Immunotherapy

IMMUNOTHERAPY

The treatment applied to activate the immune system or to reduce its effect to support the body’s fight against diseases such as cancer is called immunotherapy. There are also types of immunotherapy that target only certain cells of the immune system. Other types leave a general effect for the body. Some types of immunotherapy are listed below.

• Cytokines
• Vaccines
• Basil Calmette-Guerin (BCG)
• Some monoclonal antibodies

Immunotherapies are not only used in the treatment of cancer disease. However, its usage and importance for cancer has increased considerably in recent years. The immune system makes a great effort to separate normal cells and harmful cells. There are control mechanisms at the cellular level for this process to take place. In order to activate the defense system, the molecules that affect the control points must be active or passive depending on the situation. After 2011, drugs that activate the defense, which is a great breakthrough in the treatment of cancer, have been called immune checkpoint regulators.

‘Hidden’ immunity in Cancer Cells and Implications for Immunotherapy

The side effects of immunotherapy, which takes action against cancer, occur when the immune system also damages the normal cells of our body. Side effects occur more and more frequently in combined immunotherapy than in single-agent immunotherapies called monotherapy. As seen in most treatments, side effects in immunotherapy can affect almost every organ system. It mostly affects the intestines, hormonal system, skin, lungs. More rarely, it affects the cardiovascular system, the kidneys, the nervous system and the eyes. During the treatment, mild side effects usually occur, but unlike chemotherapy, the side effects may take longer and may last for months. Side effects of immunotherapy include diarrhea, mouth sores, skin allergies, fatigue, fever, weakness, vomiting, and nausea.

Cancer Immunotherapy

The first thing that comes to mind when this term is mentioned is the immune checkpoint regulators. These drugs activate the cells of the immune system by inhibiting the function of molecules on the cell surface called PD-1, PD-L1 and CTLA4. You can find the topics related to cancer immunotherapy on the following pages. The purpose here is to trigger the immune system to fight cancerous cells and put it in a strong position. Although the immune system is very important for our body, misdirections can lead to big problems. When it shows an uncontrolled and excessive performance, it can cause damage to various parts of our body. In an insufficient study, various diseases such as cancer may occur, with infections in the first place.

Types of Cancer Immunotherapy

Non-disease-specific immune activators

It was inspired by the Coley toxin and sought immune response against all forms of cancer. As a result, a non-specific response was obtained for the diseased individuals. These immunotherapies are still used today.

BCG vaccine

Bacillus Calmette-Guerin (BCG), the weak form of the bacterium that causes tuberculosis, is the first modern immunotherapy drug. BCG has started to be tested in cancer and it has been shown to be of great benefit, especially in the treatment of bladder cancer.

cytokines

Cytokines, which are molecules that enable immune system cells to communicate with each other, appear as non-specific immunotherapy drugs. IL-2, one of the cytokines, is used in cancers such as kidney cancer and malignant melanoma.

adjuvants

Adjuvants in the group of non-specific immune triggers are generally used with vaccines to produce a more effective defense response.

Antibody immunotherapies

Since the first group did not target a specific antigen, they constituted a general warning. Immunotherapies in this category target a specific antigen and are called specific immunotherapies. They are divided into two groups. Monoclonal antibodies bind to cancerous cells, allowing them to be recognized and destroyed by the defense system. Bispecific antibodies are proteins formed by two different monoclonal antibodies attached to each other.

Cancer vaccines

Cancer vaccines are examined under two categories. These are preventive vaccines, which are prophylactic, and therapeutic vaccines, which are therapeutic. Therapeutic cancer vaccines developed for treatment form a strong defense against the cancerous cell. It aims to destroy the cancerous cell with genetically manipulated viruses. Protective vaccines, on the other hand, develop immunity against cancer-causing viruses called oncoviruses.

Immune checkpoint blocking

New mechanisms have been discovered that can activate the weakened immune system in individuals with cancer. Among these is the brake mechanism named CTLA-4. It was determined that the immune system of the patient with malignant melanoma shrank the tumor with the inhibition of CTLA-4.

After the discovery of molecules named PD-1 and PD-L1, which have a great effect on the immune system, drugs were produced against them. PD-1, a receptor found on the surface of immune cells, is called a cell death protein. PD-L1 is released from the cancer cell and binds to ligands and initiates the braking mechanism of the defense system. Nivolumab and pembrolizumab bind to these structures and inhibit the braking mechanism. The released defense system cells also take action to recognize cancerous cells and kill them.

Cellular therapies

This category includes modified lymphocytes and CAR T cells that infiltrate the tumor. In cellular therapies, as in others, it is aimed to activate the immune system.

