Cancer Immunotherapy Awareness Month: breakthroughs in personalized treatment for advanced and metastatic cancer
Cancer immunotherapy enhances the immune system’s ability to recognize, target, and eliminate cancer cells. In recent years, it has transformed the treatment of certain cancers and helped extend and save the lives of many patients. In the long term, immunotherapy holds the potential to treat all cancers by becoming more precise, more personalized, and more effective than other types of therapy—and possibly with fewer side effects.1
To support Cancer Immunotherapy Awareness Month, in our June blog article, we’ll take a comprehensive look at this revolutionary treatment category. We will cover how it works, the latest US FDA approvals, breakthroughs in treatment response monitoring to ensure personalized therapy for advanced and metastatic cancer patients, and how you can join the cause to support immunotherapy awareness and research.
What is immunotherapy?
Cancer immunotherapy, also known as immuno-oncology (IO), is a type of treatment that uses the power of the body’s immune system to better target and eliminate cancer cells.
The main forms of immunotherapy used today include monoclonal antibodies, immune system modulators, T-cell transfer therapy, cancer vaccines, and immune checkpoint inhibitors.2 Depending on the type of immunotherapy, it can boost immune cells to help kill cancer cells, train the immune system to spot and attack specific cancer cells, or make the immune response more effective by helping the body with additional components.1
While immunotherapy can work well on its own, it can also be given in combination with surgery, chemotherapy, radiation, or targeted therapies to improve its effectiveness.
In recent years, immunotherapies have been approved in the United States and elsewhere to treat various types of cancer, including specific advanced and metastatic cancers that may have spread from where they first started to nearby tissue, lymph nodes, or other parts of the body. Some immunotherapies are also available through clinical trials, which are carefully controlled, or through monitored studies involving patient volunteers.
The immune system helps your body fight infections and diseases. It is made up of white blood cells (immune cells) and the organs and tissues of the lymph system. While the immune system has evolved to detect and destroy abnormal cells, cancer has found ways of hiding from and switching off these immune responses. For example, cancer cells may:
- have genetic changes that make them harder to recognize as abnormal
- have proteins on their surface that interact with and turn off immune cells
- change the normal cells around the tumor so they interfere with how the immune system responds to the cancer cells
By either stimulating the immune system or reinforcing it with additional medicine, immunotherapy can help your body better fight against cancer.2
Immune checkpoint inhibitors for advanced and metastatic cancers
The immune system has a mechanism in place that naturally prevents attacks against normal cells. This mechanism involves immune checkpoints—the main “brakes” of the immune system, which stop it from activating. Cancer cells are known to frequently manipulate these checkpoints in order to disable immune responses and protect themselves.
Immune checkpoint inhibitors (ICIs), considered a new standard of care across many cancer indications, work by blocking immune checkpoints and helping the immune system to eliminate cancer cells by not only amplifying existing immune responses, but also unleashing new ones.
ICIs target specific immune checkpoint receptors, such as cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) and programmed cell death protein-1 (PD-1) on immune cells, and programmed cell death protein-ligand 1 (PD-L1) on normal and cancer cells.
For example, when PD-1 on immune cells, called T cells, attaches to PD-L1 on cancer cells, it tells the T cells to leave the cancer cells alone. Blocking this PD-1/PD-L1 pathway can help restore cancer-fighting T cell activity. Similarly, blocking the CTLA-4 pathway can help promote expansion and diversification of T cells.3,4
The first checkpoint inhibitor for the treatment of cancer—the CTLA-4-blocking ipilimumab (Yervoy®) for melanoma—was approved by the FDA in 2011. Today, eight ICIs are approved to treat more than a dozen different types of cancer:3
- Atezolizumab (Tecentriq®), targeting the PD-1/PD-L1 pathway; approved for subsets of patients with bladder cancer, breast cancer, liver cancer, lung cancer, and melanoma
- Avelumab (Bavencio®), targeting the PD-1/PD-L1 pathway; approved for subsets of patients with bladder cancer, kidney cancer, and Merkel cell carcinoma
- Cemiplimab (Libtayo®), targeting the PD-1/PD-L1 pathway; approved for subsets of patients with cutaneous squamous cell carcinoma, basal cell carcinoma, and lung cancer
- Dostarlimab (Jemperli), targeting the PD-1 pathway; approved for subsets of patients with endometrial cancer
- Durvalumab (Imfinzi®), targeting the PD-1/PD-L1 pathway; approved for subsets of patients with bladder cancer and lung cancer
- Ipilimumab (Yervoy®), targeting the CTLA-4 pathway; approved for subsets of patients with melanoma, mesothelioma, liver cancer, and lung cancer
- Nivolumab (Opdivo®), targeting the PD-1/PD-L1 pathway; approved for subsets of patients with bladder cancer, colorectal cancer, esophageal cancer, gastric cancer, head and neck cancer, kidney cancer, liver cancer, lung cancer, lymphoma, melanoma, and mesothelioma
- Pembrolizumab (Keytruda®), targeting the PD-1/PD-L1 pathway; approved for subsets of patients with bladder cancer, breast cancer, cervical cancer, colorectal cancer, cutaneous squamous cell carcinoma, esophageal cancer, head and neck cancer, kidney cancer, liver cancer, lung cancer, lymphoma, melanoma, Merkel cell carcinoma, and stomach cancer; also approved to treat subsets of patients with cancers of any type that present with certain genetic mutations (MSI-H, dMMR, or TMB-H)
These approvals cover treatments for cancers that are advanced or resistant to other forms of therapy as well as first-line treatments for several types of metastatic cancer. Many other checkpoint inhibitors are currently being evaluated in a variety of cancer types in clinical trials.
