The Nobel prize in medicine this year was awarded to James Allison and Honjo Tasuku, developed another method of treating cancer — immunotherapy. Why it’s breakthrough, and what complexity does the “Pravmir”.
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What is it?
Immunotherapy is a method of treatment involving their own immune system to fight disease. This direction is called the “new era” in cancer treatment — since immunotherapy will significantly change medical practice.
The main methods of cancer treatment — surgery, radiotherapy, chemotherapy and targeted therapy. The new method stimulates own immune forces of the body and starts the process of suppressing cancer cells by the immune system.
How does immunotherapy?
The immune system protects the body from viruses and bacteria, destroys all the “alien” in the body, for example, cells that have become cancerous. Finds and destroys these abnormal cells she with the help of T-lymphocytes.
The purpose of new drugs to help the immune system to recognize and attack cancer cells.
But many tumors on their surface Express the ligand PD-L1, which interacts with the receptor PD-1 on T-lymphocytes is a complex formulation means that some tumors have the ability to become “invisible” to the immune system. And the immune system is missing a tumor, allowing it to metastasize. So scientists started to work drugs, whose main task — to help the immune system to recognize and adovate cancer cells. So there inhibitors PD-1 and PD-L1 — a fundamentally new drugs that make the tumor “visible”, do not allow the proteins PD-1 and PD-L1 be disguised as healthy cells, and T lymphocytes can thus cope with the disease. These drugs act on the entire neoplastic process, not only in the primary tumor, so they are effective for metastatic cancer.
Are there any drugs in Russia?
Yes. The first immunotherapeutic drugs have been registered in Russia in 2016 for the treatment of metastatic melanoma and metastatic lung cancer. Then there were two of the drug, and gradually there are new indications for the use of immunotherapy: for example, as monotherapy or in combination with other medications they were approved for use for metastatic bladder cancer, recurrent or metastatic squamous cell carcinoma of the head and neck, recurrent Hodgkin’s lymphoma and so on.
To understand the prospects of the drug, pharmaceutical companies are conducting global clinical studies: for example, for only one of Immunopreparat — Nitrodi (ambrosianae) — manufacturer MSD has organized 500 different clinical trials around the world, defining possibilities of drug therapy of more than 30 types of malignant tumors. The results of these studies form the evidence base for registration of new indications for the use of the drug.
What are the difficulties?
Very high price of medicines: 2-3 weeks application can cost 250-300 thousand rubles. Duration of reception is determined in each case individually: immunotherapy need to use all the time – while she’s working, in some cases the duration might be a year. Due to the high cost of patients having problems obtaining such drugs in the public health system — no money to buy them.
Immunotherapy is not a panacea. It shows not all cancer patients. Is an absolute breakthrough in treatment, but even if it is used according to indications, helps, unfortunately, not all and not always. In some cases immunotherapy, on the contrary, is able to stimulate tumor growth — that is, to cause the regress and progress of the disease.
As well as chemotherapy or targeted therapy, immunotherapy has no side effects. They differ in their “nature” — like autoimmune diseases by manifestations.
“For example, patients on a background treatment can occur autoimmune pneumonia, hipofisis (inflammatory process in the pituitary gland), even autoimmune gastritis,” – says the head of the Clinic outpatient Oncology and Hematology Michael Sweet.
Along with really works the drugs are spreading the funds unrelated to the therapy, the development of which was awarded the Nobel prize. According to oncologists, “virtually every third patient” is asked or even accepted such funds.
“ASD-2, Refnot, Ingaron is a relatively inexpensive drugs that promote or designate as immunotherapy. But no international clinical studies have confirmed their effectiveness was not carried out,” said Gentle.