100% Success Rate: Understanding Immunotherapy in Cancer Care

Memorial Sloan Kettering Cancer Center had recently published an article regarding a clinical trial that has shown 100% success rate for the 14 patients in the study. Success in this trial means full remission. Now a lot of people have been wondering why is this such a big win or that it’s only 14 patients not THAT big deal. But it is a big deal. Whenever a trial or therapy can be repeated multiple times over in this case 14 times, it holds value to the overall treatment of a disease.

Dr. Luis Diaz and Dr. Andrea Cercek were the masterminds behind the clinical trial. Both are extremely well respected doctors at MSKCC. What made this such a successful trial?

Generally, there are two angles in maximizing cancer care. Detection and Treatment.

Find the Cancer…Then Take it Down

Today there are many ways of detection. Typically if you have predisposition to cancer, your primary care physician is the one who will lead the way and run all the necessary testing. In regular practice, you would have the following steps:

Physical Exam: Doctor checks you up, top to bottom any lumps, bumps, or abnormalities

Lab Exam: Doc runs your blood work to see if any abnormal levels appear

Imaging Exams: Doc refers you to have any scans completed to actually see the growth if there is one.

Biopsy: Nowadays Fine-Needle Aspiration (FNA) is the usual method, as it is less invasive than cutting part of the tumor. FNAs is when a syringe is inserted into a tumor or growth and fluid is extracted to be observed under the microscope.

My personal favorite is Next Generation Sequencing or NGS. NGS is when fluid is taken from the patient and undergoes genetic sequencing. Once the results are available physicians are then able to identify any genetic mutation and match to the best therapy. Certain methods, such as liquid biopsies, look for tumor shedding, where some of the tumor is released into the bloodstream.

When a blood or other fluid sample is then taken, we are able to run the sequence and find what that tumor is made of…not literally...but we know more about the tumor and hence can treat it better.

In this particular study, that is what happened. The tumors were assessed and evaluated to see if they were a match for a specific immunotherapy.

Immunotherapies are treatments that are supportive to your body’s immune system…hence the name.

Imagine this:

Your body has some rookie security guards (i.e immune cells) not by age or anything else, but more of that they have a select number of troublemakers that they deal with on a daily basis at the center (i.e. the organ). Immunotherapeutic drugs are like Lieutenants to these guards, whip ‘em up and get them into shape to tackle these new troublemakers, while also providing much needed support for the wellness of the body.

Think about it, if your body’s immune cells were capable they would have seen these mutant abnormal criminals in your body and rid them out of the body anyways, as they normally would. But, it's not their fault, these criminals are crafty, they have ID badges like the rest of the team, your immune cells would never guess.

The study identified these tumors that have a specific genetic makeup known as mismatch repair-deficient (MMRd) or microsatellite instability (MSI).

MMRd: Mismatch-repair deficiency means that there are mutations in the genes that are responsible for correcting mistakes when DNA is being copied.

So when oncologists find out that a tumor is an MMRd tumor, it opens the door for possibilities in how they would treat the cancer.

Typically when a lot of mutations occur, your immune system gets a signal that something is wrong.

Your immune system security guards are now doing the patrol and notice a lot of new faces at the center. Reasonably raises alarm and now eyes are on the criminals invading the center. When this occurs the security guards can capture these foes and get rid of them.

But…like I said before these cancer cells are tricky, these troublemakers are able to block the checkpoints that our immune system uses to identify normal and abnormal cells. Think of it like the security desk where we scan your ID and let you in. Yeah, they just swiped in with a fake ID! Thus leading these cells to hide and grow.

Immunotherapy to the rescue, PD-1 monoclonal antibodies were used over the course of 6 months.

The Lieutenant sits at the security desk and provides additional support to our immune cells. So now these bad guys are trying to swipe in but the lieutenant notices that they have a funny look about them (in the real sense, these MMRd cells are covered in mutations!). Imagine someone coming into the center but their out of dress code, or they don't have the department written on their ID badge, or their ID says “McLovin”

Once identified, these MMRd cells are targeted and removed from the body. This takes time, so one treatment every 3 weeks for 6 months was appropriate for this study. At the end of the 6 month trial these 14 lucky patients were in remission, cancer-free. The primary joy point for the study is that these patients would have undergone extensive therapies, chemotherapy, surgery, and radiation, but with this clinical trial they were able to bypass all that. The drug did not come with any extenuating side effects and gives promise for future study.

Lieutenant immunotherapy and his team of skilled immune cell security guards, have entered the center early, and identified all the sneaky criminals at the center. The security guards were now hyper aware of these strange intruders and caught them where they found them. The team invaded their secret base and took them all out. Their base has been dismantled and balance is now restored in the center.

Lessons learned here:

1. Get Screened Early! Have regular visit with a primary care physician

2. Support cancer research! Next generation sequencing and other methodologies in the detection and treatment of tumors

3. Immunotherapy holds great promise for the future of cancer therapy.

4. Stay informed and aware. The first step in cancer treatment is to be educated about it.

Read the original press release from Memorial Sloan Kettering Here: https://www.mskcc.org/news/rectal-cancer-disappears-after-experimental-use-immunotherapy

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