Five Things to Know When Considering Immunotherapy

When former U.S. President Jimmy Carter credited immunotherapy for beating his cancer in 2015, it was a game-changing moment that brought this innovative treatment into the spotlight as the fourth pillar of cancer care. By tapping into the immune system’s incredible ability to fight cancer, immunotherapy has since become a powerful option for treating many types of the disease.  

However, there are certain factors regarding immunotherapy efficacy, or effectiveness, to be aware of when a person is considering immunotherapy treatment for themselves or a loved one. 

1 – Immunotherapy is More Effective with Certain Cancers 

Certain cancers have demonstrated over time that they are more receptive to immunotherapy treatment. They include, but are not limited to: lung, head and neck, and bladder cancer. Other cancers, like that of the pancreas and brain, present unique challenges that CRI scientists are striving to overcome. 

Gavin Dunn, MD, PhD, CRI Lloyd J. Old STAR, director of the Center for Brain Tumor Immunology and Immunotherapy at Mass General Brigham, and associate professor at Harvard Medical School, has firsthand knowledge of the difficulties associated with treating glioblastoma, the deadliest brain cancer. 

“The brain is unique compared to other areas in the body, and we do not have a sufficiently comprehensive understanding of how glioblastoma cells can be recognized effectively by immunity,” Dr. Dunn said. “Unlocking this pathway is absolutely critical as we consider better therapies.” His research is focused on understanding how the immune response develops to brain tumors like glioblastoma, which is critical for creating better therapies. 

2 – Immunotherapy can Take Time to be Effective 

Cancer immunotherapy trains and/or guides the immune system and its army of cancer-fighting cells to identify and eliminate invasive tumor cells. As all types of immunotherapy treatments rely on the strength of patient’s immune system, it may take some time to show complete effect depending on the preparedness of the host immune system. 

Jedd Wolchok, MD, PhD, the Meyer Director of the Sandra and Edward Meyer Cancer Center, professor of medicine at Weill Cornell Medicine, CRI Clinical Accelerator Chair, CLIP Grant Review Committee member, CRI Clinical Leadership Committee member, and associate director of CRI’s Scientific Advisory Council, spoke at CRI’s 2023/2024 CRI Patient Immunotherapy Summit and discussed why the treatment timetable can vary. Dr. Wolchok said that just like starting a car, multiple actions are required to properly activate the immune system against cancer. 

“The same type of analogy is true for the immune system,” he explained. “We have very specific locks or key pods that control the immune system that turns on only when it sees a target of interest. We also have accelerator pedals called activation pathways that get the immune system moving more quickly, and we also have brakes.” 

Additionally, immunotherapy can require patients to take a break between rounds of treatment to maximize and monitor efficacy. An individual’s cancer type and progression can affect the immunotherapy efficiency. Immunotherapy progress can be tracked through scans produced by a patient’s medical team. 

3 – Your Diet can Impact Immunotherapy Progress 

The makeup of one’s diet can greatly impact the effectiveness of immunotherapy. Thanks to research led by Jennifer Wargo, MD, professor of surgical oncology and genomic medicine, leader of the Platform for Innovative Microbiome and Translational Research (PRIME-TR) of the University of Texas MD Anderson Cancer Center, and CRI Scientific Advisory Council member, we know that dietary fiber and probiotics can positively impact immunotherapy efficacy for melanoma patients. Other evidence demonstrates certain dietary components such as vitamins, polyphenolic compounds like resveratrol, and curcumin can enhance the effect of immunotherapy by modulating the immune system’s response. The specificities of one’s diet and bacteria in the gut microbiome can also impact cancer immunotherapy treatment’s efficacy.

“Our intestinal tract is home to a lot of diverse bacteria, many beneficial and necessary,” Tal Danino, PhD, Associate Professor in the Department of Biomedical Engineering at Columbia University and CRI Lloyd J. Old STAR, told CRI in a previous interview. “In addition to helping us digest food, these bacteria interact with and help educate the immune system in complex ways. They can also impact cancer and how it responds to treatment.” 

4 – Pre-Existing Conditions 

Those with pre-existing conditions might not be able to pursue immunotherapy as a cancer treatment avenue. Specifically, patients with an autoimmune disease or an otherwise suppressed immune system are not always viable candidates for immunotherapy or clinical trials. There are some instances where combination immunotherapy, for example, can cause flare-ups in patients with pre-existing rheumatologic and gastrointestinal disorders. Physicians and immunologists are well-equipped to answer specific questions regarding pre-existing conditions when someone is considering immunotherapy treatment. 

5 – Prior Treatments’ Impact 

In some cases, immunotherapy treatment can provide complications for a person who has previously received other forms of cancer treatment. However, it is important to remember prior treatments do not have a one-size-fits all impact on immunotherapy. For some patients, immunotherapy can be a lifeline where previous treatments have failed. This is evident in April 2023 research from the University of California, Los Angeles (UCLA) that documented how prior CTLA-4 blockade therapy is associated with differences in the tumor microenvironment that can positively influence the predictive features for PD-1 blockade therapy response for patients with advanced melanoma.  

Antoni Ribas, MD, PhD, director of the Tumor Immunology Program at the UCLA Jonsson Comprehensive Cancer Center, director of the Parker Institute for Cancer Immunotherapy Center at UCLA, and CRI Scientific Advisory Council member, was the co-senior author of this research. “Our study supports how these therapies may work together to effectively treat melanoma,” he told UCLA. “It also highlights the importance of a patient’s prior treatment history as a modifying factor to consider when planning a treatment strategy.” 

Dr. Wolchok and Stephen F. Hodi, MD, Director of the Melanoma Center and the Center for Immuno-Oncology at Dana Farber Brigham and Women’s Cancer Center, the Sharon Crowley Martin Chair in Melanoma at Dana Farber Cancer Institute, professor of medicine at Harvard Medical School, and CRI Scientific Advisory Council member, also contributed to this research. 

With 45% of all newly diagnosed cancer patients, or nine million people eligible, CRI firmly believes immunotherapy is the most promising form of cancer treatment available today. This is why CRI is passionate about fueling the discovery and development of powerful immunotherapies for all cancers. It nonetheless important for us to communicate with you the factors that can contribute towards this treatment’s effectiveness. Armed with this knowledge, we are collectively one step closer to creating a world immune to cancer.