immunotherapy Center istanbul Turkiye
Acting on the immune system to fight the disease
Since 2010, immunotherapy has experienced a phenomenal boom in the field of cancer. (immunotherapy center Istanbul Turkey) Instead of directly attacking tumor cells as chemotherapy or radiotherapy do, this therapeutic approach consists of activating the patient’s immune system, to help it recognize cancer cells and lead to their destruction. Several strategies are already used in the treatment of different cancers, and ongoing research will expand the possibilities. An important point to resolve remains that of identifying patients in whom these treatments will give good results
Understanding Cancer immunotherapy
Immunotherapy acts on a patient’s immune system to help them fight their disease. In the case of cancer, it does not directly attack the tumor, but stimulates the immune cells involved in recognizing and destroying tumor cells.
Immunotherapy (Immunotherapy Center Istanbul Turkey) has experienced a boom in cancerology over the past ten years, thanks to the explosion of fundamental knowledge on cancer immunology. Indeed, this disease is no longer considered solely from the point of view of the tumor, but also from that of its environment in the body and its interactions with the immune system. We now know that it is by manipulating this whole that tumor cells manage to proliferate out of control. By understanding better and better how they proceed, researchers can now propose new therapeutic solutions.
Cancer cells scramble immune system signals
Cancer cells exhibit profound genetic alterations that allow them to acquire malignant properties. They express specific molecules on their surface—tumor antigens—that distinguish them from healthy cells and are capable of inducing immune reactions that should theoretically lead to their elimination (see box). But as the disease progresses, cancer cells continue to transform and adapt to their environment to exploit it to their advantage and continue to multiply.
Thus, certain immunogenic tumor antigens cease to be expressed: this phenomenon allows tumor cells to escape surveillance by the immune system. Malignant cells also begin to produce new proteins that inactivate the body’s defenses. From then on, the tumor microenvironment is generally immunosuppressive.
Cancer immunotherapy aims to “wake up” the immune system “put to sleep” by the disease and educate it so that it is able to eliminate cancer cells. This approach is based on the use of different tools: monoclonal antibodies, immunomodulators, therapeutic vaccination, etc.
The key mechanisms of the anti-tumor immune response:
The mechanisms involved in the anti-tumor response of our immune system are numerous and complex. However, one of them is fundamental: it relies on dendritic cells, which recognize tumor antigens and present them to T lymphocytes in the lymph nodes in order to activate them. These lymphocytes then join the tumor microenvironment and specifically eliminate the cancer cells carrying these antigens. This response, called “adaptive”, is accompanied by a “memory” response that improves the reactivity of the immune system in the event of a new encounter with the tumor antigen. At the same time, the antitumor response mobilizes many other cell types: other antigen-presenting cells, B lymphocytes, NK (natural killer) cells and even cells producing molecules involved in inflammation such as cytokines.
Use of immunotherapy in neoadjuvant
Immunotherapies have so far been developed to treat advanced cancers, when more “conventional” treatments do not work. However, with the progress of knowledge and their use in the clinic, the place of these treatments is evolving towards earlier use. The NICHE-2 trial showed the significant benefit of using immunotherapy before surgery, to reduce the size of the tumor (neoadjuvant treatment). Patients with untreated rectal cancer received nivolumab and ipilimumab before surgery. Out of 107 patients, 95% saw their tumor shrink by more than half, and in two thirds of cases, the primary tumor had completely disappeared: an exceptional result. This trial is continuing: the researchers will evaluate the survival of patients three years after treatment.
Eventually, clinicians are considering combining immunotherapies with each other and with other treatments (chemotherapy, targeted therapy or radiotherapy).
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