Timing and Sequence: Crucial for Immunotherapy Combination

Make no qualms about it: cancer is a deadly disease, more so if detected in its later stages. As such, most people will go to such lengths to ensure that their cancer treatments are effective. Unsurprisingly, while there are standard treatments for cancer, all patients are unique and respond to treatments and medications differently. As such, doctors will then adjust the treatment and doses, depending on what the patients need.

Regarding treatments, the National Cancer Institute (NCI) says that most people use a combination of cancer treatment therapies to improve the patient’s odds. The most common forms of treatment are as follows: surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy, hormone therapy, stem cell transplant, and precision medicine. Each treatment method has its pros and cons, and are used depending on the stage of cancer and the location of the tumor. Given that no two treatments are alike, it is, therefore, safe to assume that not every treatment journey is the same.

From this perspective, we hope you come to terms with the idea that most doctors combine cancer treatments. Some will start with surgically removing the tumors, and then giving the patients radiation therapy or immunotherapy, depending on how far the cancer has progressed. By combining treatments, they are doing their best to ensure that the patient will have the best chances of conquering cancer.

What is immunotherapy combination?

The premise of combining treatment is not isolated on the types of treatment alone. Rather, doctors also combine medication in a bid to make the treatment more effective. This is also apparent in immunotherapy.

The NCI defines immunotherapy as “A type of biological therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection, and other diseases. Some types of immunotherapy only target certain cells of the immune system. Others affect the immune system in a general way.”

There are many types of immunotherapy. Among the most common ones today are:

  • Monoclonal antibodies – These drugs work by targeting specific marks in the body. Some kinds of monoclonal antibodies mark tumors so the immune system will be more effective in isolating and destroying them. This is also known as targeted therapy.
  • Adoptive cell transfer – T-cells are taken out of the cancerous tumor and are modified, multiplied, or strengthened in a laboratory. Once the T-cells are deemed strong enough, they are reintroduced to your body.
  • Cytokines – Particularly the proteins interferons and interleukins, cytokines help the immune system beat malicious cells.
  • Treatment vaccines – Similar in concept with vaccines you get prior to getting sick, but also vastly different, treatment vaccines are special medications that boost your immune system’s ability to fight cancerous cells.
  • Bacillus Calmette-Guerin – Also known as BCG, it harnesses a weakened bacteria known to cause tuberculosis. It is inserted directly into the bladder, and it triggers an immune response not only against the introduced bacteria, but also to cancer cells. This is a treatment that is being used for bladder cancer.

All these therapies have been studied religiously to improve their efficacy.

Where do timing and sequence come into play?

There is a reason some forms of treatment work for some patients, and not for others. One evident problem is that the patient’s immune system is just absorbing the drugs, or that tumors are counteracting the effects of the drugs. For this reason, at least two forms of immunotherapy are frequently introduced to the patient. If only a single immunotherapy is given, then the tumor can neutralize the antitumor immune response being triggered by the drugs.

Unfortunately, using multiple immunotherapy agents doesn’t always have the intended effect, as a recent study revealed. The study, partially funded by the NIH, unveiled that “the timing and sequence of the drug’s administration are critical to the treatment’s efficacy and safety.”

The researchers studied mice who were being treated with immunotherapy. According to the NIH, “treating mice with two different immunotherapy agents at the same time had less of an effect on tumor growth compared with one of the agents alone. But staggering the timing of when the two therapies were given substantially slowed tumor growth and extended survival in the mice. However, this effect was not observed when the therapies were given in the reverse order.”

It became evident then that scheduling when the treatment should be given became paramount when it comes to boosting the medication’s efficacy.

To come to this conclusion, the researchers looked at two drugs that can potentially make a difference in the lives of patients: a PD-1/PD-L1 inhibitor, and OX40 agonists. PD-1 and PD-L1 limit the body’s ability to kill cancer cells; by inhibiting them, the T-cell will, therefore, have a better chance of beating the cancer. On the other hand, OX40 is known to improve T-cell activity. In theory, if the two drugs are combined, then the aspects of the tumor that rejects the medication will be bested by the PD-1/PD-L1 inhibitor, while the OX40 will boost the body’s ability to fight back.

Then, the researchers turned to mice who were given breast cancer that closely resembles its effects on humans. They found that using just the PD-1 inhibitor had no impact on the tumor, while the OX40 agonist was able to slow down the growth of the tumor and improve the mice’s survival. If they were given, however, it had less of an effect than just the OX40 agonist was able to create, alone. But when the OX40 agonist was given first, followed by the PD-1 inhibitor after two days, then the researchers saw an impressive response: the tumor’s growth was delayed, and the survival rate increased. Yet when they introduced the PD-1 inhibitor first followed by the OX40, there was no response, and the tumor continued to grow.

This finding is significant in such a way that doctors will now be closely looking at how the sequencing and timing of drug administration may affect a patient. If the study is anything to go by, then it only goes to show that further research must be conducted to ensure that the drugs being given to patients are at their optimum sequence for maximum effect.

It’s Time to Get the Treatment You Need

Cancer treatments may vary depending on the type and stage of the cancer, but at New Hope Medical, we recommend finding ways to treat and stop your disease using less conventional, yet effective and holistic methods. Call us today at 480-757-6573 or complete our online form.

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