Ask a Scientist Video Series

The immune system is an ecosystem within our bodies that evolved over millenia to eliminate threats to life and limb: infection, trauma, and cancer. The innate immune system contains many different players with different roles to act on threats. The adaptive immune system is the reserve players who have memory and can discern threats.

There is no reason why you can’t treat any cancer with immunotherapy. All cancers have mutations. If the mutation can be seen, an immune response can activate. In the early days, melanoma showed the most potential as an immunogenic tumor, but today, we have evidence that a whole variety of cancers can be treated with immunotherapy. Now immunotherapy is in the mainstream of cancer treatment; it will only get better as time goes on and more patients will benefit.

Yes, someone with a mild autoimmune disease should be able to receive most immunotherapies. Oncologists can work with a patient’s rheumatologist to customize a treatment plan for maximum benefit with limited adverse effects.

Yes, cancer immunotherapies may be given in combination with other immunotherapies or conventional treatments, such as targeted therapy, chemotherapy, radiation, and surgery.

PD-1 stands for Programmed Cell Death Protein 1, which is a bit of a misnomer. It is a molecule that exists predominately on the surface of T cells and acts as a brake. Tumor cells are good at evading the immune system and increase expression of PD-L1 on their cell surface, which binds to the PD-1 on the T cell, suppressing attack. PD-1/PD-L1 checkpoint inhibitors block that interaction and allow the immune system to attack in the way it should.

Clinical trials are different from regular cancer treatment. Clinical trials often test (a) drugs that are not yet approved by the FDA, (b) different combinations of drugs some of which might have already been approved by the FDA, or (c) existing FDA-approved drugs given in different schedules or different doses. Clinical trials test new ways that we hope and expect are better than conventional approaches. Some of the most promising treatments have been started in clinical trials. It’s important for patients to understand how much is known so far and ask: What are the benefits? What are the potential risks? How does this compare to a standard approach?

It’s a common fear to think “Will I feel like a guinea pig if I participate in a clinical trial?” It’s incumbent upon the doctors and treatment teams to make patients comfortable when they embark on a clinical trial. A doctor conducting a clinical trial doesn’t want any patient to feel like a guinea pig. The goal of the trial is to try to help the patient and give them access to something that may not otherwise be available. It’s important that patients feel comfortable participating. Patients should ask questions and advocate for themselves. Most patients in trials do not feel like a guinea pig.

The goal of each phase of clinical trials is different. A phase 1 trial is the first time something is being done for a patient, such as the first time a drug or drug combination is given to patients. Phase 2 trials test how effective something is in a group of patients. Phase 3 trials ask the question is a new approach better than a standard of care approach. Sometimes trial phases may blend together in modulated or combined phase trials. Discuss the pros and cons of different phase trials and the possibility of modulated or combined phase trials with your care team.

The goal of each phase of clinical trials is different. A phase 1 trial is the first time something is being done for a patient, such as the first time a drug or drug combination is given to patients. Phase 2 trials test how effective something is in a group of patients. Phase 3 trials ask the question is a new approach better than a standard of care approach. Sometimes trial phases may blend together in modulated or combined phase trials. Discuss the pros and cons of different phase trials and the possibility of modulated or combined phase trials with your care team.

Finding clinical trials is one of the most important things that patients and their care teams can do as part of the care continuum. There are many ways to find a trial. Advocate for yourself and discuss it with your oncologist or oncology nurse. If you’re near a large research center or academic institution, your care team can think about what trials may be right for you. If you’re at a smaller practice, ask your oncologist or oncology nurse if it is worth a referral to one of the large research centers. Referrals are not always necessary for clinical trials. You can also find clinical trial access programs at advocacy and resource organizations, such as the Cancer Research Institute Immunotherapy Clinical Trial Finder. The clinical trial world is complex and it’s important to talk about an individual situation in detail for what’s appropriate.

Immunotherapy is being studied for many different types of brain cancer, typically the most common brain cancers, such as glioblastoma. With more experience, promise, and benefit in common types, scientists and clinicians can move into rarer brain cancers.

Vaccine studies in glioblastoma have provided reassurance. Vaccines are given as a small injection under the skin. They have been well-tolerated with few side effects. Patients may experience redness and a little swelling at the injection site. An allergic reaction is rare and allergy medicines can mitigate those reactions.

Communicate regularly and effectively with your care team, including physicians, nurses, and research coordinators. The care team can more effectively manage and treat side effects if informed early. Maintain a healthy lifestyle to keep your immune system as strong as possible.

Clinicians treating patients with brain cancer wish to help their patients both live longer and live well: to think, keep track of things, interact with others, and do day-to-day things. Immunotherapy is not expected to have an impact on those types of brain functions. The tumor and conventional treatments can have an impact on cognitive function, so it can be difficult to tease out what the actual cause of any cognitive impairments.

Immunotherapy is believed to have an impact if used from the beginning and integrated with other standard treatments. Seek out information on clinical trials for glioblastoma after diagnosis, both locally and online, such as the Cancer Research Institute Immunotherapy Clinical Trial Finder.

The Ask a Scientist video series are part of CRI’s Answer to Cancer patient education program. If you’re interested in more Ask a Scientist video series, please contact us.