Immunotherapies for Blood Cancers

The Journal of  Community and Supportive Oncology has a really nice article in their last issue called "Immunotherapies Shape the Treatment Landscape for Hematologic Malignancies."

The journal describes itself as "Research and reviews for the practicing oncologist," so the article itself is a little technical. However, for a not-a-medical-doctor-but-still-a-cancer-nerd like me, it's a fun thing to read.

As the title of the article suggests, the focus is on looking at how Immunotherapies are playing a big role in blood cancer treatment these days. Immunotherapies are treatments that use the body's own immune system to fight off cancer. That's the problem with cancer cells -- they don't belong in the body, but they also have lots of ways of fooling the body into letting them stay. And then they grow  and do bad things.

(They're like your roommate's friend who is going just sleep on the couch for a few days "until he finds something else," and the next thing you know, it's six months later, all of his stuff has taken over the living room, and there's never any milk for your cereal because the "guest" watched The Big Lebowski one night and now he drinks White Russians all day instead of looking for his own place.

That's basically what cancer is. If you don't understand the comparison, just skip to the next paragraph.)

As the article points out, blood cancers are especially good for Immunotherapy, since the immune cells that should be attacking the cancer cells are swimming right beside them in the blood.

The author breaks down some of the Immunotherapies that have been approved or are in clinical trials.

T Cells. The first general way of using Immunotherapy is by "exploiting T cells." T cells are immune cells that work in a bunch of different ways to battle invaders in the body. One common way of using T cells is in Stem Cell Transplants. In an Allo Stem Cell Transplant, someone else's T cells are put into the cancer patient's body. The big danger is Graft Versus Host Disease, where the new T cells attack the patient's healthy cells, thinking they are invaders.

CAR-T. A more sophisticated use of T cells is through CAR-T therapies. They have been getting lots of attention lately, and for good reason. In CAR-T therapies, T cells are removed from the body, changed into something that can recognize cancer cells as the invaders that they are, and attack them. (If you want more news about CAR-T treatments and Follicular Lymphoma, go to the CAR-T and Follicular Non-Hodgkin's Lymphoma blog. They have some nice updates today.)

Monoclonal Antibodies. These are the oldest of the Immunotherapies, and Rituxan is the king. It first appeared in 1997, and it has played a huge role in increasing Survival rates in Follicular Lymphoma. There have been a lot of attempts to create a MAB that is as good as Rituxan, with little success. But that could change. For FL, an Obinutuzumab combination seems a little  better than Rituxan, and some other MABs that target different things are also being tested (like Keytruda, targeting PD-1).

Innovative Design. This group, according to the author, takes Monoclonal Antibodies "to the next level." It includes treatments like "Antibody-Drug Conjugates." Basically, you use a MAB that targets cancer cells, and add a little bit of a chemotherapy (or something like it) so the chemo gets delievered right to the cancer cell. In theory, that should mean the effectiveness of chemo but with the limited side effects that come with a targeted treatment. It also inlcudes BiTEs, or Bi-specific T-cell Engagers. These treatments involve fusing together two antibodies. there are ADCs and BiTEs that are being developed for Follicular Lymphoma, but none are very far along the trial process just yet.

B-Cell Receptors. Finally, there are B-Cell targeting treatments. These aren't really Immunotherapy treatments, but they are kind of hot right now. The target the B-Cell Receptor pathway, the chain of events that keep B-Cells alive and (if they are malignant) doing damage. of course, Follicular Lymphoma is a B-Cell lymphoma, so these treatments are especially important for us. there are some familiar names here, including Ibrutinib and Idelalisib.

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So the article provides a nice review of some of the promising developments in blood cancers, including Follicular Lymphoma. Even if you don't read the actual article, click on it and take a look at the charts, just to see how many treatments have been approved recently or are in development. It's impressive.

Of course, not all of them will work for Follicular Lymphoma, but that's OK. It's still hopeful to see how many treatments are in the works -- and this isn't even all of them.

Lots to look forward to.