RUNNING HEAD: Community Report Problem

Community Report Problem The University of Texas at El Paso Cassidy Daw Summer 2013

Community Report Problem Abstract This community problem report addresses the issue of immunology and immunotherapy when used for cancer treatment. Realizing that many people are affected, from diagnosis to recovery, the communities that this report will focus on are the patients, their families, researchers and doctors. Various angles of experimentation are taking place while trying to find the most effective way to incorporate this new method of personalized treatment into the treatment

process. This report discusses what immunology is and how your body plays an important role in the healing process, how immunotherapy is being compared to chemotherapy, the numerous steps being taken in the experimental realm and the lab stage, and how various doctors are actually putting immunotherapy to the test. Throughout this piece, many factors contribute to the possibility of success which this new treatment may hold. Patients views of learning that they have cancer in conjunction with finding alternative mechanisms may change their outlook towards not only the treatment process, but the recovery period as well.

Community Report Problem Introduction Cancer research is not only important to various medical communities, but also to the communities involving the patients who are being treated. Although this is a pressing community issue, steps are being taken to effectively and economically enhance the treatment process for the doctors, patients and their families. Immunotherapy is a new type of treatment being experimented with, and involves using personalized treatment mechanisms, which yield a better chance at remaining cancer free for a lifetime. Even though this type of treatment is still being worked on, this report will discuss exactly what immunology is, how it relates to the cancer treatment process, how chemotherapy can be used in conjunction with immunotherapy, the value of immunotherapy, and immunotherapy in action. In this day and age, specialists in immunology are hopeful and confident for drastic change when using immunotherapy for cancer treatment. Each of these topics will aid is describing the innumerable possibilities that accompany this new and improved option of treatment. Defining Immunology As one of the many branches of biomedical science, immunology is the recognition of itself and the reaction to any challenges or changes recognized within the body. From the origin of its Latin roots, immunity was derived from the word immunis, meaning exempt. There are two types of immune systems, adaptive and innate. Serving as the second line of defense, the adaptive, or more responsive, immune system takes over once the innate system cannot handle the challenge it has been faced with. The primary line of defense is the innate immune system.

This is the older, non-specific and non-resistant system. This means that this system does not get stronger with repeated exposure. In dealing with these two different systems, immunology

Community Report Problem focuses on the physiological aspect of the immune system, including the physical and chemical characteristics. Some key players in this tricky process include the skin, adenoids, lymph nodes, lymph vessels, tonsils, spleen, bone marrow and the thymus. While each of these organs are key in maintaining homeostasis throughout the body, the actual mechanisms of the immune system are many different cells, which are not associated with one specific organ in general. In working

with these many cells and their biological, physical and chemical defense mechanisms, tolerance to foreign and unwelcome organisms and materials can be built (Mandal, 2010). Serving as such a pressing matter to the medical community and the patients undergoing treatment, any new information regarding less hospital visits, less pain and more cures, is extremely hopeful news. Researchers are working endlessly to come up with an alternative method to treating cancer, which come with numerous side effects. Chemotherapy Working with Immunotherapy Chemotherapy is one of the most widely available and used treatment options for cancer. However, chemotherapy is not always the solution. While this type of treatment may offer temporary relief, if that, it is not guaranteed to last. Chemotherapy kills the targeted cells by apoptosis, or programmed cell death, a treatment declared as non-stimulatory to the immune system. However, there has been some evidence that, in order to generate an immune response, at least a small amount of cell apoptosis is required. Chemotherapy and immunotherapy have the potential to completely rid cancer from a patient. Using both of them together and following certain steps, could lead to a desired effect, Memory is defined as the capacity of the immune system to respond faster and more vigorouslylong-term immunological memory against tumor

Community Report Problem antigens could provide protection against tumor recurrence and metastases (Van der Most, 2009). However, one main concern is that chemotherapy and immunotherapy happen to be

antagonistic treatments. The one main and most important issue, with combining these two types of treatments, is the lack of specificity in cell apoptosis during chemotherapy. Once the drug is distributed to the patient, cell apoptosis occurs throughout the body. The killing off of the good cells, along with the bad, leads to a major immune system crash, which results in immunotherapy not being able to do the job it was intended for. At this point in time, many doctors and researchers agree that combining chemotherapy and immunotherapy for treatment is still in a pre-clinical stage. Once chemotherapy treatments have been started on the patient, it might be a little late to jump-start the immune system. However, both treatment options do have their benefits, when executed at the right time (Van der Most, 2009). The Value of Immunotherapy Without a doubt, both chemotherapy and immunotherapy have their specific benefits. When researching these types of treatment, many new discoveries are taking place. The director of the European Cancer Stem Cell Research Institute at Cardiff University, Professor Alan Clarke, noted that the research that it taking place could be very hopeful and exciting for the future. In a lab in Japan, researchers have come up with a cytotoxic T-cell, which not only defeated and destroyed cancer cells, but the HIV virus as well. Pulling samples from a patients skin cancer, the T-cells attacked and killed all of the cancer cells. Even though T-cells offer an apoptotic specific death of cancer cells only, this type of treatment is not quite ready for patient distribution.

