Types of Mesothelioma Immunotherapy
Immunotherapy for mesothelioma can be divided into many categories based on how the treatment is administered, the desired effect, how it affects the immune system, and other factors.
Did You Know?
There are two main types of immunotherapy: passive and active.
Active immunotherapy teaches the patient’s immune system to recognize cancer cells and realize that they are harmful to the body, triggering an immune response against these cells.
Antibodies (sera) collected in recovered patients is an example of passive immunotherapy.
In passive immunotherapy, the ready to fight cells are prepared outside of the patient and are then infused into him or her. Another type of passive immunotherapy is when medical specialists analyze cancer cells in a lab and identify their antigens.
They then grow the patient’s own immune cells in the lab, teach them to recognize the antigens (targets) that they identified in the lab, and infuse them back into the patient.
This is a more time-involving and complex process that is not available everywhere.
Active immunotherapy is divided further into two types:
- Specific: Specific immunotherapy involves designing a treatment to stimulate a specific immune response against cells with certain antigens that all cancers of particular type share. The idea behind specific active immunotherapy was to produce the immune cells that could best fight cancer to maximize results. However, this approach is becoming less popular due to less than ideal results in multiple studies over several decades.
- Nonspecific: This approach to immunotherapy involves using agents that trigger a general immune response, activating many different types of immune cells. It strengthens a patient’s overall immune activity to better fight cancer. This approach has had some success, but tends to be toxic and may is not productive in mesothelioma
Active immunotherapy can trigger checkpoints on immune cells, which some cancers can inhibit. The cells become more effective in fighting cancer.
The checkpoints on these immune cells operate like an “off switch” so they can avoid attacking other cells in the body, and cancer cells can take advantage of their presence to deflect immune response.
Checkpoint inhibitors are an exciting new and very promising new approach to prevent cancers from tuning down the immune response, and several such drugs have been approved in various cancer types.
One major type of active immunotherapy for mesothelioma includes cancer vaccines. Much like a typical vaccine, cancer vaccines are used to help the immune system learn to recognize cancer cells sooner.
These are the most common types of immunotherapy in common clinical use and being studied for mesothelioma:
- Immune checkpoint inhibitors: Drugs that the patient takes to allow their immune system to respond appropriately to cancer cells.
- Monoclonal antibodies: These antibodies make cancer cells more recognizable to T-cells and other immune cells of the patient.
- Cytokines: These are proteins, sometimes grown in a lab, that help the body increase the nonspecific immune response to cancer cells. Some cytokines help the immune system cells grow more quickly, while others help the body resist cancer cells.
Some checkpoint inhibitors are:
- Pembrolizumab (Keytruda)
- Nivolumab (Opdivo), often used with Ipilimumab Atezolizumab (Tecentiq) and Avelumab (Bavencio)
- Durvalumab (Imfinzi)
- Cemioimab (Libtayo)
- Avelomab (Bavencio)
Because immunotherapy is a newer treatment type, it continues to be studied and advanced. Your doctor will be able to help you determine if and which immunotherapy treatment is right for you.
In passive immunotherapy (also known as adoptive immunotherapy), patients receive antibodies and geared up immune cells developed in a lab.
Like active immunotherapy, passive immunotherapy can be specific or nonspecific.
Types of passive immunotherapy for mesothelioma include:
- Monoclonal antibodies: These are antibodies designed to attach to specific cancer cell proteins, like immune checkpoint inhibitors.
- CAR-T therapy: These are expanded specialized T-cells that are primed to fight cancer cells.
Cancer vaccines work with the immune system to help the body learn to defeat cancer cells. These vaccines are usually made by either editing your own immune cells to better respond to cancer cells, or by helping your immune cells better identify which cells are cancerous.
Many times the immune system will have difficulty knowing which cells are cancerous, so cancer vaccines come in to teach the immune system which cells to attack.
These vaccines are often used in tandem with surgery or chemotherapy drugs such as cisplatin and pemetrexed (Alimta). Mesothelioma cells are normal cells that have mutated, which can make it very difficult for an immune system to identify which cells to attack.
These vaccines, used with other treatment options, give a patient the best chance of reducing tumor size while keeping good cells.
When an antibody attaches to a cell’s antigen, that cell is marked for destruction by T-cells.
However, because mesothelioma cancer cells are normal cells that have mutated, it can be difficult for the immune system to identify cancer cells as dangerous, and therefore they don’t always get marked for destruction.
Monoclonal antibodies are lab designed antibodies that help the immune system by attaching to antigens that are popular in cancer cells. They are introduced through an IV and cause minimal side effects.
These drugs are sometimes used with other treatment options but sometimes used as their own treatment.
Other Types of Mesothelioma Immunotherapy
The last major types of immunotherapy being tested are immunomodulators. These drugs work with the immune system by heightening some proteins and calming down others.
These drugs include:
Other immune therapies that are being studied include:
- Bacillus Calmette-Guerin: A germ that infects human tissue and activates the immune system. This is usually a liquid treatment for bladder cancer. This is one of the oldest immunology treatments for cancer.
- Imiquimod: A drug for skin cancer, usually a cream that promotes a local immune system response where applied.