Ananya Dutta, Bose Institute
This is the aphorism of Memorial Sloan Kettering (MSK) Cancer Center, New York, USA. At MSK it is believed that immunotherapy is one of the most promising treatments to treat, cure, and eventually prevent cancer. Immunotherapy cradled from MSK about more than a century ago. William Coley (1893), a surgeon at MSK started treating cancer patients with a combination of heat-killed bacteria (“Coley’s toxins”) after he found patients with bacterial infections showing reduction of tumour size. He is known as the “Father of Immunotherapy”. Since then the researchers at MSK have led the endeavour to widen new immune-based treatments for cancer. This institute has been an epicenter for novel inventions in the field of immunotherapy and has brought forward exhilarating innovative treatment alternatives to cancer patients.
Advanced-stage cancers are commonly not curable and have a limited survival rate. Systemic therapy for ineradicable or metastatic cancers conventionally consists of cytotoxic chemotherapy, which has a restricted advantage, limited interval of responses, and is coupled with considerable toxicity. To overcome these margins personalized therapy and targeted therapies (immunotherapy) were developed. However, the resilience of response has remained limited due to the unavoidable development of drug resistance. The immune system plays a major role in the enlargement and progression of cancer. Signalling through immune checkpoints, including PD-1 repudiates antitumor immune responses in an impaired immune system.
Nivolumab (Opdivo), is a human IgG4 immunoglobulin, executing as a PD-1 binding immune checkpoint inhibitor has shown activity against a wide gamut of advanced cancers. This resulting augmentation of antitumor activity is coupled with clinical benefits such as enhanced response rates and longer endurance in patients with metastatic cancers after the failure of standard cancer treatment. Nivolumab treatment is normally well endured. Immune-related adverse events (irAEs) can happen at some point in treatment with nivolumab and other immune checkpoint inhibitors. Precise sets of paradigms have been developed for the administration of irAEs. It received its first FDA approval for treatment against melanoma.
Dr Bajorin and his co-investigators at MSK conducted a Phase III trial on cancer patients with high risk for the reappearance of urothelial cancer after removal of their bladder, ureter, or kidney for high-grade cancer. Urothelial cancer starts in the inner lining of the bladder and is thus also known as Bladder cancer. The trial had around 700 patients and was divided to ratio 1:1 who received Nivolumab(240mg) and placebo every two weeks for a year.
The trial concluded that patients who had undergone surgery and received nivolumab survived longer. The reoccurrences of the tumour outside the urinary tract and metastasis to distant sites were less in the treated individuals. Treatment-related adverse effects were noted in less than 18% of patients who received nivolumab and even the quality of life remained normal. Patients with PD-L-positive tumours were observed to be disease-free and the data were highly statistically significant and clinically relevant.
These findings have the prospective to alter the benchmark of care for bladder cancer according to Dr Bajorin. The survival rate indicated in the data is yet to mature and needs further investigations and follow-up. This study concluded that devoid of treatment, bladder cancer can be an aggressive disease and there are therapies available to decline the mortality rate and improve the quality of life of cancer patients.
References:
- https://www.mskcc.org/immunotherapy-msk
- Nivolumab, anti-programmed death-1 (PD-1) monoclonal antibody immunotherapy: Role in advanced cancers. Rajan A,Kim C, Heery C R, Guha U,and Gulley J L.; Hum Vaccin Immunother. 2016 Sep; 12(9): 2219–2231.
- Adjuvant Nivolumab versus Placebo in Muscle-Invasive Urothelial Carcinoma. D.F. Bajorin et.al. N Eng J Med 384; Nejm.org, June 2021.
Also read:
Gel-mediated drug delivery is the breakthrough in Brain disorders
PARP inhibitors: One class of drugs for Multiple Forms of Cancer
Evotype: a novel concept to understand the engineering aspect of evolution
Ayooshi Mitra, Amity University Kolkata The world has seen a revolution in the ability to engineer biology and create living systems with novel functions over the last few decades. Nonetheless, several obstacles continue to obstruct our ability to fully exploit biology’s potential. These are a consequence of the fact that individuals cannot engineer the elements […]