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Osteosarcoma is one of the three most common types of cancer in adolescents and is the most common malignant bone tumor. The basis of treatment is surgery and chemotherapy. The conventional protocol for the treatment of osteosarcoma is quite successful and allows many patients to achieve remission. A 5-year survival rate after treatment in a specialized clinic is at the level of 70-80%. Complementing the conventional protocol with the dendritic cell osteosarcoma vaccine allows doctors in Germany to control the disease even more effectively and avoid limb amputations.
Content
- Who can undergo dendritic cell osteosarcoma treatment
- How is dendritic cell immunotherapy for osteosarcoma performed?
- Results of the use of dendritic cells in treatment of osteosarcoma
- How to undergo vaccination for osteosarcoma in a hospital abroad
Who can undergo dendritic cell osteosarcoma treatment
People with primary (originating in the bone) and metastatic (spread to the bone from another site, such as a malignant neoplasm in the breast or prostate) osteosarcomas are candidates for this treatment. To clarify the diagnosis and search for the primary tumor and all foci of osteosarcoma, the patient undergoes X-ray examination, bone scintigraphy, MRI and CT with contrast or PET/CT. In addition, CT allows surgeons to plan a reconstructive operation in order to restore the function of the affected limb after surgical removal of the tumor along with a piece of bone.
To confirm the diagnosis, an incisional or needle biopsy is performed. In the first case, doctors remove a small part of the affected bone; in the second, they only insert a core needle to harvest a tissue sample. From the material obtained during the biopsy, a lysate of tumor cells is isolated for the manufacture of an individual vaccine. It is important to determine the exact type of tumor, since the World Health Organization identifies 8 histological types of osteosarcoma.
Based on the results of the examination, the tumor board elaborates treatment scheme, including vaccination with dendritic cells at one of the following stages:
- After the surgery. During the operation, the surgeon removes the affected bone with a few centimeters of healthy tissue. It is also necessary to remove tissues at the site of the biopsy, as they may contain malignant cells. Vaccination enhances anti-cancer immunity and helps the body destroy the remaining malignant cells after surgery.
- Before the surgery, simultaneous with chemotherapy. Based on the results of X-ray examination, CT and MRI, doctors determine the volume of the tumor before and after immunotherapy. This allows them to choose the best time for the surgical treatment and to carry out a bone-sparing and effective operation. The recommended duration of preoperative (neoadjuvant) chemotherapy is 2 months; this is also sufficient for a full course of vaccination with dendritic cells and the formation of antitumor immunity.
- When the operation is not indicated. Osteosarcoma is an aggressive tumor that grows rapidly, invades the blood vessels early and spreads throughout the body. In 90% of cases, the diagnosis is made quite late: in addition to the primary tumor, a person already has large or microscopic metastases in the internal organs. In this case, the operation will not cure cancer, but will weaken the patient, and the vaccine with dendritic cells will help control the disease and has virtually no side effects.
How is dendritic cell immunotherapy for osteosarcoma performed?
Treatment begins with the vaccine manufacture. Unlike chemotherapy drugs, a drug with dendritic cells cannot simply be bought at a pharmacy: doctors prepare an individual vaccine for each person. Action of the vaccine is directed against a specific tumor.
During one of the visits to the hospital, the patient undergoes leukapheresis. During leukapheresis doctors harvest monocytes (immune cells) from the blood. Specialized dendritic cells can be obtained from monocytes in the laboratory. Leukapheresis is a safe alternative to blood collection, as the patient does not lose hemoglobin, platelets, blood clotting factors and other immune cells. The procedure takes several hours and is performed on an outpatient basis.
The collected monocytes are cultivated in the laboratory in accordance with the standards of Good Laboratory Practice (GLP). When doctors have several million dendritic cells, tumor antigens are added to them – these are tissues removed during surgery or biopsy, which also undergo pre-processing. Dendritic cells "get acquainted" with tumor antigens and remember them. After being infused into the blood, dendritic cells will find such antigens and demonstrate cells with them to the immune system for the subsequent destruction.
The vaccine with dendritic cells is administered intradermally, into the area of the tumor (most often this is the knee or shoulder joint) or postoperative scar. The approximate course of treatment is 4 injections with an interval of 1 week. Injections are made on an outpatient basis, in the day hospital.
In order to increase treatment success rates, doctors may additionally prescribe interleukin-2 (IL-2). Interleukin-2 is produced by T-cells of the immune system after contact with a virus, bacterium, or atypical cell. IL-2 enhances the immune response and boosts the immune system to fight cancer. Interleukin-2 is also administered subcutaneously; the course of treatment includes 6 injections, which are carried out every other day.
If vaccination is carried out during the preoperative preparation, doctors can also administer bisphosphonates. Bisphosphonates do not have an anticancer effect, but they affect the formation of normal bone tissue.
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Results of the use of dendritic cells in treatment of osteosarcoma
Osteosarcoma development is associated with a malfunction of the dendritic cell system. Clinical trials have demonstrated that people with osteosarcoma have increased levels of dormant and inactive dendritic cells. Therefore, all patients respond to the vaccination, while chemotherapy can be ineffective, even if the therapeutic scheme consists of 3-4 aggressive chemotherapy drugs. For patients with chemoresistant tumors, immunotherapy is the only chance to reduce the size of the primary osteosarcoma and suppress the growth of its metastases.
After vaccination with dendritic cells, doctors do not need to perform mutilating operations, which were often performed in the past decades and led to the disability of adolescents and young people. In addition, intervention in the area of the knee or shoulder joint does not affect distant metastases, from which new tumors continue to grow. Immunotherapy, on the other hand, makes it possible to perform organ-preserving operations and at the same time effectively fight bone cancer.
Administration of the vaccine in the postoperative period prevents the growth of metastases while the patient is waiting for chemotherapy to begin. Chemotherapy is started only after complete healing of the surgical wound, including the wound after limb prosthetics. It can take 4-8 weeks to make a limb prosthesis, so chemotherapy is often postponed.
In clinical trials, it has been demonstrated that the use of dendritic cells can cause tumor regression even in those patients who cannot undergo surgical treatment for any reason.
Another important result of treatment with dendritic cells is prevention of osteosarcoma recurrence. After treatment according to the conventional protocol, relapse develops on average in 30% of patients. After a course of vaccination, this figure decreases to 12-15%. In any case, after completing the active treatment, a patient regularly undergoes control examinations: X-ray examination, CT scan of the chest, blood tests, etc.
How to undergo vaccination for osteosarcoma in a hospital abroad
If the clinics in your country do not offer DC therapy for osteosarcoma or do not have sufficient experience in the treatment of osteosarcoma, you can contact a specialized oncology center in Germany. You can visit a German clinic at any stage: for examination, undergoing surgery and postoperative vaccination, only for vaccination.
The Booking Health website contains information about specialized clinics and doctors, the cost of treatment, and possible appointment dates. The Booking Health team will advise you on all issues and help you undergo treatment.
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- Choice of a specialized oncology center and physician
- Preliminary distant communication with the attending physician, distant consultations after the treatment completion
- Elaboration of a preliminary treatment program based on the examinations and procedures already performed
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- Make an appointment on the desired date, without a long wait
- Additional independent control of the medical program at all stages
- Assistance in purchasing and shipping medications for the subsequent maintaining treatment in your country
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- If necessary, organization of additional medical procedures and rehabilitation
- Organizational assistance: booking accommodation, plane tickets, transfer, etc.
- Interpreting services, including accompaniment in the clinic and translation of medical reports
A personal medical coordinator will be in constant contact with you until you return home. The Booking Health team will provide assistance at all steps towards your recovery.
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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!
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