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Is Immunotherapy Used For Breast Cancer

What Are The Challenges Of Immunotherapy

Breast Cancer and Immunotherapy with Dr. Leisha Emens and Barbara Bigelow

One challenge of immunotherapy is not knowing who is likely to benefit from the treatment, as mentioned above. Second, immunotherapy can cause substantial side effects, including life-threatening ones. The most common immunotherapy side effects are skin reactions, such as redness and blistering, and flu-like symptoms, such as fever, nausea, weakness, and body aches. Different types of immunotherapy can cause different side effects. An important third challenge is the high cost of this treatment, which insurance companies may not cover.

Expert Review And References

  • Bursein HJ, Harris JR, Morrow M. Malignant tumors of the breast. Devita, V. T., Jr., Lawrence, T. S., & Rosenberg, S. A. Cancer: Principles & Practice of Oncology. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2008: 43.2: pp. 1606-54.
  • Foxson SB, Lattimer JG & Felder B. Breast cancer. Yarbro, CH, Wujcki D, & Holmes Gobel B. . Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett 2011: 48: pp. 1091-1145.
  • National Cancer Institute. Breast Cancer Treatment Health Professional Version. Bethesda, MD: National Cancer Institute 2010.
  • Breast cancer. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network 2010.
  • Tripathy D, Eskenazi LB, Goodson, WH, et al. Breast. Ko, A. H., Dollinger, M., & Rosenbaum, E. Everyone’s Guide to Cancer Therapy: How Cancer is Diagnosed, Treated and Managed Day to Day. 5th ed. Kansas City: Andrews McMeel Publishing 2008: pp. 473-514.

What Are Cancer Vaccines

Cancer vaccines work by stimulating a type of immunity that attacks and kills cancer cells.

The first FDA approved cancer vaccine, sipuleucel-T , was created for people with metastatic prostate cancer. This vaccine has been shown to increase overall survival in people with metastatic prostate cancer.

Researchers are studying many vaccine strategies in people with breast cancer. Some researchers believe breast cancer vaccines may work best when combined with other therapies. People who havent received much breast cancer treatment may also benefit from vaccines.

Vaccines can take months to cause an immune response, so they may not be appropriate for very late stage cancers when used alone. They may still play an important role when used with other therapies. Research in this area is ongoing.

In October 2019, Florida based Mayo Clinic researchers announced a vaccine theyd developed had eliminated cancer cells in their first clinical trial participant.

The clinical trial participant had received a diagnosis of early stage breast cancer known as ductal carcinoma in situ . One researcher did note that people with stage 4 breast cancer had also seen promising results after participating in a different vaccine clinical trial.

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How It May Treat Breast Cancer

Cells in the body contain proteins called immune checkpoints. These immune system regulators signal that cells are healthy.

Immune checkpoints allow the immune system to fight infected or diseased cells while preventing it from attacking healthy tissues.

The immune system is complex and involves different types of cells, including T cells, which circulate the body checking for disease or infection. These specialized cells examine other cells to identify immune checkpoints.

If the immune system does not recognize proteins within cells, it attacks them. This process is essential in allowing the body to fight diseases and infections.

Sometimes, the immune system does not fight off breast cancer cells effectively. There are two main reasons for this.

Firstly, precancerous or early cancerous cells are similar to healthy cells. The immune system may not recognize them as harmful until breast cancer develops further. Secondly, as cancerous cells develop, they can change genetically to prevent the immune system from detecting them and identifying them as harmful. Cancer cells can also grow and multiply quickly, which can overwhelm the immune system.

Immunotherapy drugs can help support the immune system to destroy cancer cells. Doctors may prescribe various options, depending on the type of breast cancer.

How Is Immunotherapy Administered

Immunotherapy successful against deadly breast cancer

Patients usually receive immunotherapy treatment at an outpatient oncology center via infusion through a port or intravenous therapy . The dosage and frequency depend on the specific medicine. Therapy intervals may range between every two weeks to every four weeks. In April, however, the FDA approved a six-week dosing regimen for the immunotherapy drug, pembrolizumab , a monoclonal antibody.

Currently, theres no designated end to immunotherapy treatment. You may continue on the regimen as long as you continue to have a good response.

