What You Need to Know to Get Started: The Basics of Cancer Immunotherapy
“In essence, as powerful as the immune system is, cancer has been even more intelligent. It is not just the fact that the immune system fails to recognize cancer that has made cancer so challenging to treat effectively, but also the fact that cancer is actively able to avoid the immune system.
In simple terms, you can think of the immune system as having two main divisions, one designed to attack harmful foreign substances and the other to protect against an overzealous immune response, acting as defense against “autoimmunity”—the process of immune cells misperceiving cells in the body as foreign invaders and attacking them by mistake. I stress this again because it is important: The division
designed to protect the body from a mistaken immune attack is known as the regulatory immune system. The regulatory immune system is obviously critical to reduce the risk of autoimmune diseases which arise when the immune system thinks the body’s own cells are foreign ones and must be destroyed. The regulatory immune system helps prevent these mistaken attacks on the body’s own cells. You can think of the protective, regulatory side of the immune system as being the “brakes” and the attacking side as being the “gas pedal.” No matter how much you push the gas, if the brakes are fully applied you will go nowhere. Unfortunately, what that means when it comes to cancer is that the regulatory portion of the immune system prevents the rest of the immune system from attacking cancer cells because those cells are masquerading as normal, natural cells that belong there. Thus, failing to recognize the cancer cells for what they are, the regulatory immune system is an important protector of cancer.
Despite these challenges, the concept of teaching the immune system to recognize cancer and destroy it has seemed like the best chance to create a cure in a high percentage of cancer patients. The immune system has its own intelligence and it has memory, both of which are crucial to seek out and kill cancer. A good immune response recognizes many targets on a cancer, so-called cancer antigens, making it harder for the cancer to hide. This is the weakness with some of the one-dimensional treatments, which includes some vaccines and original versions of CAR-T, which generally target one antigen. Later in this book, I will discuss in more detail how intra-tumoral immunotherapy, the injection of immunotherapy directly into a cancer, may be a good solution to this problem.”
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