how they're administered - is it a pill, a shot, an IV drip, etc.   Do patients typically stay on it for weeks, months, years?  Is it something that causes awful side effects?  Sorry for all the questions - just trying to understand and looking at it online overwhelms me.  i appreciate your straightforward explanations.

    Thank you!

    ~ accordiongirl

    Generally, these are

    Generally, these are administered over a 30 min – 1 hour infusion, every 3 weeks. The side effects are manageable and consists of stimulation of the immune system: any organ inflammation you can think of, ending with “-itis”, like enterocolitis, hepatitis, pneumonitis, etc. Sometimes some anti-inflammatory agents are given prophylactically, just before the infusion. Patients are staying on treatment for as long as they benefit from the treatment. Cautionary tale: sometimes a so-called “pseudo” progression may happen, when a CT scan shows an increase in the tumor volume (which would be considered progression, based on some measuring algorithms, in the case of chemo treatment). It is called pseudo, when the volume is increased temporarily - because the tumor is infiltrated with white blood cells, which is a good thing, showing that the immune cells are attacking the tumor. A second CT scan (done usually between 4-8 weeks) will show if it’s either pseudo, (when the volume will decrease significantly), or confirmed progression (when the tumor volume has not changed from the first one or it’s even larger).

    Unfortunately there is a big problem, it is not (yet) known if the treatment will work or not, before trying. It’s a kind of hit or miss situation. But considering the lower toxicity (by comparing with classical chemo) it is worth trying. More and more this is given as a first line of treatment (which makes sense, because the immune system is still OK), versus what has been tested in clinical trials at the early stages of development, when these were given as a last resort, in patients who had multiple lines of treatment, after there was no alternative treatment left.

  • CivilMatt
    CivilMatt Member Posts: 4,722 Member
    edited October 2018 #7
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    immunotheraphy

    AG,

    Whether Immunotherapy can solve are problems with cancer treatments (I say cancer, only because this is a cancer treatment forum).

    The testing of a person with cancer to determine IF they are a good candidate for immunotherapy is getting more accurate for the doctors to know if the proposed treatment plan has a high probability of success.  If your blood has the items present which they have found to produce positive results. They doctors, scientist, technicians, etc., can make a prediction about good results with confidence, (when they see these markers). Of course, the markers not found or seen during testing of the patient can make the prediction for success, go the other way

    But, they are getting better at customizing the immunotherapy to treat more people. Also, the cancers being treated are expanding,  making immunotherapy hopefully available for more  cancer patients.

    I do not know the various immunotherapies available to H&N patients, but we do have current members showing promising results from this alternate treatment.

    Good Luck,

    Matt

  • accordiongirl
    accordiongirl Member Posts: 63
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    Thank you all!

    Got my hand in a brace, so very hard to type, but wanted to thank you all for responding and giving such great info.  It helped a lot.

     

    ~ accordiongirl

  • phrannie51
    phrannie51 Member Posts: 4,716
    edited October 2018 #9
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    I’ve been on Keytruda for 16 months....

    I had mets in my neck, clavicle lymph nodes, and right lung.....Today I only have the tumor in my neck....lung and lymph nodes have resolved. They tested the tissue from my tumor to see if I was eligible for Keytruda....I was low on PD-1, but high in micro instability....I just know these are markers that indicated I could have Keytruda. 

    I haven’t had any significant side effects from Ketruda.....mouth sores is it. If your mom is eligible for Keytruda....go for it!!

    p

  • phrannie51
    phrannie51 Member Posts: 4,716
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    oops".......

    Sorry. Hit enter twice...

  • accordiongirl
    accordiongirl Member Posts: 63
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    I’ve been on Keytruda for 16 months....

    I had mets in my neck, clavicle lymph nodes, and right lung.....Today I only have the tumor in my neck....lung and lymph nodes have resolved. They tested the tissue from my tumor to see if I was eligible for Keytruda....I was low on PD-1, but high in micro instability....I just know these are markers that indicated I could have Keytruda. 

    I haven’t had any significant side effects from Ketruda.....mouth sores is it. If your mom is eligible for Keytruda....go for it!!

    p

    Thanks

    Thanks for your info.  We found out this past week that mom is not a candidate for any type of immunotherapy.  We are now focusing on getting all the quality time we can with her.  She's been put on hospice care.

    Thanks again for taking the time to give me info.....everyone here on the board is so helpful.

    ~ accordiongirl