Colon cancer immunotherapy is an innovative treatment method that can help people with resistance to chemotherapy and targeted therapy. After the development of metastases, intestinal tumors often become resistant to standard remedies and continue to progress actively. Clinics in Germany offer patients updated therapeutic protocols and conduct immunotherapy, choosing the most appropriate drug and treatment regimen for each person. You can find detailed information about clinics in Germany, medical programs, and treatment costs on the Booking Health website.
Content
- Role of immunotherapy for colon cancer
- Types of immunotherapy for colon cancer
- Advantages of immunotherapy for colon cancer
- Immunotherapy for colon cancer in Germany
Role of immunotherapy for colon cancer
The optimal time for the administration of immunotherapy is after surgical removal of the colorectal tumor and, if possible, the largest metastases.
The main candidates for immunotherapy treatment for colon cancer are patients with high-degree microsatellite instability (MSI). MSI is identified with the help of the genetic analysis of a resected tumor of the digestive system. In the human genome, there are 4 genes that are responsible for correcting DNA errors during its copying; this is an obligatory stage of the reproduction of all cells. If one or more of these genes is damaged, then defective DNA accumulates in cells – in medicine, this is called microsatellite instability.
High-degree microsatellite instability is detected in 15% of patients with colorectal cancer. Such clinical situation has certain peculiarities:
- Patients have a low risk of metastasizing (at stage 4, high-degree MSI is detected in no more than 3-4% of patients).
- Patients will benefit from immunotherapy, in particular with the use of PD-1 receptor inhibitors.
- Patients should be screened for Lynch syndrome – a hereditary malignant lesion of the intestine, in which concomitant tumors of the stomach, urinary tract, ovaries, brain, and other organs are often detected. In this case, healthcare professionals may additionally administer esophageal cancer immunotherapy, stomach cancer immunotherapy, etc.
Assessment of the microsatellite instability degree also allows doctors to assess the potential sensitivity of the tumor to chemotherapy drugs, such as platinum derivatives, alkylating agents, and 5-FU. This is important because chemotherapy and immunotherapy are often combined.
According to recent research, it makes sense to start immunotherapy earlier and administer it even in patients with early stages of cancer. This allows for achieving remission faster and increases life expectancy several times.
Types of immunotherapy for colon cancer
Colorectal tumors successfully avoid attacks of anti-cancer immunity with the help of various mechanisms: by synthesizing immunosuppressive substances, stimulating the development of inflammation, and so on. The task of immune therapy is to counter these mechanisms and activate the patient's natural anti-cancer immunity. To achieve this goal, German oncologists use several groups of drugs.
Immune checkpoint inhibitors are the most studied group of drugs in the immunotherapy of bowel cancer. These are monoclonal antibodies that selectively act on specific molecules of the patient's immune cells that normally destroy malignant neoplasms. There are several such molecules: PD-1, PD-L1, PD-L2, CTLA-4, TIM-3, BTLA, IDO, and LAG-3. Oncologists choose the drug depending on the results of the histological and genetic analysis of the tumor, so it is important to conduct these studies correctly. As mentioned above, doctors achieve the highest success rates in people with a high-degree microsatellite instability of the resected tumor. After the administration of immune checkpoint inhibitors, the normal activity of a person's anti-cancer immunity is restored.
Vaccination. Cancer vaccines help overcome tumor masking and make it visible to immune killer-cells. Several types of vaccines are used for the treatment of colorectal cancer:
- Autologous vaccines are created from parts of a patient's tumor. The tumor antigens in such a vaccine are excellently visible for anti-cancer immunity, and thus a powerful immune response is triggered. Unfortunately, these drugs do not work for all people and cause side effects.
- Peptide vaccines are a more specific type of vaccine that target cells with specific tumor markers, such as cancer embryonic antigen (CEA) or beta-hCG.
- Dendritic cell vaccines are the most studied and prescribed type of vaccine, the safety, and efficacy of which have been confirmed in numerous clinical trials. They are created on the basis of tumor material removed during surgery or synthetic tumor components. Mature dendritic cells integrate into the natural anti-cancer immunity and significantly increase their activity at all stages of the disease. Vaccines create a stable immunity, which is active several months after the completion of the course of treatment.
