Mesothelioma Immunotherapy
Immunotherapy, also known as immune therapy, is a type of cancer treatment that uses the body’s immune system to recognize and attack cancerous cells. Usually, cancers grow from healthy cells and are able to evade detection by immune cells. Different types of immunotherapy medication help the body fight cancers through techniques that utilize a range of aspects of the immune system. Monoclonal antibodies, immune checkpoint inhibitors, cancer vaccines, adoptive cell transfer, and CAR T-cell therapy all activate an immune response against cancer via distinctive means.
Medically Reviewed by: Dr. Emma Hegwood | June 24, 2024
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What Is Immunotherapy?
As you may already know, immunotherapy, also sometimes called biologic therapy, biotherapy, or immune therapy, is a treatment option that emerged in 2010. When combined with standard mesothelioma treatment options like surgery and chemotherapy, immunotherapy has been effective in alleviating symptoms and improving survival rates in some cases. While immune treatment is still being studied in many cancers, it holds promise for more effective future treatment.
Considering immunotherapy as a treatment option for mesothelioma or lung cancer can be a huge step towards managing the disease. Throughout this page, we will explore how immunotherapy works, the various types available, and its potential benefits. This information is will hopefully benefit you and increase your treatment understanding and potentially improve your quality of life. Immunotherapy offers a new avenue of hope for people with mesothelioma by boosting the body’s immune response.
How Is Immunotherapy Used to Treat Mesothelioma?
Immunotherapy is becoming increasingly common for treating mesothelioma. It aims to boost the body’s own immune system, helping it fight off the spread or recurrence of disease. It is currently being investigated in many different forms and in combination with various agents, including chemotherapy.
Immunotherapy enhances the immune system to better fight off the growth and spread of cancer. The immune system acts to protect a person’s body against infection and disease. When an unrecognized, usually toxic or foreign substance (generally called an antigen) enters the body, the immune system produces antibodies — specialized proteins — to identify the antigen as foreign and target it for destruction. Once produced, some antibodies remain in the body forever, prepared to defend it if the antigen ever re-enters it.
How Does Immunotherapy Work?
Unfortunately, cancer cells can sometimes trick the immune system. When normal cells mutate and become malignant (cancer cells), the immune system doesn’t always detect the abnormalities growing inside the body because they look similar to the body’s own cells. In other cases, the immune system recognizes the cancer cells, but its defenses aren’t strong enough to destroy them.
Immune therapy helps the body recognize the presence of cancer cells and act accordingly. It’s typically done in one of two ways: the immune system is stimulated to more effectively attack cancer cells, or man-made immune proteins are administered to assist and supplement the body’s own immune system. Some immunotherapies offer a boost to the immune system as a whole, while others help teach the immune system to target cancerous cells specifically.
Immunotherapy for Mesothelioma
Several types of immunotherapies are currently used to treat mesothelioma, many of which have shown promise in clinical trials. These types of immunotherapies can broadly be classified into either “active” or “passive” types. Common immunotherapies currently being used or studied within these categories include monoclonal antibodies, immune checkpoint inhibitors, cancer vaccines, adoptive cell transfers, and cytokines.
Active vs. Passive Immunotherapy
Immunotherapy can be categorized into active and passive approaches. Active immunotherapies guide the immune system in directly attacking cancer cells, with examples including cancer vaccines and CAR-T cell therapy. Passive immunotherapies, on the other hand, enhance the body’s existing anti-tumor responses, utilizing treatments such as monoclonal antibodies and cytokines. Understanding the differences between these approaches is key to exploring the best treatment options for mesothelioma. Active immunotherapies guide the immune system in attacking cancer cells, with examples including cancer vaccines and CAR-T cell therapy. In contrast, passive immunotherapies enhance the body’s existing anti-tumor responses, utilizing treatments such as monoclonal antibodies and cytokines.
Monoclonal Antibodies
Researchers have started recreating antibodies to reinforce the body’s natural defenses against specific antigens. The lab-made antibodies are called monoclonal antibodies (mAbs). As a relatively new area of study, researchers are still working to identify the antigens associated with mesothelioma. However, the Food and Drug Administration (FDA) has approved about a dozen of these man-made antibodies, and more are being clinically tested in clinical trials.
How Immune Checkpoint Inhibitors Work
When differentiating between normal and foreign cells, the immune system relies on specific molecules (checkpoints) to be activated or inactivated on immune system defender cells. When the cells function correctly, the appropriate immune response is triggered. Unfortunately, cancer cells can sometimes bypass these checkpoints as a way to go undetected by the immune system, thus evading an immune system attack. Immune checkpoint inhibitors are medications made from antibodies that target these checkpoints. They expose the cancer cells, allowing the immune system to recognize and attack them.
One of these checkpoints is a protein called PD-1, which is on defender cells immune system cells (T cells). When it latches onto a protein called PD-L1 on cells, it becomes inactivated, informing the defender immune cells not to attack. However, PD-L1 can be present in both healthy and cancerous cells. This is one way cancer cells can go undetected by the immune system by “hiding” from immune cells. Checkpoint inhibitors like Opdivo, Keytruda, and Tecentriq bind to PD-1 or PD-L1 cells, preventing them from inactivating the defender immune cells and allowing them to respond to cancerous cells accurately.