Photoimmunotherapies

Photoimmunotherapy is a treatment that aims to kill cancerous cells quickly and with minimal/no harm to normal cells with infrared light. In this treatment, scientists have created molecules that attach to monoclonal antibodies that recognize cancerous receptors and absorb light at a certain wavelength. The feature of the molecules here is that when they attach to the target receptor on the surface of the cancerous cell, the light in the tip is absorbed, enabling the molecule to become active.

Hyperthermia

Hyperthermia methods, especially the whole-body hyperthermia method, are applied to get the body’s fever, which is a response to natural immunity. In this method, lamps emitting infrared A rays with a depth effect water filter, which do not cause any harm to the skin, are directed directly to the body and abdomen. One of the purposes of this study is to activate the immune system like the others. In general, the range of 39-40 degrees is taken into account. Treatment varies according to the body’s response and reaching the intended heat. In recent studies, it has been reported that hyperthermia increases the expression of PD-L1 and PD-1, which are checkpoints on the surface of cancer cells. This means that the effectiveness of the immunotherapies to be applied will increase.

Radiotherapy

Radiotherapy, which is a regional treatment, leaves DNA damage in the cells in the targeted area and is expected to show its effect in the target area. In the concept defined as abscopal effect, radiotherapy can also be effective in places other than the target area. Although its mechanism is not fully understood, it is believed that it may occur through immunological mechanisms. When the dose is given effectively, radiotherapy can act like a tumor vaccine or it can cause immunological cell damage as well as death. The first cancer types that have this effect; lymphoma, leukemia, breast, neuroblastoma, melanoma and renal cell carcinoma. The appropriate dose and techniques of radiotherapy are still the subject of research.

Combination Therapies

The main feature of cancer cells is to spread and multiply very quickly. At this point, there are some advantages of immunotherapy targeting the immune system rather than the tumor. The tumor mutates very quickly and develops resistance to treatments such as chemotherapy are just a few examples. Combination therapies in immunotherapy promise more stable, long-term and potentially full recovery results. At this point, when used alone, it is still not at the expected level in many diseases. This is where the combination immunotherapies we mentioned above come into play and give hope to individuals.

If we come to the conclusion, cancer immunotherapy can be defined as a treatment method that is developing day by day. Apart from this, it should be kept in mind that resistance to immunotherapies can develop and this treatment method may not provide a certain benefit in all cancer types. It should not be forgotten that personalized therapy is a very important factor today, and it should be taken into account that the benefit of immunotherapy will differ from person to person.

Microbiota and Cancer Immunotherapy

Commensal bacteria (where one is in a positive state and the other in neutral) colonizing the gastrointestinal mucosal layer, that is, aggregating and proliferating, greatly influence the physiological functions of the host, including metabolism, cellular proliferation (rapid proliferation), immunity, and inflammation.

These effects allow bacteria to form small metabolites and molecules. It also coordinates the communication between the immune cell and the host at the intestinal barrier.

Many of the immunotherapies and current cancer treatments work by stimulating anti-tumor immune responses. However, whether the gut microbiota can influence the patient’s responses through the defense system is still a subject of research.

It is thought that the microbiota is of great importance in the occurrence and treatment of many diseases, including cancer, with ongoing studies. Studies have shown that the gut microbiota is a powerful treatment tool. With a better understanding of the role of the microbiota in carcinogenesis (the proliferation of a normal cell by turning into a tumor cell), its importance in the diagnosis, screening and treatment of cancer will increase to a great extent.

You can use the contact page for more detailed information on the subject.

Nutrition in Cancer Prevention

Of course, protection from a multifaceted chronic disease such as cancer requires a multifaceted perspective. Managing stress, having physical activity, being protected from environmental toxins are some of the factors that should be considered in order to keep the risk of cancer at a minimum. In this article, we will look at nutrition, another factor in cancer prevention.

In order to understand the nutrition that can be described as cancer-protective nutrition, we must first learn the expectation of the body from food. The body expects two types of nutrients from food: macronutrients and micronutrients. macronutrients; carbohydrates, proteins and fats. With macronutrients, the body produces energy, produces hormones, repairs cells, or performs one of countless other biological events in the body. Although micronutrients are mostly vitamins and minerals, they also include numerous antioxidant molecules, phytochemicals and pigments found in foods. A cancer-protective diet is achieved when adequate macronutrients and micronutrients enter the body’s cells by the “cleanest” way. Here let’s see what the “cleanest” way will look like.

Consume naturally produced foods as much as possible.

Industrialization in food production has had two consequences. First, food began to come with more toxic waste. While fruits and vegetables entered the markets with chemicals used in agriculture, animal products began to enter our tables with pharmaceutical wastes used in livestock. The second is that we start to take less micronutrients from agricultural products as the soil quality decreases and the diversity of the ecosystem deteriorates. Although we are not lacking in calories, our vitamin deficiencies and antioxidant deficiencies have emerged. These two situations not only expose us to a greater toxin load, but also offer less food sources to combat this toxin load. In order to be protected from cancer, we need to do the opposite. A diet without industrial waste, low in toxins and rich in micronutrients can be a “clean” diet. For this reason, we should try to consume organic foods as far as possible from industrial production.

