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Immunotherapy: A New Hope for Cancer Treatment
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Cancer, the uncontrolled proliferation of cells of the body, which may or may not invade other tissues/organs, is a long feared disease among the humans. The death of the patient it guarantees in most of the cases, is probably what makes it a fearing disease! Those who are at the initial stages of cancer and have a hope of getting treated, don't have a happy life either! The nature of the rigorous treatment regimes of Chemotherapy (Concentrated chemical mediated treatment) and radiotherapy (Use of high frequency radiations) leaves a patient weak and immune-compromised. Intensive care and pre-cautions need to be taken for the patients undergoing Chemo/Radiotherapy. And, despite all the treatments, it never guarantees that the cancer won't re-appear! Following is a nice animation of basic concept of Cancer:[/align]



The current scenario of the magnum nature of cancer and poor plight of the patients undergoing treatment, asks for a new, gentle, simple but yet effective way(s) of treating this deadly disease. A recent hope that has emerged in this regard is "Immunotherapy". Immunotherapy works on the principle of using human immune system as a tool to tackle cancer. This article focuses on this new dimension of Cancer Treatment called Immunotherrapy which has recently emerged and has rather raised expectations after some successful human trials!

The new branch of Immunotherapy aims at boosting the response of a person's own immune system to fight back the cancerous cells! The boosting is achieved in two ways generally:

a. Monoclonal Antibody Based Immunotherapy
It involves the strategy of administering concentrates of Cancer/Tumor cell specific MAbs. The MAbs then recruit the immune system cells to the site of cancer, thereby triggering the clearance of cancerous cells.

b. Immune-Cell Mediated Immunotherapy
This strategy involves the immune cells like Natural killer Cells (NKCs), Cytotoxic T Lymphocytes(CTLs), Dendritic Cells (DCs), etc., which are activated against the Cancer cells. The activation is brought about by administering of certain cytokines such as Interleukins. Also, in the case of compromised immune system, wherein the activation is not-possible, the immune cells may be isolated, enriched and then transfused into the patient's body (just like administration of concentrated MAbs) to fight the cancerous cells.

There is yet another way, Immunization Against Cancer (or simply Cancer Vaccine) which might enable a person's immune system to recognize the cancer cells and scavenge them off! (But the rates and instances of such successes are very meager).

The above mentioned modes constitute the very basis of the entire scope of Immunotherapy, and following are some of the recent success stories associated with this approach:

Yervoy (Ipilimumab)
Yervoy is probably one of the first Immunotherapic drugs "approved" by FDA! As is clear from it's name, it is a Monoclonal Antibodies based drug, which is used against Melanoma, and has been proved effective even in some cases of Advanced Melanoma. Made by Bristol-Myers Squibb (New York, US), it's remark-ability lies in its ability to recess the Cancer for upto years by just 3-4 months treatment!
It acts by blocking the inhibitory signal that prevents the action of Tumor-killing T Cells on cancer cells. The blockage enables the T-cells to recognize the Cancer cells and clear them off! Yervoy binds on the CTLA-4 receptors on T-cells, which is actually the site for binding of the inhibitory signal. In the presence of Yervoy, the inhibitory signal can no more exert its effect! So, the case of Yervoy is an ideal example of the real world application of Immunotherapy in treating Cancers. (Especially considering the fact that its FDA approved!). Following is a highly informative video on Yervoy (its side effects, treatment profile etc):
[align=center]

Provenge (Sipuleucel-T)
Provenge is the first ever FDA approved Cancer Vaccine against Prostrate Cancer, produced by Dendreon Corporation. Prostatic acid phosphatase (PAP) the antigen present in 95% of prostate cancer cells is incubated into patient's Antigen Presenting Cells (APCs) which are extracted by leukapheresis of patient. Along with PAP, GM-CSF is also incubated into the APCs that helps them to mature. The APCs are re-infused into the patient, generating an immune response against the prostrate cancer cells carrying the PAP antigen. Provenge has shown an extension of life by upto 4 months in the target patients in even final stages of the cancer.

The Cost Factor
Immunotherapic Treatments are highly cost bearing. Yervoy's monthy treatment costs US $45,000! and it's as high as US $95,000 for Provenge! But, the high prices may be attributed to the fact that the use of these drugs is currently limited to a very small market yet. Once the market expands, the prices should shrink.
As per the forecasts of the health care analysts, in 10 years or so, Immunotherapy will be treating 60% of the Cancers with a market cap of over US$35 billion a year!!

The Conjugated Treatments:
Oncologists have started the observation of the efficacy of Immunotherapy Conjugated Chemo/Radiotherapy. Patients show better response to the combined therapy than to Immuno/Chemo/Radiotherapy alone.

Summary:
A lot can be done in the field of Immunotherapy with further research on the signal pathways of cancer cells. Search for more Immunological markers associated with Cancer cells can spur the development of yet more Immunotherapeutic drugs. Immunotherapy can fill the gap left by Chemo/Radiotherapy and in conjugation with them, it possesses the capability to over run the advancement of cancers, especially the early stage detections. Drugs like Yervoy and Provenge have shown promising extensions of life of even terminal stage cancer patients, which greatly highlights the untapped potential of Immunotherapy.

At the same time, the high prices of such treatments remains a big concern and hurdle for the welfare of society at large. Expansion of market might dip the prices a bit, but still the support of government in subsidizing these therapies for average and below average economic classes will be greatly needed in future, otherwise these drugs will remain a savior of the Rich only, while a dream of the poor!
Sunil Nagpal
MS(Research) Scholar, IIT Delhi (Alumnus)
Advisor for the Biotech Students portal (BiotechStudents.com)
Computational Researcher in BioSciences at a leading MNC


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