The last decade in the field of cancer research is without a doubt the decade of immunotherapy. Longer alongside their illness. “The idea of treating cancer with the immune system has existed for at least 60 or 70 years. The researchers then thought that if they succeeded so well in neutralizing vaccine infections, there is no reason why they could not vaccinate against cancer,” explains Prof. Michal Lotem, director of melanoma at Hadassah Hospital. Oncology Research at Hadassah, Chairman of the Melanoma Department in Israel.
In fact, the immune system that protects our body from foreign factors such as bacteria and viruses also destroys cancer cells that the body constantly produces before they develop into a disease. If cancer did develop, it meant that the immune system cells were not working properly, and the big question was why. “At one point it became clear that in the cancer environment, due to various mechanisms that activate the immune system and simulate a state of chronic infection, it reaches a state of exhaustion. To action – to eliminate the cancer cells. “
One of the areas in which immunotherapy has caused no less than a revolution is in the treatment of skin cancer. In sunny Israel, skin cancer is the most common malignant disease, and it is divided into two main groups – melanoma, the most deadly of all skin cancers, which can progress rapidly and develop into metastatic disease and non.melanoma cancers that spread more slowly and are more likely to recover. “The division into groups is intended to emphasize how different melanoma is from other skin cancers, but in fact the two main types of non.melanoma cancers also make up the largest share of skin tumors,” explains Prof. Lotem. “The most common cancer in humans is Basal Cell Carcinoma or BCC, the second type is called Squamous Cell Carcinoma or SCC. The difference between the two cancers is in the stem cells from which the tumor came and with a clinical appearance. –
Ultraviolet sunlight is known to be the major risk factor in both melanoma and non.melanoma cancers, but it turns out that it is also linked to the response of skin cancers to immunotherapy. “It turns out that tumors caused by UV radiation cause many malfunctions in the genetic sequence. When the immune system encounters these cells it recognizes them well, but because it enters ‘fatigue’ very quickly, it neutralizes itself, meaning the immune system could be effective but neutralized. Today, after ten years of treating patients with these drugs, we have seen how in some patients it leads to a relapse into metastatic disease, and in patients who respond, the response may take some time. Long after the patients stop the treatment, “explains Prof. Lotem.
Immunotherapy treatment for melanoma – even before the metastatic disease
Immunotherapy also has a great impact on patients’ quality of life, as compared to traditional therapies, such as chemotherapy that affects the division of cancer cells but also healthy cells, immunotherapy only works to strengthen the immune system. “Compared to other treatments, a drug that works through a biological mechanism saves a lot of unwanted side effects. There will be no nausea, no vomiting, no hair loss and no damage to tissues like bone marrow tissue and the body’s ability to resist infections, all this will not happen. Although the cells of the immune system will not reach the state of exhaustion, they may overwork not only against the tumor but also against normal tissues, such as the digestive system, external secretory glands, muscle tissue, etc. It is terribly frightening on the face, and really in exceptional cases. It can certainly progress to a life.threatening condition, but if we are aware of these conditions, it is possible to actually control depressant drugs that suppress the immune system, and return it to its original state, “explains Prof. Lotem.
And as is often the case in oncology, the new treatment strategy was decided to test for metastatic disease, so the breakthrough came first through the treatment of melanoma. “The reason why they first start testing the treatment for metastases is that the ability to identify whether the drug is beneficial is almost immediate. If you compare two CT scans done three months apart, immediately before and after treatment, you can clearly see how the metastases shrink,” explains Prof. ‘Lotem. In fact today immunotherapy treatment is indicated for melanoma patients already in the stages of locally advanced early disease. “What happens after that is that we start talking about prevention, instead of waiting for metastases, we start implementing the strategy for patients who are at high risk for treating metastases, for example if melanoma cell foci have been found within regional lymph nodes. We know that in these cases about 50% .75% Metastases: Preventive immunotherapy can prevent the development of metastases. “
Immunotherapy prolongs life in more and more patients
The treatment of non.melanoma skin cancer immunotherapy has led to a significant revolution on many levels, explains Prof. Aharon Popovzer, director of the Sharett Institute at Hadassah Hospital, “Currently, 60% to 70% of patients respond to immunotherapy, and the response is excellent. Quality of life and also prevents very large surgeries.It is important to understand that when talking about skin cancers, in most cases of skin cancers do not require training treatments, they are usually detected early and undergo surgery or perhaps radiation.However, some are discovered at a later stage, where no surgery is needed “Simple ones that lead to both severe functional damage and damage to the appearance of the face.“
Until the introduction of immunotherapy for the treatment of skin cancers in general, and specifically for skin cancer of the coutenaus type, the treatment of advanced disease was in chemotherapy and radiation treatments, which according to Prof. Popovzer led to severe side effects and did not necessarily benefit patients. Life expectancy from the moment of diagnosis of advanced disease was a year to a year and a half. Immunotherapy changed that. “The treatment brought about a change in the paradigm. Advanced skin cancer is mainly a disease of older people who have been exposed to a lot of UV radiation over the years. Until the advent of immunotherapy, in many cases we had to give up in advance, and now they can be treated.“
In the future, Prof. Popovzer predicts, immunotherapy could be part of pre.surgery treatment for non.melanoma skin cancers as well. “I suppose it will later be possible to use immunotherapy for skin cancers in relatively large tumors or as part of adjuvant therapy, that is, complementary therapy, as has already been done today with melanoma, thus increasing the chance of cure. But today, many, who have not had treatment “Can benefit significantly from immunotherapy.“
So, after decades of dreaming about it, it seems that the treatment of cancer through the immune system with immunotherapy, leads to achievements and promotes the treatment of cancer in general and skin cancer in particular. There is no doubt that the emphasis today is still on vigilance for early detection and treatment of skin cancers, but as research in the field of immunotherapy progresses, it will be possible to continue to improve the life expectancy of patients and the quality of life of as many patients as possible.
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