One size does not fit all: Immunotherapy helps tailor cancer treatments

If someone asked you to name the year that cancer was first described, what year would you say?

Surprisingly, cancer was first described more than 5000 years ago. The first description of cancer was discovered in a partial copy of an ancient Egyptian textbook on trauma surgery from 3,000 B.C. Fossilized bone tumors and remains of human mummies were some of the earliest evidence to corroborate what the ancient Egyptians described as tumors, ulcers and bony growths. 

For a long time, cancer treatment was minimally effective. One of the first ‘procedures’ for removal of tumors in the breast, as mentioned in the Egyptian textbook on trauma surgery, used cauterization with a tool named the ‘fire drill’. Later, in the 2^nd century, the Greek physician, Galen, considered a patient incurable after a cancer diagnosis.

But scientists and physicians have made tremendous improvements in treating cancer in the intervening years. With technological and scientific advancements, procedures like cryoablation, chemotherapy, radiation and even some cancer-specific drugs have emerged. Unfortunately, even these advancements have their limitations when it comes to what types of cancer they treat.

Now, imagine someone gave you a piece of paper and asked you to write down as many types of cancer as you could think of. How many would you be able to list?

Right now, there exist more than 200 different types and subtypes of cancer. This overwhelming number of cancer types caused a paradigm shift in our approach to treating cancer.  

"Thankfully, with the emerging field of immunotherapy, we can ensure that cancer will never have to be treated with ‘fire drill’ cauterization again."

-- Sarah Allen

For quite some time, medical professionals treated cancer with a “one size fits all” approach. But since cancer can arise from any one of the roughly 30 trillion cells within the body, the characteristics and features of each cancer vary based on many factors like genetics, other comorbidities, diet and even lifestyle choices like smoking or alcohol consumption.

This means that no two cancers are the same, even within the same subtype. Physicians have radically changed their approach to be “tailored” to the individual patient and the type of cancer they have. This emerging field of cancer treatment is called immunotherapy, which the American Cancer Society defines as, “treatment that uses a person’s own immune system to fight cancer.”

Some types of immunotherapy, like CAR T-cell therapy, involve removing the patient’s own immune cells, enhancing them to better fight the cancer cells, and then putting them back into the patient. 

Other types of immunotherapy are drugs that are typically used to treat advanced stage cancers. These drugs are called immuno-modulators and they have become the dominant cancer therapy over the last decade. There are many times when surgical risks are complicated by the advanced nature of a cancer and the use of immuno-modulators really changes the playing field for oncologists and surgeons.

Immunotherapies offer patients a better treatment regimen compared to traditional, broad-spectrum treatments like chemotherapy. Chemotherapy is known to wipe out a patient’s immune system, killing good cells along with the cancer cells. This process can create more problems and comorbidities by increasing risk for infection and decreasing quality of life overall. 

As an example, let’s look at metastatic bladder cancer. 

According to the Duke Cancer Institute, “Historically, only 5% of advanced bladder cancer patients survived five years.” Typically, treatment approaches would consist of chemotherapy and radical surgery to remove the bladder. However, breakthroughs with immunotherapy are beginning to change the outlook for patients with similar prognoses.

“The survival outlook for patients with metastatic bladder cancer used to be less than one year, but I’m now seeing some of my patients coming back to the clinic over and over again, five years and longer,” said Padmanee Sharma, M.D., Ph.D., co-leader of the immunotherapy platform at the University of Texas’ MD Anderson Cancer Center.

This is a very promising sentiment for those with advanced-stage cancers. 

Immunotherapy is a riveting field; however, there are still gaps in knowledge and not all cancers respond to immunotherapy. Understanding the importance of immune cells, specifically T-cells, is paramount to breaking down the dynamic relationship between a tumor and the immune system. 

While immunotherapies may not be able to treat all 200 and counting cancer types just yet, it is a promising treatment option that can open the door even wider for more patient success stories, longer prognoses and an improved quality of life for terminal patients. Thankfully, with the emerging field of immunotherapy, we can ensure that cancer will never have to be treated with ‘fire drill’ cauterization again.