The word “tumor” is the last thing we want to hear.
After all, it immediately engenders feelings of uncertainty and anxiety. How big is it? Is it cancerous? Will surgery be needed? What if it doesn’t resolve itself? What happens if things get worse? How will the costs and treatments be afforded? What will happen to loved ones?
While all of these questions and concerns can definitely be unsettling, there’s good news. In the relentless battle against cancer, immunotherapy has emerged as a revolutionary force.
What’s immunotherapy exactly, you ask? Basically, immunotherapy works by harnessing the body’s own immune system to target and destroy malignant cells. Unlike traditional treatments, many of which kill good and bad cells, immunotherapy precisely goes after tumor cells. There are multiple forms of this therapy, and many mechanisms at play as well.
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Which is why it’s important you know where to start.
So let’s get right into it. We’ll explore everything you need to know about your options, questions for physicians, and how to identify leading clinics and hospitals for the best, most cost-effective treatment you can find.
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Bacterial Therapy
Also known as bacterial-based cancer therapy (BBCT), this form of therapy leverages the natural affinity of certain bacteria for certain tumor environments. See, the hypoxic (low-oxygen) tumor microenvironment is a favorite among many bacteria. So, by targeting these oxygen-deprived niches, it becomes a lot easier to boost the immune system.
To begin, the bacteria are actually engineered in a somewhat weakened state. Types such as Salmonella typhimurium and Clostridium novyi-NT are then sent into the tumor microenvironment, reproduce selectively, and trigger immune responses.
S. typhimurium, for example, exploits tumor hypoxia and can accumulate up to 1,000-fold more in malignant tissues than in healthy organs. In other words, you’re getting the bacteria where you need them most, minimizing unwanted side effects. These bacteria are particularly great at triggering something called tumor necrosis factor-alpha (TNF-α), which then leads to programmed cell death in cancer cells. Without these cell deaths, those nasty cancer cells may continue to divide, taking over the body and leading to further complications.
In some mouse models, bacterial therapy can lead to up to an 80 percent tumor regression, which is a spectacular result. Because bacterial therapy can penetrate dense stroma—where drugs often fail—it has become a promising and increasingly used treatment option for cancer patients.
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Cell Therapy
Not to be confused with bacterial therapy, cell therapy – specifically chimeric antigen receptor (CAR) T-cell therapy – actually reprograms a patient’s T cells. While this is a very sophisticated and complex process, the important thing to remember is what it ultimately does.
Basically, it enhances T-cell persistence, thereby amplifying tumor killing and, in some cases, showing as high as 80 percent remission rates. The good news is, this type of therapy is effective across various cancer types, whether breast, blood, kidney, lung, pancreatic, or others. Some research has even shown cell therapy to be curative in up to half of eligible patients, when paired with other therapies.
The beauty of cell therapy is that it’s typically a one-time infusion, so you don’t have to make repeated visits for exhausting treatments.
The bottom line is simple: Cellular therapies for cancer use cells, rather than chemical compounds or molecules, to fight cancer. The cells may come from a donor or the patient him or herself, and in due time, the improvement in the cells’ cancer tracking and attacking can be substantial.
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Checkpoint Inhibitors
The meaning of ‘checkpoint’ in this is comparable to a midpoint. Think of it this way: many pathways can lead to cancer. They often include numerous different proteins, activities, and other molecules, all performing various functions. Depending upon what’s happening and how far along the pathway things progress, a patient may experience a much different outcome with cancer.
Thankfully, checkpoint inhibitors work by inhibiting or blocking certain proteins like PD-1/PD-L1 that tumors exploit. By blocking these proteins, the inhibitors effectively suppress T-cell activity, giving your immune system a good fighting chance against tumors. PD-1 inhibitors, such as pembrolizumab and nivolumab, are two notable drugs in this instance.
For melanoma, nivolumab has shown over a 50 percent five-year overall survival, removing tumors by empowering your T cells to do what they do best. Meanwhile, for bladder cancer, enfortumab vedotin – when used with other therapies – can eradicate nearly 70% of tumors in certain eligible patients.
According to some research, checkpoint inhibitors induce durable responses across more than 20 cancers, leading to as high as 40 percent remission in certain cases. Although these inhibitors do not work in every case, they can definitely be effective, especially for people who have exhausted other options with minimal success.
Getting The Therapy Right For You
Now that we’ve discussed the various therapeutic options available, let’s get into the practicality of it. After all, these treatments aren’t free, nor are they offered at all clinics and hospitals.
The first step is to talk to your doctor. Start by researching your cancer type and asking: “Based on my tumor’s genetics, is immunotherapy suitable?”
From there, you can inquire about which subtypes—bacterial, cell, or checkpoint—offer the best fit. It’s also important to understand response rates and survival benefits, so that you can have a realistic outlook and make an informed decision alongside your clinician.
You will also want to ask about potential side effects, particularly immune-related adverse events, and how to manage them should they arise. To ensure you cover all these bases, bring a list of symptoms, prior treatments, and questions. Doctors always appreciate proactive patients, and if you find you’re not getting satisfactory answers, never hesitate to seek second opinions.
If you’re looking for the top clinics and hospitals for these types of cancer therapies, plenty of U.S. centers excel in them. MD Anderson Cancer Center (Houston) pioneers CAR T and checkpoint inhibitors, for one, while places like Memorial Sloan Kettering (New York) are leaders in checkpoint combos. You’ve also got the Mayo Clinic (Rochester, MN) that integrates bacterial therapy to treat brain cancers, like glioblastoma.
And if you’re unsure about the costs of treatment, you’re not alone. Truth be told, the expenses can vary widely depending on what your cancer is and where you’re going for treatment. For example, many checkpoint inhibitors like pembrolizumab average $150,000/year, some even as high as $500,000. By comparison, bacterial therapy trials can range from $50,000-$100,000.
Sound ridiculously high? The good news is, Medicare covers FDA-approved therapies under Parts A/B, while private insurance often covers 80-90 percent, if you have prior authorization.
There are also patient assistance programs, such as Merck’s Access Program, that aid the uninsured. Non-profits like CancerCare offer copay aid too ($5,000/year) and many clinical trials (i.e., via ClinicalTrials.gov) provide free treatment. You can also look into value-based pricing, which may reduce checkpoint drugs by 30 percent if in generic form. And if you’re uninsured, compassionate use programs waive fees completely.
Whatever you end up choosing, always consult financial counselors early, and speak with your healthcare team about the most affordable treatments available.
Overall, immunotherapy offers many promising benefits. It can succeed where other treatments fail, and while it can be costly, it can also save your life. So, do a little homework. Don’t hesitate to lean on support networks and seek out resources. Again, consulting healthcare and financial professionals will not only help you get on the right track, but can also ensure you get what you need, as inexpensively as possible.
Thanks to cutting-edge immunotherapies, the ‘incurable’ is now the ‘conquerable,’ and that’s a wonderful thing.
