Oncology

Biological therapy (Immunotherapy):

Biological therapies use substances similar to those naturally produced by the immune system but are made in a laboratory. These substances may kill lymphoma cells, slow their growth, or activate the patient's own immune system to more effectively fight the lymphoma.

Immunotherapy

Interferon: Interferon is a hormone-like protein produced by white blood cells to help the immune system fight infections. Some studies have suggested that giving man-made interferon can cause some types of non-Hodgkin lymphomas to shrink or stop growing.The side effects of this treatment include moderate to severe fatigue, fever, chills, headaches, muscle and joint aches, and mood changes. Because of these side effects, interferon is not used very often. It may be given to some patients in addition to chemotherapy.

Monoclonal antibodies: Antibodies are normally produced by the immune system to help fight infections. Similar antibodies, called monoclonal antibodies, can be made in the laboratory. Instead of attacking germs as usual antibodies do, some monoclonal antibodies are designed to attack lymphoma cells.After years of research, several monoclonal antibodies are now being used as treatments for lymphoma. In fact, more monoclonal antibodies are available to treat lymphoma than any other type of cancer.

The first monoclonal antibody approved by the FDA to treat any cancer was rituximab (Rituxan). This antibody recognizes and attaches to a substance called CD20 that is found on the surface of some types of lymphoma cells. This attachment seems to cause the lymphoma cell to die. Patients usually receive intravenous infusions given each week for 4 weeks. The treatments can be given in the doctor’s office or clinic. Common side effects are usually mild but may include chills, fever, nausea, rashes, fatigue, and headaches. Even if these symptoms occur during the first rituximab infusion, it is very unusual for them to recur with subsequent doses. Newer forms of monoclonal antibodies similar to rituximab but with radioactive molecules attached to them have also been developed for use in lymphomas. The first to be approved by the FDA was ibritumomab tiuxetan (Zevalin), which is the rituximab antibody that has radioactive yttrium attached to it. The second drug approved was tositumomab (Bexxar), which is an antibody with radioactive iodine attached. Their one disadvantage is they cannot be used along with chemotherapy because they lower blood counts. Generally they are used if chemotherapy has failed. Alemtuzumab (Campath) is an antibody that is useful in chronic lymphocytic leukemia (CLL) and also T-cell leukemias of the skin.Other monoclonal antibodies to treat lymphomas are also being developed.

Activation

Cancer
Cancer immunotherapy attempts to stimulate the immune system to reject and destroy tumors. BCG immunotherapy for early stage (non-invasive) bladder cancer utilizes instillation of attenuated live bacteria into the bladder, and is effective in preventing recurrence in up to 2/3 of cases. Topical immunotherapy utilizes an immune enhancement cream (imiquimod) which is an interferon producer causing the patients own killer T cells to destroy warts, actinic keratoses, basal cell cancer, squamous cell cancer, cutaneous lymphoma, and superficial malignant melanoma. Injection immunotherapy uses mumps, candida or trichophytin antigen injections to treat warts (HPV induced tumors).

Dendritic cell based immunotherapy
This utilizes dendritic cells to activate a cytotoxic response towards an antigen. Dendritic cells, an antigen presenting cell, are harvested from a patient. These cells are then either pulsed with an antigen or transfected with a viral vector. The activated dendritic cells are then placed back into the patient; these cells then present the antigens to effector lymphocytes (CD4+ T cells, CD8+ T cells, and in specialised dendritic cells, B cells also). This intitiates a cytotoxic response to occur against these antigens and anything that may present these antigens. One use for this therapy is in cancer immunotherapy. Tumor Antigens are presented to dendritic cells which cause the immune system to target these antigens, which are often expressed on cancerous cells.

T cell based adoptive immunotherapy
This therapy uses T cell-based cytotoxic responses to attack cancer. In brief, T cells that have a natural or genetically engineered reactivity to a patients' cancer are expanded in vitro using a variety of means and then adoptively transferred into a cancer patient. T cells with a natural occurring reactivity to a patients cancer can be found in infiltrated in that patients' own tumors. The tumor is harvested, and these tumor infiltrating lymphocytes (TIL) are expanded in vitro using high concentrations of interluekin-2 (IL-2), anti-CD3 and allo-reactive feeders. These T cells are then transferred back into the patient along with exogenous administration of IL-2. In the case of engineered T cells, T cell receptors (TCR) that have been identified to have reactivity against tumor associated antigens are cloned into a replication incompetent virus that is capable of genomic integration. A patients own lymphocytes are exposed to these viruses and then expanded non-specifically or stimulated using the engineered TCR. The cells are then transferred back into the patient. This therapy has been demonstrated to result in objective clinical responses in patients with refractory stage IV cancer.

Vaccination
Anti-microbial immunotherapy, which includes vaccination, involves activating the immune system to respond to an infectious agent.

Suppression
Immune suppression dampens down an abnormal immune response in autoimmune diseases or attempts to reduce a normal immune response to prevent rejection of transplanted organs or cells.

Allergies

Main article: Allergy immunotherapy
Immunotherapy is also used to treat allergies. While other allergy treatments (such as antihistamines or corticosteroids) treat only the symptoms of allergic disease, immunotherapy is the only available treatment that can modify the natural course of the allergic disease, by reducing sensitivity to allergens.A three-to-five-year individually tailored regimen of injections may result in long-term benefits. Recent research suggests that patients who complete immunotherapy may continue to see benefits for years to come (https://content.nejm.org/cgi/content/abstract/341/7/468). Immunotherapy does not work for everyone and is only partly effective in some people, but it offers allergy sufferers the chance to eventually reduce or stop symptomatic/rescue medication.

The therapy is indicated for people who are extremely allergic or who cannot avoid specific allergens. For example, they may not be able to live a normal life and completely avoid pollen, dust mites, mold spores, pet dander, insect venom, and certain other common triggers of allergic reactions. Immunotherapy is generally not indicated for food or medicinal allergies. Immunotherapy is typically individually tailored and administered by an allergist (allergologist), although standardized immunotherapy serums and injection schedules are available in some healthcare systems and can be prescribed by family physicians. This therapy is particularly useful for people with allergic rhinitis, or people with asthma.

The therapy is particularly likely to be successful if it begins early in life or soon after the allergy develops for the first time. Immunotherapy involves a series of injections (shots) given regularly for several years by a specialist in a hospital clinic. In the past, this was called a serum, but this is an incorrect name. Most allergists now call this mixture an allergy extract. The first shots contain very tiny amounts of the allergen or antigen to which you are allergic. With progressively increasing dosages over time, your body will adjust to the allergen and become less sensitive to it. This process is called desensitization. A recently approved sublingual tablet (GRAZAX), containing a grass pollen extract, is similarly effective, with few side effects, and can self administered at home, including those patients who also suffer from allergic asthma, a condition which precludes the use of injection based desensitisation. To read more about this topic, see: https://www.alk-abello.com or allergy and hyposensitization.