Personalized Medicine for Cancer: A case for affordable immunotherapies & preventive medicine

Dwayne Moore
8 min readMay 31, 2023

In the multifaceted realm of cancer research, one term has emerged at the forefront: Personalized Immunotherapy. It’s a pioneering approach designed to harness the power of the body’s own immune system, tailored to each individual’s unique genetic blueprint. However, a challenge remains: making these breakthrough therapies accessible and affordable for all.

We stand on the brink of a new era in oncology, an era where personalized immunotherapies could replace the ‘one-size-fits-all’ treatment model and bring hope to millions worldwide. But this promising future is not possible without the means to make it a reality.

We need a fundraising campaign aimed at the development and democratization of affordable, personalized immunotherapies for cancer. We need to invest in a future where every individual, regardless of their financial background, can benefit from the cutting-edge of medical science.

The Partnership for Personalized Cancer Medicine (PMPC) is a non-profit organization, aiming to position Quebec as a leader in the development and deployment of personalized medicine solutions for cancer patients.

Personalized Medicine & Cancer : Understanding Personalized Oncological Therapies

The concept of “personalized medicine” signifies a treatment regime constructed around your individual genetic blueprint and specific ailment. Genes are responsible for providing the necessary instructions for the growth and development of your body’s cells. Numerous cancers interfere with or are associated with specific genes. You can acquire more knowledge about the correlation between cancer and genes. This methodology is also referred to as “precision medicine.”

Customized oncological therapies are derived from extensive research into human genetics and genes found in various cancers. Such investigations have allowed scientists to craft more potent treatments. They’ve also employed genetic data to develop diagnostic tests for cancer and methodologies to avert it.

Personalized therapies can potentially produce fewer adverse reactions compared to other treatment strategies because they are tailored more accurately. Customized therapies are designed to minimize harm to healthy cells while primarily targeting cancerous cells.

Your physician might collaborate with you to devise a customized cancer screening or treatment strategy. This might encompass:

  1. Determining your likelihood of developing cancer and selecting screening tests to mitigate that risk.
  2. Tailoring the treatment to match your genes and the genes of your cancer, which could prove more effective and trigger fewer adverse effects.
  3. Estimating the possibility of the cancer’s return, which is referred to as the “risk of recurrence.”

The Distinctiveness of PersonalizedMedicine

Prior to the advent of customized medicine, patients with identical types of cancer would typically undergo the same treatment. Over time, it was observed that some patients responded better to these treatments than others.

Subsequently, researchers uncovered genetic variations in individuals and their cancers. These differences shed significant light on why cancers displayed divergent responses to identical treatments.

Presently, you may still undergo the standard treatment for your specific type and stage of cancer.

However, your physician might tailor this treatment based on insights gained from your genes and the genes of the cancer. This is what constitutes customized oncological therapies.

Customized therapies might also form part of a clinical trial, which is a research study involving volunteer participants.

Latest techniques in Personalized immunotherapy for cancer

Cancer, a multifaceted and difficult-to-treat disease, showcases remarkable variation among and within patients. Such variance is only beginning to be fully understood.

Personalized therapies, driven by the unique characteristics of each tumor, hold potential to yield superior clinical outcomes relative to traditional treatment modalities. Immunotherapy emerges as a hopeful tool in the personalized treatment toolkit; examples include adoptive cell therapy and neoantigen vaccines, which leverage the immune system’s ability to recognize specific antigens, thereby inducing tumor regression.

The aim of this Research is to identify and address current obstacles while proffering solutions to principal issues arising in the advancement of personalized immunotherapies for cancer, while keeping the protocol as affordable as possible for cancer patients.

This Research Topic encapsulates several critical aspects, presented in the form of exceptional research or review papers, which will be discussed henceforth. It is our hope that these articles will stimulate scientific exploration into the ensuing frontiers of personalized immunotherapies.

