Breast Cancer Awareness: Questions & Answers

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Did you know that you can reduce the risk of pancreatic cancer and improve immunotherapy response by doing aerobic exercise?

Thirty minutes of exercise a day can reduce the risk of pancreatic cancer by as much as 50%. Aerobic exercise produces adrenaline (the fight-or-flight hormone). Adrenaline can boost the immune response by enhancing how the body handles signal proteins like Interleukin-15, which activates and increases the proliferation and survival of T-cells, B-cells, and NK (natural killer) cells. For this reason, adrenaline acts as one of the keys to unlocking a broader immune response to pancreatic cancer. Aerobic exercise also releases endorphins that reduce anxiety and depression.

It should be noted that generally, after a surgical procedure, it is recommended to start physical activity gradually under the advice of your health provider.

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DOSTARLIMAB AND THE AMAZING IMMUNOTHERAPY RESULTS IN RECTAL CANCER

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Complete response in 12 Out of 12 Patients with Rectal Carcinoma using Immunotherapy

On June 5, published by Cercek et al. in The New England Journal of Medicine, a small trial of 12 patients with stage 2-3 rectal cancer was treated with the PD-1 inhibitor, dostarlimab.   Amazingly, they reported that 12 out of 12 had a complete response. Clearly very exciting and goes with my feeling that most cancer patients need to be allowed to be treated with Immunotherapy, especially if other treatments have failed. There is one special consideration in the study; the patients had what is known as a mismatch repair deficient tumor. What is mismatch repair? It is the ability to fix incorrectly inserted bases of DNA that occur during the copying of the DNA. If this process does not function correctly, more DNA errors will accumulate. The more errors, the more different the cancer DNA will be from normal cells. This gives the immune system more targets, making cancer more receptive to Immunotherapy. Unfortunately, like many other cancers, mismatch deficiency is in the minority of colorectal cancer, 15% or less. Certainly, it is essential to identify patients with mismatch deficiency and consider Immunotherapy. That is undoubtedly a common practice in evaluating the biopsy of a tumor. There are also other aspects beyond mismatch repair, such as tumor mutational burden and other mutations associated with DNA repair. Also, in some cases, certain medications can be used to block DNA repair, potentially increasing the potential to respond to Immunotherapy.

There are a few questions that arise from this trial. One question is whether dostarlimab is superior to Opdivo or Keytruda, even though all are in the same class of drugs as PD-1 inhibitors. The results seemed similar in prior trials where dostarlimab and Keytruda were used. We may see more head-to-head trials to answer this question in the future. The next question is what can be done to make the majority of patients who don’t have mismatch deficiency respond as well. Though there are many complex aspects of the immune response, one key one is to increase the immune cell infiltration into cancer. One technique is injecting immune agents into the tumor that calls the immune cells to the tumor. This now alerts the immune cells to cancer and can increase the ability to respond to other Immunotherapy. This is a way to equalize the playing field for patients who don’t have mismatch repair to be more like those who do.

Certainly, this study further demonstrates to the public what we in the scientific community already knew, that it is possible to have incredible responses with Immunotherapy. And we know the playbook and can expand this out to the majority of other cancers. That is precisely what we are doing with our patients, bringing the treatments of the future to them today.

By Dr. Jason Williams

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IMMUNOTHERAPY AWARENESS MONTH | WILLIAMS CANCER INSTITUTE

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CANCER PREVENTION AND EARLY DETECTION.

Of all the causes of death, cancer remains the second-leading in the entire world. Maintaining a healthy diet and active lifestyle is vital in fighting this disease. Regular screenings such as mammograms, pap smears, colonoscopies, and prostate exams are essential for early detection, and early detection can be critical to treatment success.

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IMMUNOTHERAPY VS CHEMOTHERAPY

When it comes to breaking down the differences between two cancer treatments and choosing
which is best, the ultimate goal is to take into consideration the individual factors and
circumstances each patient has. Each treatment will have its unique side effects and
considerations. We’ve simplified a couple of differences amongst both chemotherapy and
immunotherapy to help you better compare both treatments.
Chemotherapy
● Depletes the body’s immune system
● Decreases white blood cells count
● Causes drastic hair loss
● Causes nausea and vomiting
● Causes chemo brain (disruption in focus and concentration)
● Can be combined with immunotherapy
● Low metronomic dosing is an option
● Reduces tumor burden, making it easier for the immune system to fight
Immunotherapy
● May increase certain autoimmune diseases
● Can cause autoimmune pneumonitis
● Hormone imbalance may occur
● Cytokine Release Syndrome (CRS)
● Less invasive than chemotherapy
● When used in combination with other cancer treatments has been shown to improve the
overall treatment process
● Fewer side effects compared to chemotherapy

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