In any population in the world, lung cancer remains the most common and has the most number of victims.The idea of battling this form of cancer and the others through one’s immune system is a concept that has fascinated most populations.
With the advent of immunotherapy to combat cancer, many have thought of strengthening their immune system with the hope to alleviate their conditions and prolong survival.
However, Dr. Wong Seng Weng, Consultant Medical Oncologist and Medical Director at The Cancer Centre (Singapore Medical Group) in Paragon Medical and Mount Elizabeth Medical Centre, explains that the survival of a patient is not determined solely by the strength of their immune system.
“We come to realize that the immune system doesn’t attack the cancer because it is weak, it’s because the immune system is unable to recognize the cancer for what it is,” said Wong.
As immunotherapy gains approval from the Philippine Food and Drug Administration as a new treatment option for non-small cell lung cancer (NSCLC), Wong clarified that the antibody is not used to strengthen the immune system but to help it identify the cancer cells, enabling the immune system to attack it.
According to Wong, immunotherapy works to unveil the disguise of the cancer cells which confounds the immune system. “There is a signaling system which the normal cells use in order to tell the immune system not to attack them. This is also used by the cancer cells”.
PD-L1 or programmed death-ligand 1 is a protein that is exhibited by some cells of the body to avoid being attacked by the immune system. Cancer cells have been found to similarly express the same protein for the same effect.
“There is nothing wrong with our immune system. It is just that it doesn’t recognize the cancer for what it is, so it doesn’t attack it,” explained Wong.
The immunotherapy which is infused into the bloodstream ideally shuts down the PD-1/PD-L1 signaling system for the immune system to freely attack the cancer cells.
Wong said that the concept of immunotherapy has been under reviews for decades, but it has only been its recent development where the efficacy and the side effects have flung to the opposite sides of the spectrum.
Its recent clinical testing has determined a very high efficacy of immunotherapy as a treatment for cancer, while revealing very limited side effects such as development of rashes which easily fades whenever the immune system is calmed down.
“We are pleasantly surprised. The side effects were very minimal and the occurrences were not severe,” said Wong.
He added that the occurrence of serious side effects with immunotherapy is likely around one for every 20 patients.
The development of this line of treatment coupled with the existing treatments, chemotherapy and targeted therapy, is a pathway towards an era of precision medicine.“Before, we always look for location; always just one mode of treatment. Now that there are many modes of treating cancer, we can tailor-fit the treatments for patients because they too have different reactions to each treatment,” Wong said.
According to MSD in the Philippines oncology medical adviser Dr. Ivy de Dios, biomarkers are important to identify what is the best approach to treat lung cancer and other malignancies among patients. “For patients with tumors negative for mutations for EGFR/ALK (epidermal growth factor receptor/anaplastic lymphoma kinase) and high PD-L1 expression, monotherapy with an immunotherapy is appropriate,” de Dios said.
However, she added that for patients with negative or low PD-L1 expression, immunotherapy can also be done coupled with standard chemotherapy treatment.
Although immunotherapy can stand alone as a treatment, it also works well with the combination of chemotherapy. “Before, we were hesitant if immunotherapy can be logically paired with chemotherapy because of its inherent conflicting principles. But the way we see the results, we saw that the success rate in the combination of treatments is higher compared to either of them used alone,” added Wong.
Because of the possibility of varying effects for different cases of the patients, de Dios encouraged those who are possibly at risk of acquiring lung cancer to have themselves tested early. “Go get tested especially if you are one of the high-risk persons by being a smoker or exposed to second-hand smoke, “de Dios said.
“Filipinos should not dread knowing if they have the disease or not because there are now more options for combating lung cancer.” She added.
The development of immunotherapy is a new light to cancer treatments and a new hope for a non-relapse of the disease especially for lung cancer which has tendencies of high relapse.
As example of its efficacy, Wong cited immunotherapy being a successful treatment of melanoma or skin cancer. Prior to immunotherapy, melanoma has been feared for it was resistant to most types of chemotherapy.
Compared to other forms of treatment against cancer, Wong said that immunotherapy has great potentials of being widely used.
With proper education among medical practitioners, Wong said that the conduct of this treatment may not need specialized hospitals or an oncology center. A community hospital could be sufficient to perform immunotherapy.
The medical society is now on a journey towards a better array of treatment for cancer. Wong said that they look forward to having cancer as a disease similar to diabetes – a disease that can be controlled long term.
“That’s the future, we have not arrived there yet but we look forward to be there.” The oncology expert said.
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