What is Immunotherapy, and how does it work in treating sarcoma?
Immunotherapy is a type of cancer treatment that helps the immune system recognize and fight cancer cells. Immunotherapy is different from chemotherapy and radiation therapy, which directly target cancer cells. Immunotherapy targets the immune system, which then attacks the cancer cells.
Immunotherapy Approaches
- Immune Checkpoint Inhibitors (ICIs): Antibodies targeting proteins like PD-1, CTLA-4, and LAG-3 to enhance immune response.
- Ex Vivo Manipulation of Immune Cells: Examples include CAR-T cells and tumor-infiltrating lymphocytes (TILs).
- Redirecting Endogenous Immune Cells: Using target-specific proteins like bispecific T cell engagers, oncolytic viruses, personalized tumor vaccines, and cytokines.
Why is Immunotherapy Important in Sarcoma Treatment?
Immunotherapy is important in sarcoma treatment because it offers several benefits, including: Improved treatment options for patients with advanced or metastatic sarcoma, potential for long term responses and survival, fewer side effects compared to traditional chemotherapy, ability to target specific molecular mechanisms that drive sarcoma growth.
Immunotherapy is not yet a standard treatment for sarcoma, but it is being explored in various clinical trials. Some immunotherapy agents have been approved for specific types of sarcoma like Leiomyosarcoma, Synovial sarcoma, undifferentiated pleiomorphic sarcoma, alveolar soft tissue part sarcoma
In trials like SARC028 – pembrolizumab showed encouraging activity in patients with undifferentiated pleomorphic sarcoma or dedifferentiated liposarcoma. Median follow-up was 17·8 months. 7 out of 40 patients (18%) had a positive response to pembrolizumab
Patients with a specific type of sarcoma called undifferentiated pleomorphic sarcoma did particularly well, with 4 out of 10 patients (40%) responding positively.
This means that pembrolizumab might be a helpful treatment option for some people with soft-tissue sarcoma.
What Role Does Immunotherapy Play in Sarcoma?
Immunotherapy plays a crucial role in sarcoma treatment by:
Benefits of Immunotherapy in Sarcoma Treatment
1. Improved Survival Rates: Immunotherapy has been shown to improve overall survival rates in patients with advanced sarcoma.
2. Enhanced Quality of Life: Immunotherapy can help reduce symptoms and improve quality of life for patients with sarcoma.
3. Targeted Treatment: Immunotherapy can target specific cancer cells, reducing harm to healthy tissues.
4. Potential for Long-Term Remission: Immunotherapy can induce long-term remission in some patients with sarcoma.
Immunotherapy can be used alone or in combination with other treatments, such as surgery, chemotherapy, and radiation therapy.
In Which Types of Sarcoma is Immunotherapy Used?
Immunotherapy is being explored in various types of sarcoma, including: Soft tissue sarcomas like Leiomyosarcoma, Synovial sarcoma, undifferentiated pleiomorphic sarcoma, alveolar soft tissue sarcoma
Some sarcoma subtypes may be more responsive to immunotherapy than others. Immunotherapy can be used in early stages or advanced/metastatic sarcoma.
A metaanalysis of 27 studies of ICI in sarcomas showed different response rates for various types of sarcoma cancers: Good response rate was observed Classic Kaposi sarcoma (69%),Alveolar soft part sarcoma (35%), Undifferentiated pleomorphic sarcoma (20%)
Several immunotherapy drugs are being explored for sarcoma treatment, including:
– Checkpoint inhibitors (e.g., pembrolizumab, nivolumab)
– Cytokines (e.g., interleukin-2)
– Cancer vaccines
– Adoptive T-cell therapy
These drugs can be administered orally, intravenously, or subcutaneously.
What are the Side Effects of Immunotherapy?
Immunotherapy side effects can include:
– Fatigue
– Rash
– Nausea and vomiting
– Deranged LFT
– Infusion related reactions.
-Endocrinopathies (hypothyroidism, hyperthyroidism, adrenal insufficiency, diabetes mellitus,
hypophysitis)
-Colitis
-Pneumonitis
These side effects can be different from chemotherapy side effects and are often managed with immunosuppressive medications or supportive care.
Is Immunotherapy Expensive?
Yes, immunotherapy can be expensive. The cost varies depending on the specific treatment, location, and insurance coverage.
– Approximate Cost: The cost of immunotherapy can range from $100,000 to $300,000 per year.
– Financial Assistance Programs: Many pharmaceutical companies offer financial assistance programs
– Insurance Coverage: Immunotherapy is often covered by insurance, but coverage varies depending on the specific treatment and insurance plan.
Does Immunotherapy Require Hospitalization?
Immunotherapy is often administered on an outpatient basis, but hospitalization may be required in some cases.
– Outpatient Treatment: Most immunotherapy treatments are given in a clinic or infusion center.
– Typical Session Length: Treatment sessions can last anywhere from 30 minutes to several hours, depending on the specific treatment.
How effective is immunotherapy for sarcoma?
Immunotherapy has shown promising results in treating sarcoma, with response rates varying depending on the specific treatment and patient population.
– Success Rates: Response rates for immunotherapy in sarcoma patients range from 10% to 40%.
– Time to See Results: The time to see results from immunotherapy can vary, but responses are often seen within 2-6 months of treatment.
Is there any eligibility criteria for immunotherapy? Can every sarcoma patient receive immunotherapy?
1. Atezolizumab (Tecentriq): Targets PD-1/PD-L1 pathway; approved for alveolar soft part sarcoma (ASPS).
2. Dostarlimab (Jemperli): Targets PD-1/PD-L1 pathway; approved for advanced sarcoma with DNA mismatch repair deficiency (dMMR).
3. Pembrolizumab (Keytruda): Targets PD-1/PD-L1 pathway; approved for advanced sarcoma with high microsatellite instability (MSI-H), dMMR, or high tumor mutational burden (TMB-H).
Are there specific health conditions that may prevent its use?
Yes, certain health conditions may prevent its use, such as autoimmune disorders, organ transplantation, or active infections, pregnant patients, endocrine abnormalities
Can immunotherapy be used alongside other treatments?
Yes, immunotherapy can be used alongside other treatments, like chemotherapy, radiation, or surgery.
Is it safe to combine immunotherapy with chemotherapy, radiation, or surgery?
Generally, yes, but combination therapy can enhance treatment effectiveness and may also increase side effects.
What Lifestyle Changes are recommended during immunotherapy
1. Are there specific diet or activity recommendations during immunotherapy?
Yes, a healthy diet rich in fruits, vegetables, and whole grains can support the immune system during treatment.
2. How can patients support their immune system during treatment?
Patients can support their immune system by getting regular exercise, practicing stress-reducing techniques, and getting enough sleep.
How long does immunotherapy treatment last?
Is it a lifelong treatment or limited to a certain duration?
Immunotherapy treatment duration varies, depending on the specific treatment, cancer type, and individual response.
Usually given until disease progression or unacceptable toxicity
How often are treatment cycles given?
Every 3 weeks