Immunotherapy and colorectal cancer
Immunotherapy is a class of cancer drugs based on biologics that find and destroy colorectal cancer cells. There are different types of immunotherapy, and all immunotherapy works with your immune system to fight cancer.
What is immunotherapy?
Cancer immunotherapy, also known as immuno-oncology, is a form of cancer treatment that uses the body’s own immune system to help prevent, control, and eliminate cancer. Immunotherapy is also known as biologic therapy.
Over the last few decades, immunotherapy has become an important part of treating certain types of cancer. New immunotherapy treatments are being discovered at a fast pace and are being tested in clinical trials to obtain regulatory approvals.
How does immunotherapy work?
Immunotherapy can help treat cancer in three ways:
- Stops cancer cells from forming or prevents cancer cells from dividing once formed
- Prevents cancer from spreading to other areas of the body
- Helps the patient’s immune system destroy cancer cells
Immunotherapy works with the natural defenses of your immune system so that it can find and attack cancer cells.
It also uses manufactured substances (biologics) that are similar to substances made by your immune system. These substances coordinate with your immune system, which in turn destroys cancer cells.
Watch this
This short video from the American Cancer Society provides answers to some of the most common questions that people with cancer have about immunotherapy.
How is immunotherapy given?
You may receive immunotherapy in your doctor’s office or in an outpatient cancer center at a hospital.
There are different forms of immunotherapy. The most common for colorectal cancer treatment are:
- Intravenous (IV)
The immunotherapy goes directly into your bloodstream through a vein - Oral
The immunotherapy is taken by mouth, usually in a pill or capsule form.
How often do you receive immunotherapy?
- Immunotherapy treatment is given every day, week, or month. Most types of immunotherapies are administered in cycles.
- Each treatment cycle is a period of treatment followed by a period of rest. The rest period is important because it gives your body a chance to recover, respond to immunotherapy, and build new healthy cells.
- Immunotherapy cycles for colorectal cancer depend on how advanced the cancer is, the type of drug you receive, and how you react to treatment.
Colorectal cancer and immunotherapy
Immunotherapy is a cornerstone treatment for people with either early- or advanced-stage colorectal cancer if the tumor has findings of dMMR (deficient mismatch repair) or MSI-H (microsatellite instability-high). In addition, tumors characterized as MSS/pMMR (microsatellite stable or proficient mismatch repair) are being evaluated in clinical trials with immunotherapy treatments to expand use of these promising therapies.
Clinical trials
There are also many clinical trials underway to find other strategies for using immunotherapy in those tumors that are not MSI-H (MSS or pMMR) before surgery (neoadjuvant), after surgery (adjuvant) and to treat metastatic CRC . If you are interested in learning more about clinical trials, talk to your doctor about what may be available for your specific colorectal cancer diagnosis.
How does immunotherapy treat colorectal cancer?
When your immune system is functioning correctly, it protects your body from infection, viruses, and other pathogens and diseases. However, sometimes the immune system does not work the way it should, and it attacks normal, healthy cells. To prevent this, the immune system uses checkpoints which are proteins on immune and cancer cells that need to be turned “on or off” to induce an immune response.
Checkpoint inhibitor drugs
Colorectal cancer cells may use checkpoints to avoid being attacked by the immune system. Immunotherapy drugs target these checkpoints to restore the immune response against colorectal cancer cells.
Colorectal cancer that has tested positive for a high level of microsatellite instability (MSI-H), or changes in one of the mismatch repair (MMR) genes may be treated with checkpoint inhibitor drugs. Also, treatment of MSS (microsatellite stable) tumors is being evaluated in several clinical trials to increase patient eligibility for checkpoint inhibitor drugs.
Checkpoint inhibitor drugs may be given to patients before surgery (neoadjuvant therapy) for early-stage colorectal cancer.
