In 2020 while I was in remission, I heard a podcast on ABC’s Conversations about The Secret Life of the Plover. Andrew Darby, the author of the book Flight Lines, spoke of his journey of being diagnosed with Stage IV Lung Cancer while writing the book. Chasing the summer, grey plovers travel up to 12,000 kilometres to breed in the arctic each year before returning to Australia for a southern summer. Their ultramarathon flights and tenacity are analogous to the long-term treatment for cancer.
What put the hook into me was hearing about his success with a new treatment for cancer called immunotherapy. I tucked this snippet of information away in my memory bank. A year later, when I was diagnosed with Stage IV cancer, I recalled Andrew’s podcast. When my oncologist mentioned that I could go on immunotherapy, I was immediately hopeful. Knowing that I would get immunotherapy kept me focused during my second chemo treatment.
Immunotherapy is a relatively new cancer therapy that is more targeted than chemotherapy. Although it can also have serious side effects, it is generally better tolerated. Immunotherapy supports your immune system to keep cancer inactive after successful chemotherapy. It doesn’t work for everyone or all cancers. I was lucky that bladder cancer was one of them.
In some ways, immunotherapy is like the breakthrough of maintenance drugs in prolonging the life of patients with HIV. Once a death sentence, modern HIV drugs can allow patients to live a long and normal life. In the same way, immunotherapy can give cancer patients renewed hope.
This post examines the history of immunotherapy, what it is and my experience.
A short history of immunotherapy
Immunotherapy, aiming to boost natural defences to eliminate malignant cells, is a cancer treatment that has revolutionised the field of oncology. For most people, immunotherapy is a relatively new concept. It certainly was for me. However, the history of immunotherapy goes back centuries.
Traditional immunotherapy approaches cancer by harnessing bacterial or viral infection to enhance immune responses. In 1891, William Coley used the immune system to treat cancer after noticing that bacteria could cause tumour regression in sarcoma patients. In 12 patients, the carcinoma completely disappeared and, in others, substantially improved.
With the development of checkpoint inhibitors in 2011, immunotherapy drugs began to develop into standard-of-care treatment for some cancers.
In 2018, an American and a Japanese immunologist received the Nobel Prize in Physiology or Medicine for their work in immunotherapy.
How does cancer immunotherapy work?
In recent years immunotherapy has revolutionised cancer treatment. Several types of immunotherapy, including adoptive cell transfer (ACT) and immune checkpoint inhibitors (ICIs), produce clinical responses in patients. However, immunotherapy’s success rate is highly variable between different forms of cancer.
Cancer immunotherapy stimulates the immune system to treat cancer by improving the immune system’s natural ability to fight the disease. Immunotherapy uses the fact that cancer cells have tumour antigens – molecules on their surface detected by the antibody proteins of the immune system. Normal antibodies bind to external pathogens, but the modified immunotherapy antibodies bind to the tumour antigens marking and identifying the cancer cells for the immune system to inhibit or kill.
Immunotherapy for Bladder Cancer
Immunotherapy for bladder cancer uses drugs to help a person’s immune system recognise and destroy cancer cells. It is typically used following chemotherapy treatment for Stage IV patients. Immune checkpoint inhibitors are the most common immunotherapy treatment for bladder cancer.
What are Immune checkpoint inhibitors?
An essential part of the immune system is its ability to keep itself from attacking normal cells in the body. It uses “checkpoints” immune cells proteins that turn on or off to start an immune response. Cancer cells use these checkpoints to stop being attacked by the immune system. Immunotherapy drugs that use these checkpoints can restore the immune response against cancer cells. There are two major types of checkpoint inhibitors used to treat bladder cancer.
PD-1 and PD-L1 inhibitors
PD-L1 drugs target cancer cell proteins that keep the immune system from attacking them. These drugs can boost the immune system’s response to cancer cells by blocking the PD-L1 protein. This can shrink some tumours or slow their growth.
Other drugs target PD-1 proteins. PD-1 proteins act on T cells to keep these cells from attacking other cells. Blocking PD-1 allows the immune system to attack cancer cells. This method can also shrink or slow tumour growth.
The following describes the different scenarios to treat bladder chance with immunotherapy:
- Atezolizumab (PD-L1) and pembrolizumab (PD-1) are used for people who can’t take chemotherapy cisplatin due to hearing loss, kidney failure, or heart failure
- Avelumab (PD-L1) used as a maintenance treatment for advanced bladder cancer that did not get worse during initial chemotherapy treatment. Avelumab is the immunotherapy drug I am currently on.
- Pembrolizumab (PD-1) can treat bladder cancer that is not growing into the bladder’s muscle wall without a cystectomy
- Nivolumab (PD-1) used for people with invasive bladder cancer who have the bladder removed but are at high risk of recurrence
I receive avenlumab intravenously through my portacath every two weeks. It takes an hour for each infusion. One oncology nurse described it as lolly water in comparison to chemotherapy. My treatment is running for twelve months. I live a normal active life between sessions with none of the chemotherapy-related issues.
Possible side effects
Unlike chemotherapy, there may be no noticeable side effects. I have not experienced any of the following common side effects.
- Fatigue
- Nausea
- Loss of appetite
- Fever
- Urinary tract infections (UTIs)
- Rash
- Diarrhea
- Constipation
Less often, more severe side effects can occur:
Infusion reactions: Some people have an infusion reaction while receiving immunotherapy. This is like an allergic reaction, including fever, chills, flushing of the face, rash, itchy skin, dizziness, wheezing, and trouble breathing. At the end of my first session, I experienced chills and headaches. I now take two Panadol an hour before each session. It sounds scary, but I’ve had no issues since the first time.
Autoimmune reactions: Checkpoint inhibitors work by removing one of the safeguards of the body’s immune system. Sometimes the immune system starts attacking other body parts. This can cause severe or life-threatening problems. You may receive steroids to suppress your immune system if autoimmune reactions occur and stop treatment. Autoimmune reactions are rare. Monthly blood tests that check thyroid function and other markers mitigate this risk.
How can you help yourself to maximise the benefit of immunotherapy?
Understanding that you can directly influence the outcome of immunotherapy treatment is essential. The science shows that the microbiome, exercise, diet and supplements can directly influence treatment outcomes by supporting your immune system’s response to immunotherapy.
I have documented these strategies in posts available here:
- Get moving
- The best diet for cancer prevention and treatment
- The best supplements for cancer treatment
- Diet the gut microbiome and cancer
Conclusion
Access to immunotherapy has provided me with a lifeline for which I’m grateful daily. There are also specific strategies that maximise the benefits of immunotherapy you can implement. You can look forward to leading a normal life beyond treatment when used with the proper diet, exercise and supplements.
References
- The secret life of the Grey Plover; Available at URL: https://www.abc.net.au/radio/programs/conversations/andrew-darby/12004812
- The history and advances in cancer immunotherapy: understanding the characteristics of tumor-infiltrating immune cells and their therapeutic implications; Available at URL: https://www.nature.com/articles/s41423-020-0488-6#:~:text=The%20earliest%20case%20of%20cancer,cause%20tumor%20regression%20in%20sarcoma
- Immunotherapy for Bladder Cancer; Available at URL: https://www.cancer.org/cancer/bladder-cancer/treating/immunotherapy-for-bladder-cancer.html
