What is Immunotherapy?
Immunotherapy uses the power of your immune system to identify and attack cancer cells, stripping away the camouflage that these cells use to hide. Some forms of immunotherapy also enhance the body's immune response to cancer by boosting the number and activity of immune cells, training the immune cells to recognise cancer-specific antigens, and allowing for a more targeted and efficient approach to treating cancer.
Five Categories of Immunotherapy
Modern research highlights five major categories of immunotherapy that prove to be highly effective in the fight against cancer. Each treatment focuses on different mechanisms to stimulate the immune system to detect and destroy cancer cells.
Unfortunately, these novel immunotherapy treatments can be difficult to access, so we have taken a special interest in personalising treatment plans for patients at Sanctura to include both novel and conventional immunotherapies.
Checkpoint Inhibitors
Peptide Vaccines
Dendritic Cell Vaccines
Oncolytic Virus Therapy
CAR-T Therapy
What is Personalised Immunotherapy in Oncology?
Personalised immunotherapy in oncology is a tailored approach to cancer treatment that leverages the patient’s unique immune system characteristics to design more effective therapies. It involves customising immunotherapy based on an individual's tumour profile, genetic makeup, and immune system responses, aiming to maximise the treatment’s effectiveness while minimising side effects.
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Tumour profiling involves analysing the genetic mutations and characteristics of a patient's tumour. This information is used to identify specific antigens (proteins or molecules on the surface of cancer cells) that are unique to the tumour.
Next-generation sequencing (NGS) is often used to examine a tumour's genetic landscape, identifying mutations, neoantigens, or immune checkpoints that may serve as therapeutic targets. Tumour mutational burden (TMB) and microsatellite instability (MSI) are also assessed to predict how well the patient might respond to immunotherapy.
Immune profiling evaluates the status and function of a patient’s immune system, including the presence of immune cells like T cells, natural killer cells, and macrophages and the expression of immune checkpoints like PD-1, PD-L1, and CTLA-4.
This helps determine whether the immune system is "primed" to recognise and attack the tumour or if it requires activation or modulation through immunotherapy.
Biomarkers such as PD-L1 expression, TMB, and MSI are critical in personalising immunotherapy. These biomarkers indicate how likely a patient is to respond to treatments like immune checkpoint inhibitors.
For instance, tumours with high PD-L1 expression may respond better to anti-PD-1/PD-L1 therapies, while high TMB or MSI may suggest a broader immune response potential.
Types of Personalised Immunotherapy
Immunotherapy itself is a type of cancer treatment that helps the body’s immune system recognise and fight cancer cells. Personalised immunotherapy takes this a step further by fine-tuning the treatment to target the specific mechanisms by which a patient's immune system interacts with their cancer
Checkpoint Inhibitors
Checkpoint inhibitors are drugs that block proteins like PD-1, PD-L1, or CTLA-4, which cancer cells use to "hide" from the immune system. Personalised immunotherapy tailors checkpoint inhibitor use based on the patient’s specific tumour markers or immune checkpoint expression.
Common checkpoint inhibitors include nivolumab, pembrolizumab, and ipilimumab, which can be prescribed based on a patient's tumour PD-L1 levels or other biomarkers.
CAR-T Cell Therapy
Chimeric Antigen Receptor (CAR)-T cell therapy is a highly personalised form of immunotherapy. It involves extracting a patient’s T cells, genetically engineering them to express receptors specific to the cancer, and then reinfusing them into the patient to target and destroy cancer cells.
CAR-T therapy has shown remarkable success in treating certain blood cancers, such as leukaemia and lymphoma, but it is also being explored for treating solid tumours.
Tumour-Infiltrating Lymphocyte (TIL) Therapy
TIL therapy involves harvesting a patient's own tumour-infiltrating lymphocytes (immune cells that have migrated into the tumour), expanding them in the lab and reintroducing them into the patient. This boosts the immune system’s natural ability to fight the tumour.
TIL therapy is highly personalised because it uses the patient’s own immune cells, which are already primed to recognise the tumour.
Cancer Vaccines
Personalised cancer vaccines are developed by identifying unique tumour antigens (neoantigens) specific to the patient’s cancer. These vaccines stimulate the immune system to recognise and target the cancer cells displaying these antigens.
Personalised cancer vaccines are still largely in the research phase but show promise, particularly in melanoma and other cancers where neoantigen identification is more feasible.
Adoptive Cell Therapy (ACT)
Besides CAR-T and TIL therapies, other forms of adoptive cell transfer are used in personalised immunotherapy. These involve selecting and expanding specific immune cells that show a natural ability to target cancer, optimising their effectiveness for each patient.
Oncolytic Virus Therapy
Oncolytic viruses are genetically modified viruses that selectively infect and kill cancer cells. In personalised approaches, these viruses can be engineered to carry specific genetic information tailored to the patient’s tumour, helping the immune system recognise and attack the cancer.
Combination Therapies
Personalised immunotherapy often involves combining different treatments based on a patient's unique tumour profile. This can include combining checkpoint inhibitors with traditional therapies (chemotherapy, radiation), CAR-T cell therapy, or targeted therapies to boost immune responses and improve outcomes.
Monitoring and Adaptive Treatment
Personalised immunotherapy requires continuous monitoring of how the patient's immune system responds to treatment. Blood tests, imaging, and immune profiling can help oncologists adjust the therapy if the tumour evolves or if new mutations emerge.
Liquid biopsies, which involve analysing circulating tumour DNA (ctDNA) in the blood, can provide real-time insights into how a tumour changes and how the immune system responds.
Benefits and challenges of Personalised Immunotherapy
Benefits of Personalised Immunotherapy
Greater Effectiveness
Reduced Side Effects
Improved Outcomes for Resistant Cancers
Targets Tumour Heterogeneity.
Challenges of Personalised Immunotherapy
Cost and Accessibility
Complexity of Tumour Biology
Not All Patients Respond
Side Effects
Why is Immunotherapy Important?
Immunotherapy is vital in oncology because it offers a paradigm shift toward more effective, durable, and patient-specific cancer treatments. This will improve outcomes and provide new hope for those battling this disease.
It offers durable responses by "training" the immune system to recognise cancer, with fewer side effects than traditional therapies. Targeted approaches like checkpoint inhibitors, CAR-T cell therapy, and cancer vaccines enable precision treatment, making it effective across various cancer types, including advanced and resistant cases.
Who is Immunotherapy For?
Immunotherapy is for individuals with various types of cancer. However, its suitability depends on specific factors such as the type and stage of cancer, the patient’s overall health, and the tumour's molecular and genetic characteristics.
Immunotherapy is suitable for patients with certain cancers, particularly those with advanced or metastatic disease, specific biomarkers (e.g., PD-L1, MSI-H, TMB), or cancers responsive to treatments like checkpoint inhibitors or CAR-T cell therapy.
It benefits those who cannot tolerate conventional treatments and may be used alone or in combination with other therapies to enhance efficacy. However, it may not be appropriate for individuals with autoimmune diseases, transplant histories, or tumours lacking immunotherapy-responsive biomarkers.
Careful assessment by a specialist is crucial to determine eligibility.