Checkpoint inhibitor drugs may also be given to patients if their colorectal cancer:
- can’t be removed with surgery
- has come back (recurred) after treatment
- has spread to other parts of the body (metastasized)
Types of immunotherapy drugs
The FDA has approved several checkpoint inhibitor drugs for colorectal cancer treatment for tumors with high microsatellite instability (MSI-H) or DNA mismatch repair deficiency (dMMR). There are also several antibody-based therapies that the FDA has approved for MSI-H/dMMR and MSS/pMMR CRC diagnoses.
Checkpoint inhibitor drugs:
- Dostarlimab (Jemperli): a checkpoint inhibitor that targets the PD-1/PD-L1 pathway; approved for subsets of patients with advanced colorectal cancer that has DNA mismatch repair deficiency (dMMR)
- Ipilimumab (Yervoy): a checkpoint inhibitor that targets the CTLA-4 pathway; approved in combination with nivolumab for subsets of patients with advanced colorectal cancer that has high microsatellite instability (MSI-H)
- Nivolumab (Opdivo): a checkpoint inhibitor that targets the PD-1/PD-L1 pathway; approved for subsets of patients with advanced colorectal cancer that has high microsatellite instability (MSI-H), including in combination with ipilimumab
- Pembrolizumab (Keytruda): a checkpoint inhibitor that targets the PD-1/PD-L1 pathway; approved for subsets of patients with advanced colorectal cancer that has high microsatellite instability (MSI-H), DNA mismatch repair deficiency (dMMR), or high tumor mutational burden (TMB-H), including as a first-line treatment.
Monoclonal Antibody drugs:
- Bevacizumab (Avastin): a monoclonal antibody that targets the VEGF/VEGFR pathway and inhibits tumor blood vessel growth; approved for subsets of patients with advanced colorectal cancer, including as a first-line therapy
- Cetuximab (Erbitux): a monoclonal antibody that targets the EGFR pathway; approved for subsets of patients with advanced, EGFR-positive colorectal cancer, including as a first-line therapy
- Panitumumab (Vectibix): a monoclonal antibody that targets the EGFR pathway; approved for subsets of patients with advanced, EGFR-positive colorectal cancer
Ramucirumab (Cyramza): a monoclonal antibody that targets the VEGF/VEGFR2 pathway and inhibits tumor blood vessel growth; approved for subsets of patients with advanced colorectal cancer, including as a first-line therapy
What are the side effects from immunotherapy?
Immunotherapy can cause certain side effects. It’s important to remember that each person has different side effects, and that they may occur both during and/or after treatment. Because you may receive immunotherapy for a long period of time, side effects may vary throughout the course of treatment. Very rarely, some types of immunotherapies may cause severe or fatal allergic reactions.
It’s very important to talk with your doctors and nurses about potential side effects before beginning your therapy so you know what signs to look for so that you and your care team can effectively manage symptoms.
Factors that affect your side effects include:
- your type of cancer
- the stage of cancer
- your overall health
- the type and dose of immunotherapy you receive
Common side effects from immunotherapy include:
- pain at the injection site
- rash
- swelling
- redness
- itchiness
- skin changes
You may also experience flu-like symptoms including:
- fever
- chills
- dizziness
- weakness
- fatigue
- headache
- body aches
- diarrhea
- fluid retention
- heart palpitations
- sinus congestion
- shortness of breath
Side effects from specific types of immunotherapies
Each type of immunotherapy has its own set of potential side effects. Click on the types below to learn about side effects associated with each:
Special precautions with immunotherapy use
There are some precautions to keep in mind when you are receiving immunotherapy since some forms are considered hazardous.
Protect yourself and others: Your care team may caution you to not let others come into contact with the drug or your body fluids while taking it, and for a period after taking it. You may be advised to wear protective gloves when you are handling the drug.
Disposal: Some drugs and their packaging will need to be disposed of in a certain way. If you are taking an oral immunotherapy drug at home, be sure to ask your care team about any special instructions for using them safely.
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