Who is the Best Candidate For Cancer Immunotherapy?
As one of the leading causes of non-violent death worldwide, “cancer” often appears to be a single, all-encompassing disease. In reality, cancer refers to thousands of different mutations that can affect almost any organ in the body.
Each one of these diseases will respond to treatment differently. When presented with too many options, it’s easy to feel confused, especially when a patient is still trying to come to terms with their diagnosis. Conversely, acting like there is only one right treatment can be equally demotivating – not to mention inaccurate.
In reality, neither standard treatments nor anti-cancer immunotherapy will be effective in all cases. However, there are some cases where evidence shows that immunotherapy will work best.
What Does it Mean to be a “Good” Candidate?
When recommending a treatment course, doctors must look at the whole patient. Each decision must balance the cost, risk, and disruptions it will produce against the extra years it will provide and the quality of any time gained.
When it comes to cancer, we usually choose a treatment soon after the initial biopsy or cancer removal surgery. After obtaining a tumor sample, a specialized pathologist can identify the precise type of cancer a patient has developed. Only after this information can we determine which treatment will offer the best chances of remission.
When oncologists talk about a “good” candidate, they refer to patients more likely to reap the deepest benefits from a type of treatment than those of cheaper or simpler options. This must be contrasted against the possible side effects or complications and the degree of life disruption offered by each option.
When does Immunotherapy Work Best?
Anti-cancer immunotherapy should be considered whenever a patient faces low survival chances through standard chemotherapy or radiotherapy or where the damage from chemotherapy will surpass the possible benefits.
Based on past clinical experience, two types of patients fall into this category.
1. Patients with Known Resistant Mutations
Some types of cancer are already notorious because they do not respond properly to treatments such as chemotherapy or radiotherapy. These types of cancer cells either grow too quickly or do not shrink when exposed to conventional protocols.
In some cases, oncologists will still try to use the road most traveled first – either because the insurance company demands it or because it is the only locally-available option. In these cases, conventional treatments may increase life expectancy by a few months or even a few years, despite enduring severe side effects. The patient will remain at a much higher risk of seeing cancer grow back or metastasize.
Patients with these types of tumors should instead consider immunotherapy from the beginning, either instead of chemotherapy or immediately after completing it.
2. Patients who Develop Multi-Drug Resistance
Even if a specific cancer mutation is known to respond well to conventional treatments, there is still a possibility that it will become resistant later on. This is particularly likely if the initial round of chemotherapy or radiotherapy fails to completely eliminate the tumor, leaving cancer stem cells behind.
Tumor cells that survive repeated rounds of treatment are more likely to develop multi-drug resistance. When this happens, further courses of chemotherapy are unlikely to provide any benefit: they will not impact tumor size, and the tumor will continue spreading despite it. Yet, the patient will still feel the detrimental effects of chemotherapy, such as excessive weight loss (wasting), immune suppression, and generalized weakness.
Immunotherapy can help the patient’s immune system recognize and fight these cancer cells.
Treating the Person, not the diagnosis
Currently, many common cancer types respond efficiently to chemotherapy or radiotherapy, and it is easier for patients to undergo conventional and easily-accessible treatments. However, some types of cancer cannot be cured this way. In these cases, immunotherapy will offer them a different way to combat cancer cells and eliminate tumors.
