Immunotherapy - Immunotherapy
Immunotherapy
Immunotherapy differs from traditional cancer treatment concepts. Cancer immunotherapy is becoming increasingly popular in Hong Kong. Immunotherapy does not directly attack tumors, but rather fights cancer cells by activating the patient's own immune function. The duration of immunotherapy varies from person to person and requires a personalized plan based on the patient's specific situation.
Principles of immunotherapy
The human immune system has a self-suppressive mechanism, much like a checkpoint at a border crossing. When it detects that an excessive immune response has been triggered after successfully expelling or eliminating foreign invaders or substances not belonging to the body, such as bacteria or viruses, it activates the checkpoint to lower the immune system to a normal level. However, cunning cancer cells know how to exploit this checkpoint mechanism to evade the immune system's detection.
The medical community has discovered that some cancer cells possess a protein called PD-L1 on their surface. Once PD-1 binds to the PD-1 receptor on T cells, the normal function of the immune system is halted, and the T cells are unable to recognize the cancer cells, allowing them to grow and spread freely within the body. In other words, as long as the binding of the PD-1 receptor to the PD-L1 protein is prevented, the immune system can function normally. Immunotherapy is a treatment specifically developed to address this mechanism.
Since 2015, cancer immunotherapy has been gradually introduced in Hong Kong. Initially, only a few diseases were approved for treatment with cancer immunotherapy in Hong Kong, but the range of applicable cancers has now expanded significantly, including various types of cancer such as lung cancer, kidney cancer, melanoma, and head and neck cancer. Doctors will select the appropriate immunotherapy drugs based on the patient's condition and clinical data. Currently, the immunotherapy drugs registered in Hong Kong fall into two main categories: PD-1 inhibitors and PD-L1 inhibitors.
Immunotherapy treatment duration
Immunotherapy is typically administered intravenously, with the specific treatment time and duration depending on the individual patient's condition. Administration is usually every 2 to 3 weeks, with each session lasting approximately 30 to 90 minutes. In Hong Kong, doctors closely monitor the patient's condition to adjust the dosage, ensuring the safety and effectiveness of the treatment.▲Which patients are suitable for immunotherapy?
For example, lung cancer patients must undergo an "immunobiomarker test" to detect the level of PD-L1 protein on the surface of their tumors. Clinical studies have shown that the higher the level of PD-L1 protein on the surface of the tumor, the better the response to immunotherapy.
The "immunohistochemical assay" is performed using "immunohistochemistry" (IHC). Pathologists determine the PD-L1 protein level (ranging from 1% to 100%) based on the percentage of the tumor tissue sample that is stained. A level above 50% is considered high, and 1% to 49% is considered low.
For cases where the tumor does not have a specific gene mutation (and is not suitable for targeted therapy), if the test results confirm that the tumor has a high level of PD-L1 protein (above 50%), the effect of immunotherapy is better than chemotherapy.
▲Side effects of immunotherapy
Because immunotherapy utilizes the body's own immune system to fight cancer cells, it theoretically does not harm normal cells and is generally very safe. However, because the immune system is activated, there is a possibility of side effects such as immune dysregulation, which can cause pneumonia, thyroiditis, gastroenteritis, hepatitis, and dermatitis due to the immune system attacking normal organs. Less than 3% of these cases result in severe immune dysregulation. If these serious adverse reactions occur, doctors will advise patients to discontinue the medication and prescribe steroids to control the excessive immune system response, depending on the situation.
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FAQ
What is cancer immunotherapy?
Cancer immunotherapy works by activating the patient's immune system to fight cancer cells, rather than directly attacking the tumor. It mainly uses drugs such as PD-1 and PD-L1 inhibitors to enhance the immune system's ability to recognize and attack cancer cells.
Which patients are suitable for cancer immunotherapy?
Immunotherapy is generally suitable for tumors without specific gene mutations, and the PD-L1 protein level must be confirmed by immunobiomarker testing in order to evaluate the treatment effect.
What are the common side effects of immunotherapy treatments?
Because the patient's immune system is activated during the treatment, it may trigger immune system disorders such as pneumonia and thyroiditis. If a patient experiences severe side effects, doctors performing cancer immunotherapy in Hong Kong will generally prescribe steroids or other medications to manage them, depending on the patient's condition.
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