cancer immunotherapy treatments There are several different approaches to cancer immunotherapy Wherever you are on your cancer treatment journey, you may want information on the types of immunotherapy available today. Here we provide a description of some of the different approaches to cancer immunotherapy and how they are used to treat a wide variety of cancers.

The following tables provide helpful specifics on the various types of immunotherapies, along with some representative treatments Please note that these tables do not include all cancer immunotherapies currently available, but represent some promising approaches that are currently approved by the FDA or being tested in clinical trials.

Monoclonal antibodies (mAbs) are specifically designed to target cancer cells What isimmunotherapy it called? How treatments does it work? cancer

Monoclonal antibodies (mAb) Monoclonal antibodies (mAb)

•m  Abs are a special type of protein designed to target antigens, or Immune checkpoint inhibitors/modulators markers, located on the surface of cancer cells

Immunotherapy mAbs are approved by the FDA for a wide range of cancers including:

•A  ntibodies locate antigens and recruit immune cells to attack

• Hodgkin’s lymphoma (Adcetris®)

•m  Abs can also interfere with cell signaling, helping to block growth and communication of tumor cells Therapeutic cancer vaccines

For which cancers is it currently used or being studied?

Oncolytic virus immunotherapy

• Breast (Herceptin®, Kadcyla®) • Non-Hodgkin’s lymphoma (Rituxan®, Zevalin®) • Colorectal (Avastin®, Erbitux®, Vectibix®) • Lung (Avastin®)

Adoptive T cell transfer

• Chronic lymphocytic leukemia (Gazyva®, Campath®, Rituxan®, Arzerra®) • Gastric (Herceptin®) • Kidney (Avastin®)

Cytokines

Adjuvant immunotherapy

Several mAbs are currently in clinical trials for a wide variety of cancer types: • Bavituximab (breast, liver, lung, melanoma, pancreatic, rectal) • Ch14.18 (neuroblastoma) • Rilotumumab (fallopian, gastric, ovarian) Bi-specific antibodies (BiTEs) target multiple antigens, and include: • Blinatumomab (acute lymphoblastic leukemia, non-Hodgkin’s lymphoma, gastric, and lung) • MT110 (colorectal, gastric, lung) 1

Checkpoint inhibitors/immune modulators can make cancer cells more susceptible to attack by your immune system What is it called?

Checkpoint immunotherapy treatments

al antibodies (mAb)

Cytokines

inhibitors/ immune modulators Immune checkpoint

inhibitors/modulators

Oncolytic virus immunotherapy

How does it work? •S  ome proteins in immune cells act as “checkpoints,” or brakes, on the immune system response •D  rugs known as checkpoint inhibitors can be used to “release the brakes” on the immune system, allowing a stronger immune attack against cancer

• If checkpoint inhibitors are drugs that let up on the brakes of the immune system, then immune modulators are drugs that “step on the gas” of the immune Adoptive T cell transfer response

Adjuvant immunotherapy

For which cancers is it currently used or being studied? Checkpoint inhibitors: • CTLA-4 inhibitors: Yervoy® is currently approved by the FDA for the treatment of melanoma and is being studied for the treatment of non-small cell lung cancer and prostate cancer; another CTLA-4 inhibitor, tremelimumab, is also being studied in melanoma and mesothelioma • PD-1/PD-L1 inhibitors: Keytruda® (pembrolizumab) is currently approved by the FDA for the treatment of melanoma after failing prior treatment with Yervoy. Other PD-1/PD-L1 inhibitors include nivolumab, MPDL3280A, and MEDI4736, and have shown important benefits in patients with advanced melanoma, lung cancer, kidney cancer, and a number of other cancers • Other checkpoint inhibitors, including ones targeting the immune proteins LAG-3 and KIR, are currently in clinical development Immune modulators: • Immune modulators that are currently in clinical development include drugs targeting the immune proteins CD137/4-1BB, CD27, GITR, and OX40

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cancer immunotherapy treatments

Immune checkpoint

Monoclonal antibodiesvaccines (mAb) inhibitors/modulators the immune system to Therapeutic cancer stimulate attack cancer

What is it called?

How does it work?

For which cancers is it currently used or being studied?

Therapeutic cancer vaccines Therapeutic cancer vaccines

•T  herapeutic cancer vaccines The therapeutic cancer vaccine trigger the immune system to Provenge® is currently approved by Oncolyticand virus attack certain recognize the FDA to treat prostate cancer. immunotherapy Adoptive T cell transfer markers, or antigens, present Therapeutic cancer vaccines are on or in cancer cells also being studied for treatment •U  nlike traditional vaccines, of the following cancers: which help to prevent disease, • Non-Hodgkin’s lymphoma and therapeutic cancer vaccines treat mantle cell lymphoma (BioVaxID) disease that is already there • Breast (NeuVax) •T  here are many different types • Brain (DCVax, CDX-110) of therapeutic cancer vaccines. Cytokines Adjuvant immunotherapy Some are made of individual • Pancreatic (GVAX Pancreas, proteins; others are made of whole HyperAcute™ Pancreas) cells. One promising type is made • Colorectal (Imprime PGG®) of antigen-presenting cells called dendritic cells • And many more •C  ancer vaccines often require additional substances called adjuvants for optimal effectiveness

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cancer immunotherapy treatments

Oncolytic virus imununotherapy uses a modified virus that can Immune checkpoint inhibitors/modulators both cause tumor cells to self destruct and activate a greater immune response

Monoclonal antibodies (mAb)

erapeutic cer vaccines

What is it called?

