Immunotherapy vs. Chemotherapy
Are we entering a new era of cancer treatment?
Is immunotherapy or chemotherapy better in terms of safety and effectiveness, the two primary considerations used by the Food & Drug Administration (FDA)?
“Chemotherapy” denotes any chemical used against any cancer. It can be administered to the patient orally, intravenously or directly into an artery.
According to Robin Geller, writing in FIVE PLUS, chemotherapy is designed to stop the division of cancer cells or to kill them. It acts against any quickly-multiplying cell type but is non-specific, so that it also kills healthy cells that fall into this category. This leads to the many harmful side effects that are well known to occur with chemotherapy.
“Immunotherapy,” on the other hand, does not act only against the cancer but also fortifies the patient’s own immune system to fight infection more effectively. It is widely believed by researchers that patients do not die from cancer itself but from infections to which their illness makes them vulnerable. Chemotherapy does nothing for infections.
Immunotherapy also energizes the patient’s immune system to directly destroy the cancer cells. The elements of the human immune system are highly keyed to specific targets, so once cancer cells are recognized, the body’s immune agents will attack them only, sparing other cells. Immunotherapies are not poisons that destroy a range of cells unnecessarily.
Historically, however, there has been great difficulty in focusing human immune agents on cancer cells. Most tumors have mechanisms that avoid detection by the immune system.
This summer the FDA approved Kymriah, the first CAR-T cell immunotherapy, for use against recurrent acute lymphoblastic leukemia (ALL), a common form of childhood leukemia. Kymriah is produced by Novartis and was developed by the independent research firm WIRB-Copernicus Group. The patient’s own immune system T cells are altered outside the body and re-injected to fight the ALL, producing an 83-percent remission rate.
After collection, the immune system’s lymphocytes, known as T cells, are given an extra gene that includes a protein called a chimeric antigen receptor (CAR) that causes T cells to attack cancer cells containing the antigen CD19.
“We’re entering a new frontier in medical innovation with the ability to reprogram a patient’s own cells to attack a deadly cancer,” according to FDA Commissioner Scott Gottlieb, M.D.
"This therapy is a significant step forward in individualized cancer treatment that may have a tremendous impact on patients' lives," said Carl June, MD, the Richard W. Vague Professor of Immunotherapy, Director of the Center for Cellular Immunotherapies at the University of Pennsylvania Penn's Perelman School of Medicine.
“Like you, I stand in awe of what we have accomplished in such a short period of time,” concluded Donald A. Deieso, PhD, chairman and chief executive officer of WIRB-Copernicus Group.
This breakthrough in practical immunotherapy comes at a price: according to Eric Sagonowsky in Fierce Pharma, Kymriah costs a staggering $745,000 per does, exclusive of in-patient hospital costs for extracting and re-introducing the patient’s T cells. The FDA has approved this on a “pay for performance” basis, so that a patient must improve within a given time period for Novartis to be paid.
This new treatment is specific and personalized, as opposed to the shotgun approach of chemotherapy, without the use of cell-killing toxins. The future of cancer treatment clearly lies with immunotherapy.