Modern immunotherapy is playing an increasingly important role in oncology. The fact that the Nobel Prize for Medicine and Physiology was awarded to cancer researchers James Allison and Tasuku Honjo for their discoveries emphasises the importance of the resulting immunotherapy against cancer. It can already be said that immune checkpoint inhibitors have established themselves as a new mainstay in oncology. Many studies are currently underway worldwide to further investigate immune checkpoint inhibitors. New success stories are constantly being presented. The aim of research is to enable more and more patients to benefit from immunotherapy.
Course of treatment
Immunotherapy aims to activate the patient's own immune system against the tumour. This mode of action is in contrast to conventional chemotherapy, which attacks the tumour cells directly.
Modern immunotherapy is based on drugs that influence the control of the immune response and do not directly attack the tumour cells. This takes place at so-called immune checkpoints. Immune checkpoints are several important switching points in the immune system which, among other things, ensure that an immune reaction is inhibited. This is important to prevent the immune system from overreacting and triggering autoimmune reactions (i.e. a defence response directed against the patient's own body). However, tumours can take advantage of this targeted "brake" on the immune response. The tumour cells can use these immune checkpoints to block defence cells (= immune cells) that are directed against them. One of these checkpoints is the so-called PD-1/PDL-1 signalling pathway.
This is where the new drugs, the immune checkpoint inhibitors, come in: They inhibit these checkpoints and thus release the tumour-related "brake" on the immune defence. Figuratively speaking, they take the "foot off the brake pedal" so that the immune system can "drive off" again and attack the tumour cells.
Authorised drugs and administration
Several immune checkpoint inhibitors are authorised in Switzerland. All of these drugs are artificially produced monoclonal antibodies. They are administered every 2-3 weeks (depending on the drug) as an infusion via the vein.
Side effects of immunotherapy
It is very pleasing that the immune checkpoint inhibitors are often very well tolerated and therefore quality of life is maintained. The possible side effects differ greatly from those of classic chemotherapy. The most common is fatigue. However, by releasing the brakes on the immune system, it can also turn against its own body and trigger so-called autoimmune inflammations. These can affect, for example, the skin (rash, itching), the gastrointestinal tract (autoimmune colitis with diarrhoea), the lungs (autoimmune pneumonitis with shortness of breath, cough), the liver (autoimmune hepatitis) or the endocrine glands (including hypothyroidism or hyperthyroidism). The treatment of these autoimmune inflammations generally consists of suppressing the excessive immune system using steroids or, if necessary, other immunosuppressive drugs.
Impressive results
The immune checkpoint inhibitors have shown impressive results in the treatment of some tumours. One example is melanoma (malignant melanoma): The 1-year survival rate for metastatic melanoma was increased from 42 to 72 per cent compared to conventional chemotherapy. The proportion of patients with long-term tumour control in metastatic melanoma with the new immune checkpoint inhibitors is 30-40 percent. Such a good result has never been seen in this disease with conventional chemotherapy.
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