Intratumoral immunotherapy
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Immunotherapy is the most rapidly developing area of cancer treatment in the 21st century. Many methods and drugs have already been approved that significantly improve the results of cancer therapy, especially in the advanced stages. Immunotherapy causes immune cells to attack cancer cells more actively, improving survival rates and treatment success rates. It is usually used systemically, and drugs can be administered intravenously, subcutaneously, or intramuscularly. But in recent years, an approach in which an immunotherapy drug is injected directly into the tumor has become increasingly common. It is already possible to undergo intratumoral immunotherapy at some German hospitals. Although most drugs are still being used in clinical trials, some have already been approved by medical associations and have become part of standard cancer treatment.
Content
- What is intratumoral immunotherapy?
- Why is intratumoral immunotherapy used?
- How is intratumoral immunotherapy performed?
- Areas of application of intratumoral immunotherapy
- Where can I undergo treatment?
Intratumoral immunotherapy involves injecting immune-activating agents directly into the tumor. This stimulates a local immune response, helping the body recognize and attack cancer cells more effectively.
Intratumoral immunotherapy can be used to treat various cancers, including melanoma, breast cancer, and head and neck cancers. It is particularly effective for tumors that are accessible for direct injection.
Benefits include a localized treatment approach, reduced systemic side effects, and the potential for a strong and sustained immune response against the cancer. This therapy can improve overall outcomes and quality of life.
Effectiveness is monitored through regular imaging tests and clinical evaluations. These assessments help doctors determine the therapy's impact and make any necessary adjustments.
Most side effects are localized and mild, such as pain at the injection site and inflammation. Severe side effects are rare but can occur, necessitating close monitoring during treatment to manage any adverse reactions promptly.
What is intratumoral immunotherapy?
Human intratumoral immunotherapy (HIT-IT) is the injection of immunostimulating agents or immune cells into a tumor to enhance the antitumor immune response. It has a number of advantages compared to systemic immunotherapy. These are as follows:
- There are fewer systemic side effects because only a small portion of the administered dose enters the systemic circulation. In addition, the dosage of the administered drug is much less than that used in systemic therapy.
- Less consumption of the drug, which also means a lower average cost of treatment.
- Higher efficiency at the tumor site where the injection is made due to direct delivery of the drug to the target area.
- High local concentrations of chemokines, which help attract immune cells into the tumor microenvironment.
Despite the fact that intratumoral immunotherapy involves a direct injection of the drug into the tumor site, the effect is not limited to its effect only on it. As a result of the administration of the drug, the tumor disintegrates. Its components enter the systemic bloodstream, causing strong antigenic stimulation of the immune system. As a result, the overall antitumor immune response is enhanced. Therefore, this type of immunotherapy also affects other tumors and cancer cells in the body. The method works well even at the metastatic stage of cancer.
Why is intratumoral immunotherapy used?
The goals of treatment are as follows:
- A local effect is the shrinkage of the size of the tumor to create conditions for its subsequent surgical removal or relieve symptoms
- A systemic effect to control metastatic foci and destroy clusters of cancer cells, thereby increasing the patient's life expectancy
- Improving the effectiveness of systemic immunotherapeutic drugs
- Overcoming cancer cell resistance to immunotherapy
- Suppressing tumors that "hide" from immune cells behind tissue barriers, thereby reducing the effectiveness of systemic therapy
Intratumoral immunotherapy is considered primarily as a method of controlling advanced tumors and reducing symptoms as well as a neoadjuvant therapy option to shrink the tumor before its removal, make it resectable, and lower the risk of relapse.
How is intratumoral immunotherapy performed?
As the name of the procedure suggests, this type of immunotherapy involves performing an injection directly into the tumor. The treatment is therefore more traumatic compared to intravenous infusions of the drug.
It is good if the tumor is located close to the surface of the human body. The drug can then be injected into it using a transdermal method. But even when tumors are deep, doctors can find ways to deliver the drug to the target area. They can use:
- Colonoscopy (colon endoscopy)
- Cystoscopy (bladder endoscopy)
- Bronchoscopy (insertion of an endoscope into large bronchi)
- Thoracoscopy or laparoscopy (minor operations involving the insertion of an instrument into the chest or abdominal cavity)
These routes of administration are rarely used. Intratumoral immunotherapy is mainly used in the presence of tumor lesions larger than 1 cm located in the skin, subcutaneous tissue, or palpable lymph nodes.