Keep your food variety rich.

The greatest benefit of food diversity is that it brings the micronutrient diversity that the body needs. Micronutrients are so numerous that it has not been possible for nutritional science to find every micronutrient in every food until now. Phytochemicals, which are new to the category of micronutrients, are bioactive molecules in plants and they support the body in countless different ways from cell repair to reducing free radicals, activating longevity genes to more effective energy production. Incorporating different foods into your diet is an important part of a cancer prevention diet as it will provide the body with all the micronutrient diversity needed. By diversity we mean, of course, plant diversity; We should diversify the vegetables and fruits that we include in our diet.

Do not consume processed food.

Avoiding processed and packaged foods with extended shelf-life in your diet is a cancer-preventive approach. If a food contains ingredients such as white sugar, fructose syrup, preservatives, flavors, white flour, and unfamiliar food additives, it is an indication that food has been processed and will do more harm than good to your body. Industrial foods and the ingredients of these foods have been in our lives for the last 100 years. Considering the evolution of life, this is a very short time, and therefore the human body does not recognize these foods or their ingredients. This situation causes industrial foods not to be tolerated well, wastes cannot be disposed of, and causes damage to all body cells, especially the intestine. Processed foods are both nutritionally deficient and highly toxic in terms of additives. They are not “clean” sources for obtaining macronutrients or micronutrients. Processed and packaged foods have no place in a cancer-preventing diet.

When you consume naturally produced foods, create a varied nutrition plan, and remove processed foods from your life, you add a cancer-protective diet plan to your life. Despite this, as we said at the beginning, cancer is a multi-faceted chronic disease and therefore we must always consider factors other than nutrition.

Nutrition in Cancer

It is not possible to find the exact cause of cancer formation in an oncology patient. We cannot blame a single cause among different cancer-triggering factors such as unhealthy diet, stress, environmental pollution or genetic inheritance, or we do not know at what rates different causes affect. For this reason, no matter what type of cancer it is, it is very important to take a holistic approach to treatment and plan sustainable changes in one’s life. Nutrition is also an issue that must be addressed specifically for the patient in a holistic change after the diagnosis of cancer.

After the diagnosis of cancer, a two-stage process begins in our lives. The first is the cancer treatment process, and the second is the process of maintaining a lifestyle and nutritional plan that will keep the risk of recurrence after treatment minimal. First, let’s look at the treatment process and nutrition in this process.

Recent studies have shown that the type of diet that has the most positive effect on cancer treatment is the ketogenic diet. Ketogenic diet is a type of diet that includes adequate protein, low carbohydrate, and large amounts of healthy fat intake. The daily amount of carbohydrates consumed in this diet is limited to 50 g. The point to be considered in the ketogenic diet is not to consume too many animal products. The desire to consume more products such as red meat, chicken, eggs and cheese, which comes with the restriction of carbohydrates, does not comply with a diet plan that supports the cancer treatment process. The food groups that we need to increase in our diet in the ketogenic diet are non-starchy vegetables (green leafy vegetables, cruciferous vegetables, zucchini, beans, mushrooms…) and healthy oils (olive oil, nuts, olives, avocados, seeds). Sugary and white flour foods, fruits, legumes, starchy root vegetables, cereals and grain products are not included in the ketogenic diet because of their carbohydrate content. In addition, alcohol and cigarettes should not be included in the diet. Fried and burnt foods should not be eaten during the treatment process.

During the cancer treatment process, eating difficulties may occur due to chemotherapy or radiotherapy. Taste, sense of smell, swallowing and chewing functions may be affected. This can cause an appetite suppressant effect. In these cases, small but frequent feeding is supportive for the person. It is important that healthy foods that can be snacked and that the person can tolerate, such as nuts and olives, are always available to support the treatment. Water consumption, which is another important point, is also a point to be considered during the treatment process. Making sure that a person consumes enough water between meals is part of a healthy eating plan.

Nutrition in the post-treatment period is just as important as in the treatment. In order to keep the risk of relapse to a minimum, a person should follow a healthy eating plan throughout his life. In this nutrition plan, the priority should be on vegetables and healthy fats. Legumes, whole grains, fruits and starchy vegetables that are not on the ketogenic diet are included in the diet during this period. A person should stay away from consumption of large amounts of animal products, fried fats, sugary and white flour foods, alcohol and cigarettes all his life.

A holistic approach is of great importance in post-treatment nutrition. What you eat and don’t eat often is more important than what you eat occasionally or not. For this reason, you should make sure that you have a sustainable healthy plan in your life. For this, it is useful to remember that not only the support of a dietitian, but also the support of a psychologist may be required.