Patients sometimes ask to take a break from treatment. They may be experiencing side effects or want a break for a personal reason. When that happens, we monitor the patient with scans and tests every three months or so. We dont fully understand why yet, but somenot allcontinue to have a good response after stopping therapy. One possibility is that for those patients, immunotherapy may work like a light switch: Once its been turned on, it stays on.

For example, one recent study showed patients with PD-L1expressing advanced nonsmall-cell lung cancer who were treated for at least two years with pembrolizumab continued to experience long-term benefits of treatment, even after taking a break from treatment. Researchers and oncologists are trying to figure out who may be able to stop immunotherapy indefinitely and still maintain the benefits.

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What Should You Do If Youre Interested In Immunotherapy Treatment

If youre wondering whether immunotherapy may be an option for you, researching treatments on your own may be a good place to start. Read about treatment options for your specific type of cancer.

Have an honest conversation with your doctor and your care team to get better insight into your disease. Some questions to consider asking are:

  • What’s my overall outlook? Is my cancer curable?
  • What are our goals? What’s the realistic outcome?
  • Am I a candidate for genomic testing?
  • Am I a candidate for immunotherapy? If so, when would we use that in my treatment, and what are the common side effects?
  • Do you have any clinical trials I may qualify for?

Try to get access to genomic testing as early as possible in your cancer journey. Some rare genetic mutations have a high response rate to targeted therapy. If you wait until youre out of other options, you may be too sick to qualify or to travel for treatment if its not available locally.

Consider getting a second opinion. A second opinion may give you a better understanding of your cancer type and stage, but it may also reveal innovative treatment options your current doctor may not have access to.

Immunotherapy is not an appropriate solution for all cancer patients, but some are thriving on the treatment. Those patients are potentially living longer with fewer side effects and a higher quality of life.

What Are Active Immunotherapies

Active immunotherapies essentially push your immune system to do more to respond to your cancer. Healthcare providers create these immunotherapies by examining your cancer cells for antigens. Antigens are toxins or foreign substances. When your immune system runs into an antigen, it goes after the antigen. By identifying cancer cell antigens, providers can create drugs that focus your immune system on the cancer cells.

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What To Expect When Taking Keytruda

Keytruda is given as a 30-minute infusion, every 3 or 6 weeks, depending on the dose given at each infusion. The Keytruda infusion is given before the chemotherapy infusion. If you are receiving Keytruda for metastatic or unresectable locally advanced triple-negative breast cancer, you may continue treatment with Keytruda and chemotherapy for up to 2 years, unless the cancer grows or you develop unacceptable side effects.

Women who are pregnant or planning to get pregnant should not be given Keytruda. Keytruda can cause embryo death and birth defects. Its important that you dont get pregnant while youre getting Keytruda you must use effective birth control.

Which Cancers Can Be Treated With Immunotherapy

Immunotherapy and breast cancer: how does it work?

Not all types of cancer have been approved for immunotherapy treatment at this time. Researchers need to prove that a new treatment is as effective as or better than the current, accepted therapies before it can be approved as standard of care. Scientists have made advances in immunotherapy research through clinical trials, such as those offered at CTCA® and other cancer research hospitals.

Melanoma and non-small cell lung cancer were the first cancers to get FDA approval for immunotherapy treatment because studies have amassed more long-term data for its use with those cancers. Until about five years ago, these cancers were primarily treated with interleukin-2 and interferons . Today, immune checkpoint inhibitors are more commonly used.

Other types of cancer that may be treated with immunotherapy include:

  • Liver cancer
  • Bladder cancer
  • Lymphoma

The FDA has not specifically approved immunotherapy for pancreatic cancer and colon cancer. Exceptions have been made in using immunotherapy to treat these and other cancers, however, thanks to advances in advanced genomic testing.

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Does Breast Cancer Respond To Immunotherapy

In short, its too soon to say how all the various types and stages of breast cancer will be affected by immunotherapy.

The U.S. Food and Drug Administration has approved two immunotherapies. One treats early-stage triple-negative breast cancer. The other is limited to certain metastatic breast cancers.

Meanwhile, there are hundreds of clinical trials involving immunotherapy, particularly looking at how immunotherapy and chemotherapy could be used together to treat breast cancer.

