Immunotherapy for pancreatic cancer

Post by Master, Doctor Mai Vien Phuong - Gastrointestinal Endoscopy - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital.

Currently, much research is progressing rapidly and it is likely that immunotherapies for pancreatic cancer will continue to improve. As such, we may be one step closer to an effective, long-term treatment for pancreatic cancer.

There is an urgent need for improved treatment options for pancreatic cancer (K ​​pancreatic cancer). This is a particularly difficult cancer to treat, even in its early stages. In the United States, it is also the fourth leading cause of cancer death.
The most effective treatment is surgical removal of all or part of the pancreas. Unfortunately, less than 20% of people with pancreatic cancer qualify for surgery.
The disease is also more resistant to chemotherapy than some other cancers. Currently, there is no effective long-term treatment.

2. What is immunotherapy? Immunotherapy (also called biological therapy) is being used to treat certain types of cancer. It's a way of using your body's internal defense system to fight disease. It works by:
Stimulates the immune system to fight cancer cells Makes tumors more susceptible to attack by the immune system Uses immune system proteins created by biotechnologists and designed to attack cancer cells. To date, the US Food and Drug Administration (FDA) has not approved an immunotherapy for pancreatic cancer. However, it has been the subject of a lot of research.
3. How does immunotherapy work? There are different types of immunotherapy, and they work in different ways.
Monoclonal antibodies Monoclonal antibodies are lab-made molecules that target specific tumor antigens.
Immune checkpoint inhibitors Your immune system works by attacking foreign cells. It must not harm healthy cells in the process. To induce an immune response, molecules on specific immune cells need to be activated or deactivated. This is called a “checkpoint” and your immune system needs to be able to distinguish cancer cells from healthy cells. Unfortunately, cancer is pretty good at evading detection at these sites. "checkpoints," so drugs called immune "checkpoint" inhibitors target these checkpoints. They help the immune system recognize cancer cells as foreign and fight.

Cancer vaccines These vaccines are designed to boost your immune response against cancer cells.
Acceptable T-cell Transfer In this treatment, T cells (a type of white blood cell) are removed from your body. They are genetically engineered or processed to enhance activity. When they return to your body, they can do a better job of killing cancer cells.
Oncolytic virus therapy In this therapy, a virus carries modified genes to tumor cells. Those genes cause tumor cells to self-destruct. This will trigger your immune system to attack. It also improves your overall immune response to cancer.
4. What does the research say? Researchers are currently working to:
Identify more antigens associated with pancreatic cancer Develop a vaccine to prevent recurrence after surgery Develop a vaccine to slow or stop the growth Cancer development in people who can't have surgery Immune checkpoint inhibitors, vaccines, and combination immunotherapy have all shown promising results in the treatment of pancreatic cancer. Here are a few examples:
A 2017 research paper showed that MUC4 nanovaccine stopped tumor progression. The study authors say there is a good case for evaluating vaccines in combination with immune checkpoint inhibitors. A 2015 study reported extended survival with prime/hyperprimary heterozygosity for Cy/GVAX and CRS-207. A 2013 study used mice to test a drug called AMD3100 (plerixafor). The drug is designed to break down a barrier around pancreatic cancer, allowing T cells to pass. T-cell activity is enhanced by an antibody to block the second target, leading to a reduction in cancer cells. A 2012 phase II trial combined algenpantucel-L with standard adjuvant therapy (to kill cancer cells left behind after primary treatment, to reduce the risk of cancer coming back). The 12-month disease-free survival rate was 62%. The overall 12-month survival rate is 86%. 5. What about clinical trials? There are many steps needed to get FDA approval for new therapies. One of these is a clinical trial. It's the best way for researchers to assess the safety and effectiveness of treatments in humans. Even when treatments don't go quite as expected, trials help advance science.
Participation in clinical trials may be the only way to access breakthrough therapies. However, not everyone is eligible for every test. Eligibility can be based on many factors, such as age, the specific type of pancreatic cancer, and the stage at diagnosis. Any previous treatments may also be taken into account.
If you want to join a clinical trial, talk to your oncologist. Currently, there are many trials of immunotherapy for pancreatic cancer, most of which are overseas.

6. What is the outlook? Your prognosis depends on several things. Tumor type, grade, and stage at diagnosis all play a role. This is how the system works.
Of course, some people respond to treatments better than others. People who have surgery tend to do better than those who don't.
These are the survival rates for exocrine pancreatic cancer. It is important to note that these are figures from 1992 to 1998. The 5-year survival rates for exocrine pancreatic cancer by stage are as follows:
1A: 14% 1B:12% 2A: 7 %2B:5% 3:3% 4:1% This is the survival rate for neuroendocrine pancreatic tumors (NETs) that are treated with surgery. These numbers are based on people diagnosed between 1985 and 2004.
Five-year survival rates for NETs treated with surgery are as follows:
1: 61% 2: 52% 3: 41% 4: 16% Survival rates for pancreatic cancer may have changed since these statistics were compiled. So talk to your oncologist about your personal outlook. They will be able to evaluate your personal health record and provide some idea of ​​what to expect.
Research is progressing rapidly and it is likely that immunotherapies for pancreatic cancer will continue to improve. As such, we may be one step closer to an effective, long-term treatment for pancreatic cancer.

References:
American Cancer Society medical and editorial team. (2016). Pancreatic cancer survival rates, by stage. cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/survival-rates.html Banerjee K, et al. (2017). Abstract 3678: Muc4 nanovaccine and checkpoint blockade based combination immunotherapy for pancreatic cancer. DOI: 10.1158/1538-7445.AM2017-3678 Feig C, et al. (two thousand and thirteen). Targeting CXCL12 from FAP-expressing carcinoma-associated fibroblasts synergizes with anti–PD-L1 immunotherapy in pancreatic cancer. pnas.org/content/110/50/20212.full