Why monitoring ICI treatment response is important
Although immune checkpoint inhibitors are a new and revolutionary cancer treatment option, not all patients respond to this type of treatment.5
- Approximately 43.5% of cancer patients are eligible for ICI treatment.
- Fewer than 20% of eligible patients will respond to or benefit from ICIs over the long term.
Monitoring ICI treatment response can help your doctor determine if immunotherapy is working and better personalize your individual treatment plan. While imaging scans, biomarker tests, and other lab tests are commonly used to monitor treatment response and cancer recurrence, they may not be able to provide a clear picture of whether ICIs are effective or an alternative treatment strategy should be considered.
Signatera: a better way to help monitor your immunotherapy treatment
Natera’s recent INSPIRE trial showed that Signatera, a new personalized cancer-monitoring test, can help determine—earlier than traditional tests—whether you are responding to immune checkpoint inhibitors by assessing the changes in levels of circulating tumor DNA (ctDNA) throughout your treatment.
Based on this study, which was across 25 different cancer types, Signatera can accurately identify both patients who do not respond to immunotherapy and long-term responders who have achieved sustained clinical benefit with immunotherapy. Alongside standard monitoring tests, these results can be incredibly helpful when deciding on treatment plans.
There’s also an opportunity for patients with advanced or metastatic solid tumors to be a part of a new clinical trial that will further examine the impact of incorporating Signatera into their immunotherapy cancer treatment. Learn more about BESPOKE IO, which is currently enrolling people living with colorectal cancer, non-small cell lung cancer, or melanoma.
Get more information and join the cause
With the recent spotlight on immunotherapy, multiple online resources are now available for you to learn more about it. Natera’s partners Society for Immunotherapy of Cancer (SITC), European Society for Medical Oncology (IO), and AIM with Immunotherapy also offer plenty of patient resources that are customized by region. The Additional Resources section below includes some comprehensive immunotherapy resources.
To help raise immunotherapy awareness, participate in fundraising efforts, and connect with the immunotherapy community during the month of June and beyond, check out the 9th Annual Cancer Immunotherapy Month™, hosted by the Cancer Research Institute.
1What is cancer immunotherapy? Cancer Research Institute. Updated October 2020. Accessed May 10, 2021. https://www.cancerresearch.org/immunotherapy/what-is-immunotherapy
2Immunotherapy to treat cancer. National Cancer Institute. Updated September 24, 2019. Accessed May 10, 2021. https://www.cancer.gov/about-cancer/treatment/types/immunotherapy
3Immunomodulators: checkpoint inhibitors, cytokines, agonists, and adjuvants. Cancer Research Institute. Updated January 2020. Accessed May 10, 2021. https://www.cancerresearch.org/immunotherapy/treatment-types/immunomodulators-checkpoint-inhibitors
4Immune checkpoint inhibitors and their side effects. American Cancer Society. Updated December 27, 2019. Accessed May 10, 2021. https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/immunotherapy/immune-checkpoint-inhibitors.html
5Haslam A, Prasad V. Estimation of the percentage of US patients with cancer who are eligible for and respond to checkpoint inhibitor immunotherapy drugs. JAMA Network Open. 2019;2(5):e192535.