Invasive techniques have been used in clinical research, but they limit the repeatability of injections, so these methods of drug delivery are considered less promising for widespread use in the future.
Below are the drugs that can be used to stimulate immune cells:
- Toll-like receptor (TLR) agonists
- ST stimulator of interferon genes (STING) agonists
- RIG-I-like receptor agonists
- Monoclonal antibodies ("naked" and conjugated – bound with chemotherapy or radioactive substances)
- Oncolytic viruses
- Peptides
- Cytokines
- Immune cells, mainly modified T cells
- Immunomodulators
- Microparticles or nanoparticles
Areas of application of intratumoral immunotherapy
Intratumoral immunotherapy was first used in the 19th century. William Coley, a surgeon from New York, injected live bacteria and their toxins into tumors. He treated hundreds of patients with various tumors but did not obtain any significant results, and this technique was forgotten for a long time.
But in the 21st century, it is being revived. More and more oncological diseases are being treated with immunotherapy agents injected into the tumor. However, so far, patients are treated mainly within the framework of clinical research.
Currently, one intratumoral immunotherapy drug is approved and used as a standard cancer treatment. It is called talimogene laherparepvec (T-VEC, Imlygic), an oncolytic virus used for treatment of metastatic melanoma.
Indications for the use of T-VEC are stage III melanoma and higher, unresectable tumors (those that cannot be removed), and involvement of regional lymph nodes, skin, and subcutaneous tissue. The effectiveness of the drug was confirmed in the OPTIM study. It increases the relapse-free period and improves the overall survival of patients.
The virus is injected into the tumor once every two weeks. It helps to shrink not only the tumor focus at the injection site but also other tumors. Moreover, the drug is safe. The most common side effects are flu-like reactions and pain at the injection site.
Dozens of other drugs have also been developed and are undergoing clinical trials. Some are not yet approved, and others are part of standard treatment but are administered systemically (intravenously).
Doctors are researching both the possibility of monotherapy using intratumoral administration of immunotherapeutic agents and various combinations of this method with chemotherapy, radiation therapy, and tumor removal surgery. In some research projects, not one but several drugs are injected into the tumor at once, which enhances the effect of each other, making it possible to more effectively destroy cancer cells.
Below are diseases for which the effectiveness of intratumoral therapy is being studied:
- Gliomas
- Ovarian and fallopian tube tumors
- Primary peritoneal tumors
- Kaposi's sarcomas
- Colorectal cancer
- B-cell non-Hodgkin lymphomas
- Non-melanoma skin malignancies
- Soft tissue sarcomas
- Urothelial cancer
- Breast, lung, liver, pancreatic, kidney, cervical, bile duct, stomach, esophageal, and oropharyngeal prostate cancer
So, doctors are trying to use intratumoral immunotherapy to treat many oncological diseases. Currently, more than one and a half hundred studies are being conducted around the world to evaluate its effectiveness, and promising results have already been obtained.
Where can I undergo treatment?
You can undergo your treatment in Germany. Intratumoral immunotherapy is already available in many German hospitals.
You can select a hospital for your treatment in Germany through the Booking Health service. The website presents current prices, so you can compare the cost of services in different German hospitals and choose the most suitable option. When you make an appointment for your treatment through Booking Health, the cost of treatment in a German hospital will be lower for you due to the absence of additional fees for foreign patients.
The specialists from the Booking Health company will take care of all the arrangements for your treatment in Germany. We will contact the hospital administration, make an appointment for your preferred dates, book a hotel room, book airline tickets, meet you at the airport, and take you to the hospital by car.
Choose treatment abroad and you will for sure get the best results!
See the interview for more information:
INNOVATIVE DENDRITIC CELL TREATMENT IN GERMANY – interview with Prof. Dr. med. Frank Gansauge
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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Sources:
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