The most important member of every healthcare team is you, the patient. It is essential that every member of the healthcare team empower you with the tools necessary to make informed decisions regarding your health care. The information provided in this “Patient toolkit” is designed to answer several of your questions and provide information on certain aspects of the ever-evolving field of immunotherapy for cancer. We include several sources, including frequently asked questions, resources for additional reading, and national societies for more information.
Recent advances in immunology are paving the way for an enhanced understanding of the interactions between cancer and the immune system and the development of strategies to reactivate immune responses and reverse the mechanisms cancer cells use to avoid detection and destruction by the body’s immune system.1,2 Evidence shows that the introduction of cancer immunotherapies has resulted in improved outcomes for patients with several different cancer types.2 Immunotherapy strategies include monoclonal antibodies, cell- or antigen-based vaccines, and small molecules targeting immune-cell processes. Cancer cells hijack and elude the body’s immune system, impacting its ability to overpower tumor cell growth via several mechanisms.3,4 “Adaptive” immunity plays a critical role in antitumor processes due to its ability to differentiate “self” from “non-self” cells.3 FDA-approved immunotherapy checkpoint inhibitors (the class of immunotherapy with the most data) include anti-PD-1, anti-PD-L1, and anti-CTLA4 monoclonal antibodies. Immunotherapies and their indications are listed in the table.
|Nivolumab||Anti-PD-1||NSCLC, metastatic melanoma, renal cell carcinoma, squamous cell carcinoma of the head and neck, classical Hodgkin lymphoma, urothelial carcinoma|
|Pembrolizumab||Anti-PD-1||Melanoma, NSCLC, head and neck squamous cell cancer, classical Hodgkin lymphoma, urothelial carcinoma, microsatellite instability-high cancer|
|Atezolizumab||Anti-PD-L1||Locally advanced or metastatic urothelial carcinoma, NSCLC|
|Avelumab||Anti-PD-L1||Metastatic Merkel cell carcinoma|
|Durvalumab||Anti-PD-L1||Locally advanced or metastatic urothelial carcinoma|
|Ipilimumab||Anti-CTLA4||Adjuvant stage III melanoma and metastatic melanoma|
- Dunn J, Rao S. Epigenetics and immunotherapy: the current state of play. Molecular Immunology. 2017; volume 87: pages 227-239. Available at www.sciencedirect.com/science/article/pii/S0161589017301116
- Freeman-Keller M, Kim Y, Cronin H, Richards A, Gibney G, Weber JS. Nivolumab in resected and unresectable metastatic melanoma: characteristics of immune-related adverse events and association with outcomes. Clinical Cancer Research. 2015; volume 22: pages 886-894. Available at http://clincancerres.aacrjournals.org/content/22/4/886.full-text.pdf
- De Felice F, Marchetti C, Palaia I, et al. Immunotherapy of ovarian cancer: the role of checkpoint inhibitors. Journal of Immunology Research. 2015; volume 2015: 191832. Available at http://dx.doi.org/10.1155/2015/191832
- Peterson JJ, Steele-Moses SK. Update on new therapies with immune checkpoint inhibitors. Clinical Journal of Oncology Nursing. 2016; volume 20: pages 405-410.
- Bellmunt J, Powles T, Vogelzang NJ. A review on the evolution of PD-1/PD-L1 immunotherapy for bladder cancer: the future is now. Cancer Treatment Reviews. 2017; volume 54: pages 58-67. Available at www.cancertreatmentreviews.com/article/S0305-7372(17)30007-5/pdf
- Callahan MK, Rostow MA, Wolchok JD. Targeting T cell Co-receptors for cancer therapy. Immunity. 2016; volume 44: pages 1069-1078. Available at www.cell.com/immunity/pdf/S1074-7613(16)30152-2.pdf