Unlike chemotherapy or targeted therapy, immunotherapy acts slightly differently, since it does not directly affect the tumor, destroying it, but helps the immune system recognize cancer cells for subsequent destruction. Immune therapy blocks the signals that a cancer cell emits against the immune system. Thus, the immune system, without hearing the signals that tricked it into a normal cell, can destroy a cancer cell.
The most commonly used immunotherapy:
Pembrolizumab or Nivolumab are monoclonal antibodies that are directed against the PD1 protein expressed in T lymphocytes. By blocking the messages between PD-1 and PD-L1 that are expressed on cancer cells, these antibodies block the cancer cell inhibitor signal directed towards T lymphocytes ( killer cells CD8 +). This allows to reactivate killer cells against cancer cells. Indications for such therapy are metastasized small cell lung cancer, melanoma, and oncology of ENT organs. This treatment can be both first and second line, can be carried out in conjunction with chemotherapy or separately.
Monoclonal antibodies that are directed against PDL-1 also inhibit the interaction of PD1 / PDL1 (Atezolizumab, Durvalumab, Avelumab). These proteins are expressed on tumor cells.
They are used in stage III (locally advanced) or metastatic lung cancer or in second-line urothelium cancer.
There is also another class of anti-CTLA 4 immunotherapy (Ipilimumab) that blocks the molecular interaction of CTLA4 / B7 between dendritic cells and T lymphocytes. This CTLA4 / B7 signal blocks the immune response. By inhibiting this blocking signal, we activate the immune system. Such treatment is used in combination with PD1 / PDL1 inhibitors for melanoma.
Side effects are quite rare: distyroidism (biological monitoring of TSH and T4), digestive problems (diarrhea), liver problems (increased AST and ALT, liver cytolysis), kidney problems (renal failure, biological monitoring of creatinine), pneumonia, skin rash (vitiligo).
For some patients, immunotherapy may be combined with stereotactic radiotherapy for one or more cerebral or extracerebral (pulmonary, hepatic or bone) metastases.
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