Immune Checkpoint Inhibitors For Breast Cancer

An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses proteins on immune cells that need to be turned on to start an immune response. Breast cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. Drugs that target these checkpoint proteins, help restore the immune response against breast cancer cells.

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There Are Several Types Of Cancer Immunotherapy Including:

  • monoclonal antibodies
  • adoptive cell transfer therapy
  • vaccines

Monoclonal antibodies are man-made proteins that mimic the body’s natural antibodies. Antibodies are substances produced by the immune system that help to destroy infectious organisms and toxins. Monoclonal antibodies can be made to target specific cancer cells. When these antibodies attach to cancer cells, they can help the immune system to destroy them.

Cytokines are proteins that are produced by the body in response to infection or inflammation. They help to regulate the immune system and can promote or inhibit the growth of cancer cells. Checkpoint inhibitor therapy uses drugs that block certain proteins that normally keep the immune system from attacking cancer cells. This allows the immune system to attack and destroy the cancer cells.

Adoptive cell transfer therapy is a type of immunotherapy that uses laboratory-grown immune cells to fight cancer. Immune cells are collected from the patient’s blood or tumor and then grown in the laboratory. These immune cells are then injected back into the patient, where they help to fight the cancer cells.

Vaccines are substances that are used to stimulate the immune system to produce antibodies against a specific disease.

What Are The Risks Of Using Immunotherapy To Treat Breast Cancer

Breast cancer: New immunotherapy leads to complete regression

Like many cancer treatments, immunotherapy has several side effects. More common side effects are:

Other, more serious side effects occur less often:

  • Infusion reactions: Some people might have an infusion reaction while getting these drugs. This might feel like an allergic reaction. You might have fever, chills, itchy skin, feel dizzy or that your face is flushed. You might have trouble breathing or begin to wheeze.
  • Autoimmune reactions: Sometimes your immune system starts to attack other areas of your body. Thats why there are safeguards on your immune system. Immunotherapy removes one of those safeguards, making your body more vulnerable to autoimmune reactions that can cause life-threatening problems in your organs.

Tell your healthcare provider right away if you have either of these reactions. They might decide to stop treatment temporarily.

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What Are The Benefits Of Immunotherapy

Key benefits of immunotherapy over conventional therapies, such as chemotherapy and radiation, include:

  • Fewer immediate and long-term side effects
  • The ability to continue treatment on a long-term basis while maintaining good quality of life

Conventional therapies may cure some cancers, but they may also cause difficult, long-term side effects, like peripheral neuropathy, heart problems, surgical complications, lung damage, hormone dysfunction and memory and cognition problems. Eventually, standard therapies may also compromise or overpower the immune system.

Cancer immunotherapy, on the other hand, may have fewer immediate and long-term side effects. The most common immunotherapy side effects patients may experience while receiving treatment include:

  • Diarrhea
  • Rash
  • Autoimmune response

If you experience a side effect from immunotherapy, we may be able to treat it directly, or we may delay your next treatment to allow you some time to recover. Supportive care therapies may also help you manage side effects. Occasionally, steroids may be used to suppress the reaction. If the reaction involves a severe autoimmune response, you may have to discontinue immunotherapy.

What Are Immunotherapy Side Effects

Immunotherapy may cause a variety of side effectsmany are flu-like symptomsincluding:

  • Rashes or itching

The side effects of immunotherapy generally become less severe after the first treatment.

Throughout your treatment, your care team will provide integrative care services, including nutritional support, naturopathic support, pain management, oncology rehabilitation, behavioral health and spiritual support. These therapies may help reduce side effects and improve your overall quality of life during immunotherapy.

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Identifying Responders To Immunotherapy: Current Status And Future Perspectives

KEYNOTE-522 results prompted a rapid change in clinical practice, leading to the FDA approval of the first immunotherapy agent for early-stage TNBC. This landmark achievement, however, has raised a multitude of scientific questions, requiring a new set of prospective clinical trials.

