Immunotherapy Treatment Guide

If you’ve been diagnosed with lymphoma, leukemia, myeloma, or any solid tumor from breast cancer or colorectal cancer to lung cancer or melanoma or any other malignancy then this guide is for you. We developed it to help you explore the types, benefits and potential side effects of immunotherapy and cellular therapy treatments.

Baylor University Medical Center at Dallas (Baylor Dallas), part of Baylor Scott & White Health, is one of the largest cancer treatment centers in the United States and the only medical center in North Texas that has the capability to both manufacture novel cellular therapy cancer treatments and deliver them to patients on the same campus. In fact, Baylor Dallas was the first North Texas hospital to offer adult commercial use of chimeric antigen receptor (CAR) T-cell therapy, to treat patients with lymphoma, leukemia, and myeloma. These cellular therapy strategies activate a patient’s immune cells to attack and destroy cancer.

If you have any questions after reading this guide, please discuss them with your doctor. We hope you find this resource helpful on your journey to Better.

An Overview of the Immune System

The immune system is a network of cells, tissues and glands that defends the body against viruses, bacteria and diseases such as cancer. It includes antibodies—that attach to potentially harmful cells and signal other disease-fighting molecules.

Of the billions of cells that help make up the immune system, the most important are lymphocytes. A kind of white blood cell, lymphocytes are divided into three main types:

• B lymphocytes (B cells)make antibodies to fight infection.
• T lymphocytes (T-cells)have several functions, including helping B-cells make antibodies and directly killing infected cells.
• Natural killer (NK)cells are non-B and non-T lymphocytes that don’t require a specific signal from the immune system to detect and kill threats.

Immunotherapy uses the body's lymphocytes and immune system to fight cancer.

Understanding Immunotherapy

In cancer treatment, immunotherapy helps to stimulate a patient’s immune system to do the job even better. Immunotherapy for cancer can:

• Educateyour immune system to recognize and attack specific cancer cells
• Boostimmune cells to help them eliminate cancer
  
• Provideyour immune system with additional components to enhance their response
  

Immunotherapy may provide an effective treatment option for patients who didn’t see results from traditional treatment options — or who aren’t candidates for other treatments.

The immune system is also highly adaptive and has a remarkable “memory.” One of the challenges with cancer is its ability to change to escape the body’s defenses. With the help of immunotherapy, the immune system can keep up with these changes and stay on the offense. It’s also able to “remember” cancer cells for a long time after they’ve been destroyed, just in case they return.

Types of Immuno-Oncology

Immuno-oncology is made up of a broad array of drugs but in general, can be divided into two categories called immune checkpoint inhibitors and cellular therapies. The difference is that immune checkpoint inhibitors such as the PD-1 inhibitors (e.g., Nivolumab, Pembrolizumab, Atezolizumab and Durvalumab), CTLA4 inhibitors (Ipilimumab) or LAG3 inhibitors (Relatlimab) are the best known and are introduced to the body off-the-shelf to give instructions to the body on how to fight the cancer. Cellular therapy drugs are built from your own immune cells by extracting those cells, modifying them in a way that gives them an enhanced cancer-fighting ability, and infusing them back into your body. Let’s look at different types of each of these drug classes:

Immunotherapy Drugs Include:

Immune checkpoint inhibitors– Our body uses proteins called “immune checkpoints” to signal the immune system to leave normal cells alone. When proteins on T-cells recognize and bind to “partner proteins” on other cells, they send a kind of “red light” signal to the immune system. Unfortunately, this can stop cancer cells from being attacked. Immune checkpoint inhibitors are drugs that block these checkpoint proteins from binding with partner proteins so the immune system can target the cancer cells. Examples include:

• Pembrolizumab (Keytruda)
• Ipilimumab (Yervoy)
• Nivolumab (Opdivo)
• Atezolizumab (Tecentriq)
• Avelumab (Bavencio)
• Durvalumab (Imfinzi)

Cellular Therapy Drugs Include:

Also called adoptive cell therapy, adoptive immunotherapy or immune cell therapy, this treatment boosts your cells’ natural ability to fight cancer. The most active cancer-fighting cells are taken from either a patient’s blood or directly from a patient’s tumor, grown in large batches in a lab and reintroduced to your body through a vein infusion.

Tumor-infiltrating (TIL) therapy– TIL therapy takes T-cells from your tumor, multiplies them and infuses them back into your tumor. By using the lymphocytes in or near the tumor, your treatment uses immune-system cells with the best ability to recognize and attack cancer effectively.

