Dr. Matthew Anaka explains what immunotherapy is, how it works and whether there are side effects, making this cutting-edge treatment option understandable for all.
By Elizabeth Chorney-Booth
Photographs by Buffy Goodman
There are treatment terms within cancer care that are immediately recognizable to the general public. Think surgery, radiation and chemotherapy. Immunotherapy is an increasingly common treatment option for individuals living with different types of cancer, but for many, the first time they hear the word is often while sitting in their oncologist’s office. For individuals for whom immunotherapy is an option, this relatively new treatment can be a game changer.
“Immunotherapy is like the discovery of chemotherapy 50 years ago,” says Dr. Matthew Anaka, an oncologist at the Cross Cancer Institute in Edmonton. “It’s a whole new type of treatment that’s made an impact across cancer care.”
Anaka, who specializes in advanced skin cancers, including melanoma, has more experience with immunotherapy than many oncologists because it is the primary treatment type for these cancers. The idea of using the immune system to cure cancer has existed for over a century. Anaka says current forms of immunotherapy clinical trials for skin cancer only began about 25 years ago; phase 1 clinical trials began in 2001 and the first FDA-approved trials started in 2011. They’ve since become standard of care for many individuals with cancer. However, it’s still not widely understood by people outside of the cancer community.
What is immunotherapy and how is it administered?
Anaka explains that while chemotherapy acts to kill cancerous cells, immunotherapy helps a person’s own immune system to eliminate cancer cells. Certain types of cancer cells carry a signal or “checkpoint” that essentially hides the cells from the natural immune system. The breakthrough with immunotherapy is in giving power back to the immune system to protect the body from cancerous cell growth.
“The type of immunotherapy we use most commonly is called a checkpoint inhibitor,” Anaka says. “These drugs block the signal cancer uses to tell the immune system not to attack. That allows the immune system to become active against the cancer and try to remove it.”
He adds that, like chemotherapy, immunotherapy is typically delivered intravenously, usually with multiple doses given over the course of several weeks. It’s often used in conjunction with chemotherapy and other traditional cancer treatments.
Who is eligible for immunotherapy?
While immunotherapy was first used for individuals with skin cancer who didn’t respond to chemotherapy, Anaka explains it is now regularly used to treat lung, bladder, kidney and many other kinds of cancer. Since clinical trials for new cancer treatments are often for individuals with stage 4 cancer, immunotherapy was once only used on individuals with advanced cancer. But now, it is often applied earlier in an individual’s prognosis, specifically for cancers like melanoma, where there is a good track record of success.
“There are many situations in which we will recommend immunotherapy,” Anaka says. “It’s really based on whether or not there has been a clinical trial done that shows that it’s helpful.”
Are there side effects?
Anaka says immunotherapy doesn’t cause the hair loss and nausea associated with chemotherapy, which makes it an attractive option for individuals struggling with those side effects. While Anaka describes immunotherapy as generally being “gentler” than chemotherapy, he warns it can come with side effects of its own. While negative reactions to immunotherapy are not universal, it might cause symptoms similar to autoimmune diseases such as rheumatoid arthritis or Crohn’s, which might require additional medication.
“Chemotherapy is at least somewhat predictable,” Anaka says. “With immunotherapy, side effects might happen after the first treatment, or they can start three or six months after the treatments are finished.”
Anaka says there’s much more work to be done in order to further investigate the possibilities of immunotherapy. This includes continuing to expand its use in other cancer types and combining it with other drugs to optimize the benefits. So far, though, Anaka has seen immunotherapy drastically improve the prognosis of Albertans with melanoma, which is cause for significant optimism.
“The average survival time for metastatic melanoma used to be six months because we didn’t have any treatments that worked. Now, half of people with immunotherapy treatment can have a durable remission that can go on for many years,” he says, noting that similar stories are starting to emerge with other types of cancer. “It is the biggest thing to have impacted cancer outcomes in quite some time.”
