Oncology: Immunotherapy

Immunotherapy

Classification

  • Checkpoint Inhibitors
  • Monoclonal Antibodies
  • Cytokines
  • Adoptive Cell Therapy
  • Cancer Vaccines

Checkpoint Inhibitors

  • Ipilimumab (Yervoy)
    • Mechanism: CTLA-4 Inhibitor (Stimulates at Immune Checkpoint)
    • Use: Melanoma & RCC
  • Pembrolizumab (Keytruda)
    • Mechanism: PD-1 Inhibitor
    • Use: Melanoma, NSCLC, H&N SCC
  • Nivolumab (Opdivo)
    • Mechanism: PD-1 Inhibitor
    • Use: Melanoma, NSCLC, RCC
  • Atezolizumab (Tecentriq)
    • Mechanism: PD-L1 Inhibitor
    • Use: Lung Cancers, Liver Cancers & Breast Cancers
  • Avelumab (Bavencio)
    • Mechanism: PD-L1 Inhibitor
    • Use: Merkel Cell Carcinoma & Urothelial Cancers
  • Durvalumab (Imfinzi)
    • Mechanism: PD-L1 Inhibitor
    • Use: NSCLC

Monoclonal Antibodies (MAB)

  • Bevacizumab (Avastin)
    • Mechanism: Anti-VEGF
    • Use: Metastatic Colorectal CA
      • Can Affect the Liver & Should Limit Dose Prior to Metastasectomy
      • Can Increase Risk of Leak
  • Cetuximab (Erbitux)
    • Mechanism: Binds EGFR
    • Use: Metastatic Colorectal CA (K-RAS Wild Type) & H&N Cancers
  • Trastuzumab (Herceptin)
    • Mechanism: Binds HER2
    • Use: Breast & Stomach Cancer
  • Rituximab (Mabthera)
    • Mechanism: Binds CD-20
    • Use: CLL & Non-Hodgkin Lymphoma

Cytokines

  • Aldesleukin (IL-2/Proleukin)
    • Use: RCC
  • Interferon (Intron A)
    • Rarely Used in Modern Practice
    • Use: RCC & Leukemia

Adoptive Cell Therapy (Cellular Immunotherapy)

  • Tumor-Infiltrating Lymphocyte (TIL) Therapy – Harvests Naturally Occurring T Cells Within the Tumor, Actives/Expands & Then Reinfuses Them
  • Engineered T Cell Receptor (TCR) Therapy – Harvests Patient T Cells & Adds New T Cell Receptors to Target Specific Cancer Antigens
  • Chimeric Antigen Receptor (CAR) T Cell Therapy – Equips T Cells with Synthetic Receptors
  • Natural Killer (NK) Cell Therapy

Cancer Vaccines

  • Prophylactic Vaccines:
    • Human Papillomavirus (HPV) Vaccine
      • Prevents Cervical Cancer & Some Anal/Throat Cancers
    • Hepatitis B Virus (HBV) Vaccine
      • Prevents HBV & Associated HCC
  • Therapeutic Vaccines:
    • Bacillus Calmette-Guerin (BCG) Vaccine
      • Originally Developed for TB
      • Now Used for Bladder Cancer Treatment
    • Sipuleucel-T
      • Treats Advanced Prostate Cancer
    • Talimogene Laherparepvec
      • Treats Melanoma