CAR T-cell therapy– CAR T-cell therapy also uses your T-cells to fight cancer. Once extracted from blood through a process called apheresis, the T-cells are genetically modified by adding a synthetic receptor called a chimeric antigen receptor (CAR) on each T-cell. CARs are proteins that allow the T-cells to recognize a threat from the tumor cells. After billions of them are produced in a lab, the re-programmed CAR T-cells are thawed and infused back into your blood to target specific antigens on the surface of cancer cells.

Natural Killer (NK) cell therapy– A natural killer (NK) cell is a type of immune cell that looks for any abnormal cells in the body and attacks them. In the lab, NK cells can be multiplied or modified and then infused into your body to help the body better attack cancer cells.

T-Cell Receptor (TCR) therapy这个治疗修改自己的t细胞lab with a receptor that can target specific cancer cells. These modified cells are multiplied and infused back into your body to attack cancer.

Therapeutic vaccines– These work against cancer by boosting your immune system’s response to cancer cells. When modified in a lab and delivered as a vaccine, immature dendritic cells, a type of immune cell, can help prompt the immune system to target cancer cells as invaders.

Bispecific T-Cell Engagers (BiTE) therapy– These are antibodies with two arms. One arm of the drug attaches to a specific protein on a tumor cell. The other arm activates immune cells in the patient to kill the cancer cells. In essence, these drugs bring a patient’s immune cells closer to a tumor cell with the aim of generating an immune response.

Non-Specific Immunotherapy

Non-specific immunotherapies don't target cancer cells specifically. Instead, they stimulate the immune system overall. Most people get this type of therapy after or with other cancer treatments, such as chemotherapy or radiation therapy. In some cases, non-specific immunotherapies may be the main form of treatment. Two common non-specific immunotherapies are:

Interferons– Interferons are proteins produced by your immune system to alert your body of a threat (typically a virus) in your body. Lab-made interferons can help your immune system fight cancer. They may also slow the growth of cancer cells.

Interleukins– Interleukins are proteins that help cells communicate. They can also trigger an immune system response to diseases like cancer. The lab-made interleukin-2 (IL-2) is sometimes used to treat kidney cancer and skin cancer, including melanoma.

When Is Immunotherapy Given?

• Intravenous (IV), into a vein and directly into your bloodstream
• By mouth,使用药物或 胶囊 你吞下
• Topical, on your skin, using a cream in cases of very early skin cancer
• Intravesical, directly into your bladder.

Possible Side Effects

• Inflammation in major organs or the thyroid
• Skin reactions
• Mouth sores
• Fatigue
• Nausea
• Headaches
• Body aches
• Changes in blood pressure

How Long Does Immunotherapy Last?

When a tumor responds to immunotherapy or cellular therapy, the decrease or disappearance of cancer (remission) can last a long time. During treatment, tumors may swell but will shrink as the cells die. Because immunotherapy can “train” the immune system to remember cancer cells, the treatment may keep cancer from returning.

Safety

Because immunotherapy drugs are newer, the long-term effects of exposure are not yet known. To be safe, experts recommend taking these precautions:

Being careful when taking oral or topical immunotherapy. Your care team may recommend wearing gloves when touching immunotherapy pills, capsules or cream. Have others avoid coming into contact with your medications or your body fluids while you’re taking the medication and for some time after. Your care team will go over any special precautions you need to take to ensure your safety.

Keeping family and friends safe. You are the only person who should be exposed to the immunotherapy drugs you get. During the weeks and months of your immunotherapy treatment, you can usually be around family and friends. If you get treatment at a center, family and friends can often accompany you, but some centers only allow patients in the infusion area and require visitors to stay in the waiting room.

Why Baylor Scott & White

For more than 40 years, Baylor Scott & White Health has delivered life-changing cancer care to residents across Texas, pioneering many techniques that have revolutionized cancer treatments. As a major academic medical center with a multidisciplinary team of researchers and specialists in cancer care, Baylor University Medical Center is a destination center in cancer care and immuno-oncology. The center is accredited by the Foundation for the Accreditation of Cellular Therapy (FACT) as a facility working to define the next generation of immunotherapeutic combinations. With the support of Baylor Scott & White Research Institute, Baylor University Medical Center is the only hospital in North Texas to administer genetically-altered immune cell therapies, manufacture treatment, and conduct lab work on one campus where patients are being treated.