Adoptive Cell Therapy: TIL, CAR, or TCR Based

Adoptive cell therapy employing ex vivo amplified TILs (tumor infiltrating lymphocytes) has emerged as an effective treatment for patients suffering from metastatic melanoma. Nevertheless, one of the primary technical challenges lies in selectively expanding anti-tumor TILs without concomitant expansion of bystander T cells. A potential solution to this predicament was proposed by Yunger et al., who employed a synthetic immune niche composed of immobilized CCL21 and ICAM1 to optimize TIL expansion. This strategy resulted in a TIL product characterized by an elevated expansion rate and reduced expression of exhaustion markers compared to conventional methods. (Source: frontiersin.org , Modulating the proliferative and cytotoxic properties of patient-derived TIL by a synthetic immune niche of immobilized CCL21 and ICAM1, This study was supported by grants from the Israel Science Foundation, program: Israel Precision Medicine Partnership (IPMP) and the Volkswagen Foundation to BG.)

Cryopreservation, an indispensable stage in adoptive cell therapy, has potential to adversely impact the quantity and quality of T cells during the production process. An influential study conducted by Brezinger-Dayan et al. investigated the implications of cryopreservation on CAR-T cell products. Comparisons between fresh and cryopreserved CD19 CAR-T cells, in terms of phenotypes and in vitro anti-tumor reactivities, revealed superior anti-tumor reactivity in fresh CAR-T cells. Despite this, the authors surmised that using cryopreserved CAR-T cells remains a feasible option, as cryopreservation seemingly did not influence clinical responses in the trial.

Phase I/II clinical trials represent critical milestones in assessing the safety and potential efficacy of recently developed therapies, such as adoptive cell therapy. Crucially, identifying immune-related adverse events, for instance, cytokine release syndrome, is paramount for immunotherapy clinical trials. Maggadóttir et al. meticulously delineated a clinical trial design, which encompasses the transient expression of anti-hTERT TCR in autologous T cells, in conjunction with dose escalation. This clinical trial will be employed to evaluate the safety and tolerability of this T cell product in treating patients with metastatic non-small-cell lung cancer.

Featured:- An Opportunity for cost reduction of immunotherapy

A clinical study in India may Herald an Era of Economically Accessible Immunotherapy Globally.

An investigative endeavour within India has reported that a dramatically reduced dose of the immunotherapeutic pharmaceutical, nivolumab (Opdivo), enhances survival duration in patients suffering from advanced stages of head and neck cancer. Intriguingly, this dosage is a mere 6% of what is conventionally administered within the United States and Europe, suggesting a potential for enhanced economic accessibility.

Within this clinical experimentation, the investigative group introduced an ultra-minimal dosage of nivolumab into the conventional treatment procedure for head and neck cancer, specifically implemented within India. This combined methodology, remarkably, more than doubled the proportion of patients surviving at the one-year mark, in comparison to the results of the standard treatment strategy in isolation, as documented in the Journal of Clinical Oncology on the 20th of October.

Despite these promising results, Charalampos Floudas, M.D., a medical oncologist specializing in head and neck cancers at NCI’s Center for Cancer Research, who was not directly involved in the study, advised caution regarding the direct applicability of these findings in the US context. The etiology and treatment modalities of head and neck cancers differ significantly between India and the United States.

Nevertheless, a consensus amongst several researchers suggests a broader implication of these results, underscoring the potential of making costly immunotherapeutic pharmaceuticals more economically viable, specifically for a larger demographic of cancer patients in low- and middle-income nations.

The use of an ultra-minimal dosage of nivolumab within this study “decreases the cost of therapy to 5% to 9% of the cost of full-dose immunotherapy regimens,” articulated the study’s lead investigator, Kumar Prabhash, M.D., and his scientific colleagues.

Anticipating Immune Epitopes

Predicting immunogenic MHC class II epitopes has represented a considerable technical obstacle. In their study, Xu et al. introduce a novel bioinformatics instrument based on a convolutional neural network model, termed FIONA. This tool is capable of accurately forecasting MHC class II epitope binding and immunogenicity. It holds potential for use in predicting CD4+ T cell immune responses against tumors, leading to the creation of personalized treatment plans, which could include personalized neoantigen vaccines. (Source: Frontiersin.org, A Highly Effective System for Predicting MHC-II Epitopes With Immunogenicity)

Preventive Techniques for Cancer: Pioneering Cost-Effective Obesity Interventions: A Pathway to Curtail the Impending Cancer Epidemic

Recent research has positioned obesity as a major risk factor in the development of certain cancers. However, by embracing affordable and accessible obesity interventions, we may stand a chance in averting the impending cancer epidemic.

