Cancer is a broad term used to describe the uncontrollable proliferation of mutated cells deleterious to the body. Any tissue in the body can become mutated and drive tumor progression. Unfortunately, each cancer type is different and requires specific treatments. As a result, standard-of-care is dependent on the location and stage of cancer. In the last two decades immunotherapy has been developed to effectively target hematological and solid tumors. However, the field of immunotherapy still has a long way to go to completely cure patients of cancer.
Immunotherapy is a type of treatment that redirects the immune system to recognize and target cancer cells. There are many different approaches, but most immunotherapies are designed to enhance T cell response. T cells are specific immune cells responsible for the elimination of infected cells. Their primary role is to get rid of infection and disease. Other immunotherapies work on mitigating immune suppression to allow T cells to properly function. Therefore, the overall goal of immunotherapy is to activate an immune response and enhance anti-cancer T cell activity.
A common form of cancer treatment includes surgery combined with chemotherapy. Additional therapy is needed after surgery to ensure all the cancer is eliminated. However, tumors recur even after this combination regimen. Currently, scientists are working out a schedule to enhance surgical success by administering chemotherapy or immunotherapy at different timepoints.
A recent article in the Journal of Clinical Oncology, by Dr. Rodabe N. Amaria and others, demonstrated that therapy administered before and after surgery resulted in significantly longer survival rates in a cohort of 30 patients. Specifically, two immunotherapies given both prior to and following surgery in patients with stage III melanoma resulted in a majority of patients remaining tumor-free for four years post operation. Amaria is a physician-scientist and Assistant Professor at The University at Texas, MD Anderson Cancer Center. Her work focuses on improving immunotherapies and conducting clinical trial research to enhance standard-of-care in patients with solid tumors.
Amaria and her team treated patients with two different immunotherapies before and after they had their tumors removed. Physicians then followed-up with patients from this Phase II clinical trial. Researchers found that 87% of patients with stage III melanoma that received this treatment regimen were alive four years later. Administering therapy before surgery generates an antitumor response that reduces tumor size before surgery. Further treatment post-surgery eliminates any residual tumor cells. Robust antitumor activity minimizes the chances of recurrence. This discovery provides hope that combination therapy given at critical points of surgery can enhance survival.
Stage III melanoma is highly aggressive with a high recurrence rate. Therefore, the long-term benefit by changing the regimen schedule is groundbreaking. Researchers also discovered an array of surface markers that can serve as biomarkers of disease progression. These markers can be used in the future to better predict patient response to treatment and tailor therapies to different individuals. The idea of personalized medicine can improve treatment efficacy. This study highlights the impact of incorporating multiple ideas of cancer research and applying them to the clinic to improve patient outcomes. Overall, Amaria and others have expanded standard-of-care therapy and developed potential biomarkers to further enhance treatment efficacy in the future.
Article, Journal of Clinical Oncology, Rodabe N. Amaria, The University at Texas, MD Anderson Cancer Center