CTLA-4 Pathway and Checkpoint Inhibitors
CTLA-4 is a member of an immunoglobulin-related receptor family that helps with the regulation of T-cells at certain stages of the immune response. The CTLA-4 pathway is believed to regulate T-cell reproduction, principally in the lymph nodes. When this pathway is blocked during earlier stages of the disease, sometimes with a checkpoint inhibitor known as Tremelimumab (Imjudo), patients can experience reduced tumor growth in the lymph nodes.
Yervoy (Ipilimumab) is also a checkpoint inhibitor that can help block CTLA-4 pathways, allowing the body to attack cancer cells. It’s also sometimes used in combination with a checkpoint inhibitor called nivolumab (Opdivo). It can be administered into your bloodstream through a tube that attaches to a vein in your chest (called a medical port) or through a tube that goes into a vein in your arm.
Nivolumab (Opdivo), Pembrolizumab (Keytruda), and Ipilimumab (Yervoy) are often used to treat mesothelioma. These drugs are relatively better tolerated than chemotherapy, but they can cause serious immune-mediated side effects by stimulating the immune system to attack normal organs in the body.
Cancer Vaccines
Similar to preventative vaccines given to prevent the development of diseases like hepatitis, polio, measles, and influenza, researchers are working to create a vaccine to help treat mesothelioma. Cancer vaccines, usually made up of cancer cells or pure antigens, are injected into the body with the goal of boosting the immune response to dangerous cells. Unlike preventative vaccines, these new vaccinations work to train the immune system to attack a disease that is already present in the body.
Patients who received the vaccine experienced a median overall survival time of 22.8 months, compared to the 18.3 median experienced by those who received a placebo. The vaccine has yielded promising results, offering hope to people with mesothelioma, but more studies are being done.
Additionally, researchers at the John A. Burns School of Medicine at the University of Hawaii Cancer Center are working on a preventative mesothelioma vaccine. The vaccine, HIvax, targets a protein found in mesothelial cells called survivin. A 2015 release from the Human Vaccines and Immunotherapeutics stated that the vaccine is still being tested in mice, but work is being done to prepare it for human clinical trials.
Adoptive Cell Transfer
Adoptive cell transfer is a process in which immune system T-cells are collected from a patient and grown in a lab, thereby increasing the number of available T-cells to fight cancer. The cells are then re-infused into the patient in the hopes that they will recognize and attack cancer cells.
Adoptive T-cell transfer (ACT) using chimeric antigen receptors (CARs), known as CAR T-cell therapy, has shown strong results in treating certain tumors. CAR T-cell therapy enhances T-cell function by identifying and latching onto specific antigens. Clinical trials are underway to learn more about using ACT to treat mesothelioma.
Cytokines
This form of immunotherapy uses cytokines (inflammatory cells), an immune system protein, to boost the immune response to cancer cells. Interleukin-2 (IL-1) and interferon, cytokines that regulate macrophage and T-cells of the immune system, are common cytokines used to assist in the treatment of mesothelioma. They can help to create more attack cells in the immune system, assist in the detection and attack of cancer cells present in the body, and stop or slow the growth of cancer cells.
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Benefits of Immunotherapy for Mesothelioma
Immunotherapy is a growing and rapidly progressive field in cancer research. Some researchers regard it as the future of cancer treatment. Immunotherapy helps to limit the growth and spread of cancer cells while boosting the body’s own defenses. It generally has less severe side effects than traditional cancer treatments like chemotherapy. Much research is being done to figure out ways of stimulating the immune system to fight cancer.
Key Immune Cells in Immunotherapy
Understanding the key immune cells involved in immunotherapy is essential for grasping how this treatment works. These cells play critical roles in identifying and attacking cancer cells, making them pivotal in the fight against mesothelioma. Below, we outline the primary types of immune cells and their functions in the immune response.
- Dendritic cells – Presents antigens to B and T-cells to trigger a response.
- Lymphocytes – B-cells, also known as B-lymphocytes, are white blood cells that produce antibodies to destroy antigens. Natural killer (NK) cells are white blood cells that attack infected cells more efficiently than T-cells, hence their name “natural killers.” T-cells, or T-lymphocytes, are white blood cells that attack infected cells in the body.
- Macrophage cells – A type of white blood cell that cleanses the body of unwanted substances, such as dead cells and bacteria, and stimulates other immune cells, such as T-cells
How Can I Get My Immunotherapy Treatment Covered?
We understand that the journey can be financially, physically, and emotionally challenging, and are committed to supporting you every step of the way. Your next step is to contact our patient advocate team, who will connect you with a medical professional to discuss your immunotherapy treatment options. If you are currently in immunotherapy treatment, we can then connect you to our Legal team to evaluate your case and see if we can seek compensation. Navigating the complexities of treatment and insurance coverage can be daunting, but you don’t have to face it alone. Remember, while the path may be hard, you are not alone.