Besides baseline biomarkers, one established dynamic biomarker, namely the achievement of pCR after neoadjuvant treatment, showed a critical value in KEYNOTE-522. Indeed, a major absolute benefit in terms of EFS was observed among patients not achieving pCR, with a 10% improvement in 3-year EFS for patients receiving pembrolizumab, whereas only a 2% difference was observed in those patients achieving pCR. This finding – together with the results of GeparNuevo showing survival outcomes similar to KEYNOTE-522 with immunotherapy administered only before surgerysupport the experimental testing of strategies to de-escalate adjuvant immunotherapy in patients achieving pCR with chemo-immunotherapy. Nonetheless, until prospective evidence is available, current standards of care should include the adjuvant administration of pembrolizumab to all patients receiving it in the neoadjuvant setting without experiencing concerning irAEs. Moreover, when comparing EFS curves from patients achieving pCR in the two arms, it is important to stress the fact that the addition of pembrolizumab led to more patients achieving pCR, ultimately enriching the population of patients achieving a favorable EFS.

Whats The Difference Between Immunotherapy And Chemotherapy

Dr. Adams on Immunotherapy in Triple-Negative Breast Cancer

Both immunotherapy and chemotherapy are commonly used cancer treatments that use drugs to stop or slow the growth of cancerous cells. However, while chemotherapy drugs are used to attack rapidly producing cells throughout the body, immunotherapy triggers the immune systems ability to identify and attack cancer cells.

The side effects can be very different between chemotherapy and immunotherapy, too. Because chemotherapy cant differentiate between the cells its targeting, it affects both fast-growing cancerous and fast-growing normal cells, like those responsible for hair and skin growth and those lining the digestive tract and forming bone marrow. That why side effects like hair loss, nausea and vomiting, and skin and nail changes are more common and sometimes more severe with chemotherapy.

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Research Agenda For The Next Decade

The introduction of immunotherapy marks a revolution in the treatment of early-stage TNBC. KEYNOTE-522 has shown that, by unleashing anti-cancer immune responses through ICIs, long-term benefits can be obtained for the treatment of this aggressive BC subtype. However, it represents a starting point rather than a finish line, and additional efforts will be required precisely implement immunotherapy for the treatment of TNBC .

Fig. 1: Next decade research agenda for neo immunotherapy in TNBC.

Abbreviations: IO, immunotherapy, TNBC, triple negative breast cancer TMB, tumor mutational burden ADC, antibody-drug conjugate ER, estrogen receptor CD, cluster of differentiation TILs, tumor infiltrating lymphocytes PD-L1, Programmed death-ligand 1 HLA, human leukocyte antigen PD-1, Programmed cell death protein 1 A, adenosine T, thymine C, cytosine G, guanine BRCA, BReast CAncer gene EFS, event-freee survival RD, residual disease me1, mono-methylated form BC, breast cancer. Created with biorender.com.

Other Types Of Immunotherapy In Breast Cancer

While there are not currently any other immunotherapy drugs approved for breast cancer, a number of methods are being evaluated in clinical trials.

Myths surrounding clinical trials abound, and many people express anxiety about participating. It’s important to keep in mind that every therapy we currently have approved was once studied in a clinical trial.

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Global Cancer Immunotherapy Market

DUBLIN, April 6, 2022 /PRNewswire/ — The “Cancer Immunotherapy Market: Global Industry Trends, Share, Size, Growth, Opportunity and Forecast 2022-2027” report has been added to ResearchAndMarkets.com’s offering.

The global cancer immunotherapy market reached a value of US$ 96.6 Billion in 2021. Looking forward, the publisher expects the market to reach a value of US$ 167.5 Billion by 2027 exhibiting a CAGR of 9.10% during 2022-2027. Keeping in mind the uncertainties of COVID-19, we are continuously tracking and evaluating the direct as well as the indirect influence of the pandemic. These insights are included in the report as a major market contributor.

This, coupled with the rising prevalence of multiple myeloma and melanoma, is catalyzing the demand for cancer immunotherapy. Besides this, leading players are sponsoring patient assistance programs that provide financial assistance to low-income individuals for augmenting the existing prescription drug coverage. This, in turn, is positively influencing the market. Other factors strengthening the growth of the market are technological advancements in clinical therapies, extensive research and development activities, and the introduction of advanced variants with enhanced efficacy and effectiveness of treatment.

Competitive Landscape:

Key Topics Covered:

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