Immunotherapy is a type of treatment that uses the body's own immune system to fight cancer. The therapy mainly consists of stimulating the immune system to help it do its job more effectively. Immunotherapy is a fairly new way to fight colorectal cancer. Many of these treatments are still in clinical trials.
Types of Immunotherapy
Biological Response Modifiers. These substances do not directly destroy the cancer, but they are able to trigger the immune system to indirectly affect tumors. Non-specific biological response modifiers include cytokines (chemicals produced by cells to instruct other cells) such as interferons and interleukins. This strategy involves giving larger amounts of these substances by injection or infusion in the hope of stimulating the cells of the immune system to act more effectively.
Colony-Stimulating Factors. These are substances that stimulate the production of bone marrow cells (the soft, sponge-like material found inside bones), which include both red and white blood cells and platelets. White blood cells fight infection; red blood cells carry oxygen to and carbon dioxide from organs and tissues; and platelets are cell fragments that help the blood to clot. Often, other cancer treatments cause decreases in these cells. Thus, colony-stimulating factors do not directly affect tumors, but they can help support the immune system during cancer treatment.
Tumor Vaccines. Researchers are developing vaccines that may encourage the immune system to better recognize cancer cells. These would, in theory, work in a similar way as vaccines for measles, mumps, and other infections. The difference in cancer treatment is that vaccines are used after someone has cancer, and not to prevent the disease. The vaccines would be given to prevent the cancer from returning or to get the body to reject tumor lumps. This is much more difficult than preventing a viral infection. The use of tumor vaccines continues to be studied in clinical trials.
Monoclonal Antibodies. These are substances produced in the lab that can locate and bind to cancer cells wherever they are in the body. These antibodies can be used to see where the tumor is in the body (detection of cancer), or as therapy to deliver drugs, toxins, or radioactive material directly to a tumor.
In February 2004, the FDA approved the first monoclonal antibody to treat metastatic colorectal cancer -- cetuximab (Erbitux).
Also in February 2004, the FDA approved another first-of-its-kind monoclonal antibody called (bevacizumab (Avastin). Ramucirumab (Cyramza) and Ziv-aflibercept (Zaltrap) are similar to Avastin and are also approved to treat advanced colorectal cancer that has spread to other organs.
Bevacizumab and ramucirumab attack the blood supply of the cancer. Currently, doctors can't predict which patients will respond best to them.
The drugs cetuximab and panitumumab must be used in patients who do not have a mutation of a gene in their colon cancer known as K-ras. If this gene is present these drugs won’t work. Individuals with advanced colon cancer should routinely be checked for K-ras.
Ipilimumab (Yervoy) works in a similar way when targeting the CTLA-4 protein.
What Are the Side Effects of Immunotherapies?
Like other forms of cancer treatment, immunotherapies can cause a number of side effects. These side effects can vary widely from person to person. Biologic response modifiers may cause flu-like symptoms including fever, chills, nausea, and loss of appetite. In addition, rashes or swelling may develop at the site where they are injected and blood pressure may drop as a result of treatment. Fatigue is another common side effect of biologic response modifiers. In addition:
- Side effects of colony-stimulating factors may include bone pain, fatigue, fever, and loss of appetite.
- The side effects of monoclonal antibodies vary and serious allergic reactions may occur.
- Vaccines can cause muscle aches and low-grade fever.
- Rashes are a common and may be a severe side effect of Erbitux or Vectibix. Rashes are usually indicative that these drugs are working. They are a side effect of the drugs, not an allergy.
- Bleeding, blood clotting, or bowel perforation may occur as a side effect of Avastin or Cyramza and Zaltrap.
Talk to your doctor to learn if immunotherapy is right for you.