Obesity, characterized by an excess of body fat, is now considered a global health crisis with over 650 million adults classified as obese as of 2016 according to the World Health Organization. It has been intrinsically linked with a multitude of health complications, not least of which are various types of cancers, including those of the breast, colon, and pancreas.

Firstly, it’s crucial to acknowledge that obesity instigates a milieu of metabolic disturbances, including chronic inflammation and insulin resistance, both of which have been associated with carcinogenesis. Therefore, interventions aimed at reducing obesity could, in effect, modulate these processes, thereby reducing cancer risk.

Next, let’s delve into the cost-effective obesity treatments that are now accessible and their implications for cancer prevention. These interventions encompass lifestyle modifications, such as dietary changes, increased physical activity, and behavioural therapy. More recently, pharmacological therapies have emerged, targeting specific metabolic pathways to induce weight loss.

Dietary changes advocating for a balanced diet rich in whole foods and lean proteins and low in processed foods and sugars are an affordable means to tackle obesity. Coupled with regular physical activity, this approach can have a significant impact on body weight and metabolic health, and by extension, cancer risk.

Behavioural therapy, although often overlooked, is an essential component of any obesity treatment strategy. It promotes healthier lifestyle choices, portion control (sometimes with use of over the counter aids), enhances motivation for change, and supports individuals in their weight loss journey. (Source: OutlookIndia, Over the counter obesity drugs alternatives)

These interventions, provided through digital health platforms, have become increasingly accessible and affordable, making them viable options for large-scale implementation.

In tandem, pharmacological therapies have evolved dramatically, with the development of more efficacious and less costly drugs. These medications, aimed at mitigating the physiological drivers of obesity, have shown promise in achieving sustainable weight loss and enhancing metabolic health. Their improved accessibility might significantly contribute to the reduction of cancer incidence linked to obesity.

However, the development and implementation of affordable obesity treatments must be paired with a concerted effort to raise awareness about the link between obesity and cancer. This knowledge, coupled with the availability of cost-effective interventions, could galvanize individuals to proactively manage their weight, thus mitigating their cancer risk.

The Partnership for Personalized Cancer Medicine (PMPC) is a non-profit organization, aiming to position Quebec as a leader in the development and deployment of personalized medicine solutions for cancer patients. All partners and collaborators of the PMPC, who bring key expertise in molecular biology, genomics, proteomics, medical imaging, clinical management, pharmacoeconomics, ethics, bioinformatics, and information technologies, will structure an integrated network supporting the deployment and practice of personalized medicine in Quebec, and will provide solutions tailored to its implementation in the healthcare system. The outcomes of the PMPC’s projects suggest a measurable impact, both on clinical diagnostics and therapeutic management of various types of cancer, as well as on efficiency and cost management for the healthcare system.

References

https://www.nih.gov/news-events/nih-research-matters/identifying-immune-cells-personalized-cancer-immunotherapy
https://www.nature.com/articles/d41591-022-00108-x
https://www.cancer.net/node/24897
Doi.org /10.3389/fonc.2023.1116328 — Modulating the proliferative and cytotoxic properties of patient-derived TIL by a synthetic immune niche of immobilized CCL21 and ICAM1
Doi.org /10.3389/fonc.2022.888556 — A Highly Effective System for Predicting MHC-II Epitopes With Immunogenicity
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7682753/
https://www.cancer.gov/news-events/cancer-currents-blog/2022/cancer-immunotherapy-low-dose
https://www.outlookindia.com/outlook-spotlight/phentermine-over-the-counter-13-best-generic-adipex-p-phentramine-d-phenaprin-phenalean-alternatives-with-reviews-news-214637
https://medium.com/@dwayne_19846/the-case-for-1-prescription-weight-loss-drug-9b85cb733fc8

--

--