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“So in 2015, something new came on board in the cancer world on a semi-regular basis. And it changed a lot of things for a lot of people. And that’s called immune therapy. Now immune therapy has kind of vague or non-specific term because sometimes it does apply to rituximab and other things where we use antibodies. But traditionally, from what you see, maybe on the commercials now, when people are talking about immune therapy in lung cancer and a lot of other primary cancers now, they’re talking about things that have to do with either the PD 1 or PD-L1 receptor in association with your lymphocytes, or CTLA four. And basically all that means is your cancer cells can sometimes develop basically a stop sign that tells your lymphocytes or your body to say, hey, don’t attack me, keep moving. And it can express that and that pathway, one of them to kind of block or basically screen them from your own immune system, is the PD 1 PD-L1 interaction.
And so what immune therapy does is they basically knock that stop sign off. So whether it’s CTLA four mediated or BPD-L1 or PD1 mediated, that stop sign gets knocked off on the cancer cell. And then all of a sudden your own body can start attacking it. It’s effective. The problem is, it can be very tricky in the sense that sometimes the immune therapy may just be too effective and get over-hyped. And now it has permitted your lymphocytes to start attacking anything on your body, right? Because your normal cells may have a stop sign knocked off. So unlike cytotoxic chemo, where we have just like, you know, a good idea could be neuropathy, which means tingling in your hands or nausea and vomiting and diarrhea. Anything can happen with immune therapy. So we have to be very aware, your ER doctor, your primary doctor, anyone else involved has to be aware, as well as your family members, that maybe some blurry vision or some difficulty looking left or diarrhea or shortness of breath, head to toe, any cell can be affected.
And that’s what makes it tricky. But it has changed in a huge way, how we treat cancers, especially in the stage four setting, because now we use immune therapy and a whole bunch of stuff. It started in lung, but now it’s in renal cell and bladder and breast and head and neck. So we’re continuing to look at things that aren’t necessarily cytotoxic chemo that allow you to be on these things for a very long time. It is important to know though that a lot of times they are more effective when they’re given with chemo at first. So you get a quick tumor kill with the cytotoxic chemo, and then you just kind of keep doing the immune therapy afterwards.”