Adoptive cell transfer is an effective technique that involves harvesting a patient's immune cells (T-cells) and training them in the laboratory. After laboratory processing is completed, T-cells become more active and numerous, and better recognize cancer cells. The trained T-cells are given intravenously to the patient; this procedure does not require hospitalization and does not cause side effects.
Toll-like receptor (TLR) agonists. Toll-like receptors are located on immune cells that are present in humans from birth. One of the ten types of such receptors, namely TLR-9, is able to protect the intestinal mucosa from the development of malignant neoplasms. Agonists of toll-like receptors enhance this ability and allow fighting already formed intestinal tumors.
Correction of the intestinal microbiome. This treatment method is not implemented in clinical practice yet. It is based on the fact that the immune system interacts with the bacteria inhabiting the intestines (microbiome). By changing the composition and activity of the microbiome, oncologists can enhance the efficacy of chemotherapy and immunotherapy agents. On the other hand, chemotherapy disrupts the normal composition of the intestinal microflora, and doctors should take this into account when planning treatment. In the clinical trials, the mutual influence of the microbiome and drugs (chemotherapy, immunotherapy) is studied.
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Advantages of immunotherapy for colon cancer
In countries with developed healthcare systems, immunotherapy is increasingly becoming one of the first-line treatments for colon malignancies, although initially it was used only in people with advanced cancer (i.e. metastatic and resistant tumors). If chemotherapy and targeted therapies fail, the average life expectancy of a person with metastatic colon cancer is 6 months. In countries with poorly developed medicine, tumor resistance to standard chemotherapy means that the possibilities of medical care are exhausted, and doctors proceed to symptomatic and palliative treatment.
Such an indication for immunotherapy was justified: by switching to this type of treatment, doctors could significantly extend the life of patients. For example, after adoptive cell transfer, the average life expectancy of people with metastatic colon cancer increases from 14 to 28 months.
The next practical step was the administration of immune checkpoint inhibitors and vaccination with dendritic cells at earlier stages of the disease when other methods of treatment could still be used. The only condition was the preliminary surgical removal of the tumor if the doctors considered such an operation possible.
Clinical trials and practical experience demonstrate that after the start of an immunotherapy course, numerous cytotoxic T-lymphocytes appear in the blood of patients. These are cells that actively destroy the primary intestinal tumor and its metastases. The progression of cancer slows down, up to remission even in the advanced stages.
Immunotherapy for colon cancer in Germany
If you want to undergo immunotherapy at any stage of colon cancer, but your clinic does not provide this type of treatment or does not have sufficient experience, then you can come to one of the German cancer centers. German oncologists actively use immunotherapeutic drugs of all groups and are ready to help people with all types of colorectal tumors.
Booking Health will help you come to Germany for treatment. Booking Health has been organizing the treatment of people from 75 countries in specialized oncology centers in Germany for over 12 years.
The Booking Health team consists of healthcare professionals, patient case managers, and travel managers. Their tasks include:
- Choosing the most suitable oncology center or oncology department of a large university hospital
- Making an appointment for a convenient day, without long waiting
- Organization of a preliminary distant consultation with the attending physician
- Preparation of a preliminary examination or treatment program, so that you can estimate its duration and cost in advance
- Exclusion of taxes for foreign patients from the prices for medical services (savings up to 50%)
- Additional medical control of all stages of the program
- Assistance in purchasing medicines to continue the course of treatment in your country
- Communication with the hospital after the completion of treatment, receiving and translating medical reports into your language
- Control of prices and invoices from the clinic, return of unspent funds
- Organization of additional examinations or rehabilitation, if necessary
- Service of the highest level: assistance in obtaining a visa, booking accommodation, tickets, transfers
- Translation services
Fill out the "Send Request" form and a patient case manager will contact you on the same day to start arranging treatment in Germany.
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Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
Sources:
Journal of Gastrointestinal Oncology
NIH, National Library of Medicine
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