Transcript Your Cancer Treatment

YOUR CANCER
TREATMENT:
WHAT TO EXPECT FROM THE LATEST ADVANCEMENTS
MIRIAM J. ATKINS, M.D.
IMMUNOTHERAPY
• Vaccines – stimulate the immune system against tumor antigens (Sipucel-T)
• Cytokines – stimulate broad based immune response (interferon alpha)
• Oncolytic Virus Therapy – genetically modified viruses to kill cancer cells (T-VEC)
• Monoclonal Antibodies – therapy designed to attach to specific proteins in a cancer cell
IMMUNE SYSTEM TERMINOLOGY
• T-cells – patrol the body searching for signs of disease or infection
• B-cells – bind to specific antigens and initiate an antibody response
• Cytotoxic T-lymphocyte Associated Protein 4 (CTLA-4) – located on the surface of Tcells in certain cancers
• Programmed Death 1 (PD-1) – inhibitory receptor expressed by T-cells ln certain tumors
• Programmed Death Ligand 1 (PDL-1) – maintain immune homeostasis. Bind to receptors
on T-cells
WHAT ARE CHECKPOINT INHIBITORS
• Drugs, often made of antibodies
• Block normal proteins on cancer cells
• Block proteins on T cells that respond to cancer cells
• Seek to overcome one of cancer’s main defenses of immune system attack
HOW CHECKPOINT INHIBITORS WORK
CHECKPOINT INHIBITORS
• Specific indications
• Not used as first line treatment except Ipilimumab for Melanoma
• Well tolerated but can have serious side effects
NEW AGENTS (CHECKPOINT INHIBITORS)
• Pembrolizumab (Keytruda) – PD-1 blocking antibody (inhibitor) approved for treatment
of Melanoma and Non-small cell lung cancer
• Nivolumab (Opdivo) – PD-1 inhibitor approved for treatment of Non-small cell lung
cancer, Melanoma, and Renal Cell Carcinoma
• Ipilimumab (Yervoy) – antibody against CTLA-4 approved for treatment of Melanoma
PEMBROLIZUMAB
• Non-small cell lung cancer that expresses PDL-1 with disease progression after platinumcontaining chemotherapy regimen
• After treatment with agents for cancers with EGFR or ALK genomic tumor aberrations
NIVOLUMAB
• Metastatic Non-small cell Lung cancer with progression after platinum-based
chemotherapy
• Metastatic non-small cell lung cancer after therapy with EGFR and ALK inhibiting agents,
if the patient has these genomic aberrations
• Metastatic or unresectable Melanoma in combination with Ipilimumab in patients with
BRAF wild-type
• Advanced Renal Cell Carcinoma who have received anti-angiogenic therapy
IPILIMUMAB
• Monoclonal antibody that stimulates the immune system by targeting CTLA-4
• Cytotoxic T Lymphocytes (CTLs) recognize and destroy cancer cells
• Turns off the inhibitory mechanism and allows the CTLs to function
• Approved for the treatment of melanoma
CHECKPOINT INHIBITORS
• Very effective
• Well tolerated
• Different measurement of response
• Can have serious, late side effects
TUMOR RESPONSE TO IMMUNOTHERAPY
• Depends on how well your immune system can target the cancer cells
• Immunotherapy my help shrink the tumor
• Slow the growth of the tumor
• Stop the active growth of the tumor
• The tumor may look larger on the initial scans
RESPONSE TO IMMUNOTHERAPY (PSEUDOFLARE)
SIDE EFFECTS (-ITIS)
• Pneumonitis
• Colitis
• Hepatitis
• Nephritis
• Encephalitis
• Endocrinopathies (Diabetes, Hypothroid)
• Rash
PNEUMONITIS
• Radiograhpic changes
• New or worsening cough
• Chest pain
• Shortness of breath
• Treat with steroids
COLITIS
• Diarrhea
• Bloody stools
• Severe stomach or abdominal pain
• Treat with steroids or Infliximab, if severe
HEPATITIS
• Elevated liver function tests or bilirubin
• Jaundice
• Nausea and vomiting
• Right sided abdominal pain
• Treat with steroids
ENDOCRINOPATHIES
• Hypo/hyperthyroidism
• Diabetes
• Adrenal insufficiency
• Headaches, extreme fatigue, weight gain or loss, dizziness, mood changes hair loss
increased thirst or urination
• Treat with steroids, insulin, thyroid hormone replacement, etc.
NEPHRITIS
• Increase creatinine
• Decrease urine output
• Swelling in ankles
• Loss of appetite
• Blood in urine
• Treat with steroids
SKIN TOXICITY
• Rash
• Itchy skin
• Blisters
• Mouth ulcers
• Treat with steroids
ENCEPHALITIS
• Headache, confusion, hallucinations
• Fever
• Tiredness or weakness, sleepiness
• Seizures
• Stiff neck
• Treat with steroids
CONCLUSIONS
• Check point inhibitors are part of the future of cancer treatment
• Using the immune system to fight cancer is a novel concept
• Ongoing clinical trials with many tumor types
• Well tolerated but, can have serious late side effects
• Do not hesitate to contact your physician if you are being treated with these medications
and have what appears to be minor side effects
QUESTIONS??
THANK YOU