How does it work?

Oncolytic virus immunotherapy Oncolytic virus

•O  ncolytic viruses are viruses that directly kill (“lyse”) cancer cells and can also activate cells of the Adoptive T cell transfer immune system, such as dendritic cells and T cells, to target and eliminate cancer throughout the body

immunotherapy

Cytokines

•S  ometimes, oncolytic viruses are genetically modified to produce immune-stimulating chemicals, or to make them more specific for Adjuvant immunotherapy cancer cells •O  ncolytic virus immunotherapies are often combined with other types of cancer immunotherapies, including therapeutic cancer vaccines and mAb therapy

For which cancers is it currently used or being studied? No oncolytic virus immunotherapy is FDA approved. Oncolytic virus immunotherapies are currently being studied in clinical trials for a number of cancers, including: ­• CG0070 (bladder) ­• Reolysin (prostate, colorectal, ovarian, lung, and breast) ­­• CAVATAK (melanoma) ­­• JX-594 (ovarian) ­­• MV-NIS (multiple myeloma) ­• And many more

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therapy treatments

Immune checkpoint inhibitors/modulators

Adoptive T cell transfer can enhance the natural cancer-fighting ability of your body’s T cells

)

ncolytic virus mmunotherapy

What is it called?

How does it work?

Adoptive T cell transfer

Adoptive T cell transfer is an anti-cancer approach that enhances the natural cancer-fighting ability of the body’s T cells by removing immune system cells, growing and/ or making changes to them outside of the body, and then re-infusing them back into the patient.

Adoptive T cell transfer

There are 3 different approaches to adoptive T cell transfer: Adjuvant immunotherapy

•T  cells can be collected from a sample of a patient’s tumor and multiplied in a laboratory

For which cancers is it currently used or being studied? • No adoptive T cell transfer technique is FDA approved, but several have shown great promise in early clinical trials • Adoptive T cell transfer has shown promise in the treatment of metastatic melanoma, lymphoma, leukemia, neuroblastoma, and synovial cell sarcoma; it is currently being investigated for use in other solid tumors and blood cancers

•T  cells can be taken out of the body and genetically modified to attack antigens on cancer cells •T  cells can be taken out of the body and equipped with special receptors called chimeric antigen receptors (CARs); when given back to the patient, these “CAR T cells” recognize and attack cancer cells

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Therapeutic cancer vaccines

Oncolytic virus immunotherapy

Adoptive T cell transfer

Cytokines help your immune system recognize and destroy cancer cells For which cancers is it currently used or being studied?

What is it called?

How does it work?

Cytokines

•C  ytokines are messenger Adjuvant immunotherapy molecules that help control the growth and activity of immune system cells, as well as blood cells

• Kidney (IL-2, IFN-alpha)

•T  ypes of cytokines include interleukins (IL), which help immune cells grow and divide more quickly; and interferons (IFN), which boost the ability of certain immune cells to attack cancer cells

• Follicular non-Hodgkin’s lymphoma (IFN-alpha)

Cytokines

• Melanoma (IL-2, IFN-alpha) • Hairy cell leukemia (IFN-alpha)

• Cutaneous (skin) T cell lymphoma (IFN-alpha) • Chronic myelogenous leukemia (IFN-alpha) • Kaposi’s sarcoma (IFN-alpha)

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Cytokines

Adjuvant immunotherapies can help produce a greater immune Adoptive T cell transfer response

Oncolytic virus immunotherapy

What is it called?

How does it work?

Adjuvant immunotherapy

•A  djuvant immunotherapies are substances that are either used alone or combined with other immunotherapies to boost the immune response even more

Adjuvant immunotherapy

•A  djuvant immunotherapies can improve responses to therapeutic cancer vaccines that require the work of T cells or other immune cells •S  ome adjuvant immunotherapies use ligands—molecules that can bind to protein receptors—to boost immune responses

For which cancers is it currently used or being studied? • Bacillus Calmette-Guérin (BCG) is FDA approved to treat superficial bladder cancer • Granulocyte macrophage colony-stimulating factor (GM-CSF) is a cytokine that stimulates dendritic cells to develop, and is often used as an adjuvant with therapeutic cancer vaccines, including those for prostate and pancreatic cancer • An adjuvant immunotherapy called Montanide is currently being used in vaccine trials for a number of cancers • Toll-like receptor (TLR) ligands are used to enhance the body’s immune response, and have shown effectiveness in brain, kidney, lung, colon, pancreatic, prostate, ovarian, and breast cancer

Access this cancer immunotherapy list to help stay informed on TheAnswerToCancer.org

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