A Research Blog

As we say goodbye to 2016 and usher in the new year, the Microscope team would like to celebrate, as we look forward to another year of breakthroughs and advancements, the fantastic year it has been for research. To kick off 2017, we asked each Signature Research Programme Director to pick the top research story impacting their respective research areas in the past year, and have put together a series of posts about each story and its significance for the coming year. Join us over the next few weeks to find out more about the hottest research topics.

In this first instalment, we share with you Professor David Virshup’s pick for the Cancer and Stem Cell Biology Programme at Duke-NUS: Immunotherapy.

What is immunotherapy?Infusions

Immunotherapy has been labelled the newest cancer treatment on the block, a game changer in the way cancer treatment is being approached. Instead of using cytotoxic treatments such as chemotherapy and radiation therapy to kill cancer cells, immunotherapy takes advantage of the patient’s own immune system to recognise and attack cancer cells.

How does immunotherapy work?

The main effector of immunotherapy, as the name suggests, is the immune system. These therapeutics aim to attack cancer cells in one of two ways, actively, by directing the immune system to attack tumour cells, or passively, by enhancing the body’s native anti-tumour responses. One way in which this has been achieved is via checkpoint inhibition. Another is via cell therapy where immune cells are harvest, modified and reintroduced into the patient to enhance the body’s ability to identify and destroy cancer cells.

Checkpoints exist within immune systems to ensure that responses are kept in check to only attack foreign invaders. Cancer cells are able to engage these checkpoints and thereby evade detection and removal by the immune system. Checkpoint inhibitors override immune checkpoints and allow the body’s immune system to “see” cancer cells and tag them for destruction. Ipilimumab and nivolumab are two monoclonal antibodies developed as checkpoint inhibitors, and are available for the treatment of melanoma, bladder cancer and lung cancer.

As with any treatment, patients should be mindful of possible side effects, and the use of checkpoint inhibitors is no exception. Without immune checkpoints in effect, there is the possibility of the immune system going rogue to start attacking normal healthy tissue.

Why is immunotherapy such a big deal?

Immunotherapy has been described as revolutionising our approach to the treatment of cancer, especially in cases where cancers are refractory to other treatments. In an article in The New York Times, miraculous recoveries and remissions from terminal cancers were recounted when patients were treated with checkpoint inhibitors. These treatments have been touted as the future of cancer treatments. In some cases, where tumours were terminal and inoperable, immunotherapy was able to shrink the tumour to the point of remission, or where it may be easily excised surgically, leading to full recoveries.

Such stellar results certainly provide hope for curing cancer. Immunotherapy represents a fundamentally different way of approaching cancer treatment. Instead of using cytotoxic treatment strategies such as chemotherapy or radiation therapy, which are rife with serious side effects, immunotherapy provides an alternative that may be more effective with lesser side effects.

What is next?

Unfortunately, while immunotherapy may be highly successful in some cancer patients, it does not work at all in others. Why is this? What makes some patients more receptive to immunotherapy compared to others? Do some patients have more than one fail-safe, requiring immunotherapies to override multiple immune checkpoints before becoming effective? What are these additional fail-safes? These are some of the questions that research is trying to answer; others include minimizing side effects while maximising efficacy.

Who knows? Maybe with these questions answered, cancer will be history!

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