More Essential Information About Cancer Chemotherapy

There are currently four checkpoint inhibitors that are approved for use in treating cancer in the United States and many other countries. The drugs are Keytruda (pembrolizumab), by Merck, Yervoy (ipilimumab) and Opdivo (nivolumab), made by Bristol-Myers Squibb, and Tecentriq (atezolizumab), by Genentech. In the United States, not every kind of immunotherapy is covered by insurance, but these four drugs are. Opdivo is even heavily advertised on TV. Checkpoint inhibitors are approved for treatment of melanoma, Hodgkin's lymphoma, and cancers of the bladder, lungs, kidneys, and head and neck. They are being tested for many other forms of cancer.

What About Cell Therapy?

Checkpoint inhibitors have an action analogous to taking your foot off the brakes of your car, while cell therapy acts something like pressing down on the accelerator. In cell therapy, some of the patients white blood cells are removed and then genetically modified. They are cultured so more white blood cells can be returned than were withdrawn. Patients get IVs of their own genetically modified white blood cells like a transfusion. Each batch of cells has to be individually modified for the specific patient from their own cells.

Cell therapy is primarly used for leukemia and lymphoma, with 25 to 90 percent response rates. Some patients will stay well for years and years, but others will relapse in just a year.

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Bispecific Antibodies

Bispecific antibodies are genetically engineered so that they "stick" to both a T-cell (white blood cell) circulating in the bloodstream and a cancer cell. The antibody "glues" a white blood cell to cancer so the cancer is destroyed. In the United States, there is one drug in this class approved for fighting a rare form of leukemia. The drug is called Blincyto.

Vaccines Are Part of Cancer Immunotherapy, Too

Certain vaccines are used for treating specific cancers. Unlike vaccines used to prevent infections, vaccines for cancer are given after cancer has been diagnosed to stimulate the immune system. Vaccines for cancer are not widely accepted. The only vaccine approved in the United States for treating cancer is Provenge, used for treating prostate cancer. It is successful in only a minority of cases, and extends life for months, not years. In some other countries the BCG vaccine, which is primarily used to prevent tuberculosis, is used to treat bladder cancer. It stimulates the immune system in specific ways that enable it to attack this cancer, but not other forms of cancer.

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Are There Side Effects from Cancer Immunotherapy?

Checkpoint inhibitors can cause the immune system to act a little too well. The immune system does its job by generating inflammation. These drugs can cause breathing problems and diarrhea. They can trigger inflammation that causes joint and muscle pain or even rheumatoid arthritis. Taking two checkpoint inhibitors at the same time to fight cancer can sometimes cause severe damage to the heart, or damage the thyroid and/or pituitary gland. These effects can be minimized with the use of steroid drugs like Prednisone, but steroid drugs cause their own side effects.

Cell therapy can cause potentially fatal overstimulation of the immune system that has to be treated in the ICU.

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How Much Does Cancer Immunotherapy Cost?

The cost of checkpoint inhibitors is usually around $150,000 a year, although insurance will usually cover it (although Medicaid sometimes will not). Cell therapy, when it is approved, will cost $300,000 to $500,000 a year in the United States, but will also be covered by insurance. Other forms of cancer immunotherapy may cost $90,000 a year and up.

Any oncologist will be able to explain and if appropriate prescribe cancer immunotherapy. Oncologist offices will usually work with their patients to make sure they stay on the right insurance plans to get their treatment covered. If you can't afford treatment, you may be able to get free drugs by participating in a clinical trial. Links to two sources of information about clinical trials are posted at the end of this article. However, if you participate in a clinical trial, you may get either the investigational drug or a placebo. You will not know which, and neither will your doctor.