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Although researchers are ecstatic at the thought of a new and fool-proof cancer treatment, the execution is still unclear. Even though this cell has been tested and can be made in a lab, it is still unclear about how the cell, or the cancer will react once introduced to the patient. Regarding this discovery, Professor Clarke stated, Nevertheless, there is real promise of this becoming an alternative when conventional therapies have failed (Gallagher, 2013). Immunotherapy in Action Along with many other researchers intrigued by the topic of immunology and its relevance in todays society, Dr. Glenn Drandoff, Dr. Marr and Dr. Ralph Steinman took a vast amount of interest in this subject. Harvard University professor Dr. Drandoff took the idea of immunology and put it to the test in experimentally simulated rat tumors. By treating the rats in different ways in which immunology was compared to chemotherapy, the rats were a synonymous example of how the human immune system would react to treating cancerous tumors. In his experiment, he found that, Experimental mouse tumour models have provided key mechanistic insights into host antitumour immune responses, and these have guided the development of novel treatment strategies (Drandoff, 2012). Dr. Marr, of the University of Glasgow, also completed research surrounding immunology for cancer. His project was based on the best treatment option for which cancer could be stopped, and then prevented from reoccurring, due to immune recognition. Dr. Marr, along with his colleagues, Dr. Campbell, Dr. Gilham and Dr. Fraser, who all worked for the Chemokine Research Group as Glasgow agreed, the immune response is responsible for controlling nascent cancer through immunesurveillance (Marr, Campbell, Gilham and Fraser, 2012).

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The final researcher, Dr. Steinman, took his research opportunity to the next level. When diagnosed with pancreatic cancer, Steinman treated himself solely with immunotherapy. He hoped that his body would be strong enough to fight off the cancer, but unfortunately the cancer prevailed. Steinman stated in his immunology research, The subject is the need for a much better supported and organized effort to design optimal studies of immunology in cancer patients so that cancer vaccines can become a major means to prevent and treat this

disease (Steinman, 2009). Pictured in Figure 1, Steinman

Figure 1

hoped that this was the cell that could cure his cancer, in reprogramming his body to fight off this disease. His visionary approach led the way to many new personalized treatment visions, in which patients are given cells that would help their bodies learn to fight off the disease. Steinmans contributions were so monumental, that they earned him the Nobel Prize, just three days before he passed away (Engber, 2012). Conclusion The possibility of immunotherapy for treating cancer is nonetheless hopeful and still out there. However, obvious and much needed improvements to perfect this treatment still need to be made. This report specified the definition, how immunotherapy can work with chemotherapy, the value of immunotherapy and the many ways in which doctors have actively tried to incorporate it. The amount of researching which goes into the value and policies of immunology have opened up a chance that this method is something that could be seen in action in the near future. With huge advances in this field, such as the T-cell being grown in a lab, once it is successfully transferred into a patient, it will cure present and future cancer cells within the body. Knowing

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this information is something that can affect future patients along with the way they react to their many possibilities of treatment.

Community Report Problem References

Dranoff, G. (2012). Experimental mouse tumour models: what can be learnt about human cancer immunology?. Nature Reviews Immunology, 12(1), 61-66. doi:10.1038/nri3129 Engber, D. (2012, December 21). Is the cure for cancer inside you?. New York Times. Retrieved from http://www.nytimes.com/2012/12/23/magazine/is-the-cure-for-cancer-insideyou.html?pagewanted=all&_r=0 Gallagher, J. (2013, January 03). Immune system 'booster' may hit cancer. Retrieved from http://www.bbc.co.uk/news/health-20898931 Mandal, A. (2010, February 18). What is immunology?. Retrieved from http://www.news-medical.net/health/What-is-Immunology.aspx Marr, L. A., Gilham, D. E., Campbell, J. M., & Fraser, A. R. (2012). Immunology in the clinic review series; focus on cancer: double trouble for tumours: bi-functional and redirected T cells as effective cancer immunotherapies. Clinical & Experimental Immunology, 167(2), 216-225. oi:10.1111/j.1365-2249.2011.04517.x Steinman, R. M. (2009). Some Scientific and Organizational Challenges in Cancer Immunology. Annals Of The New York Academy Of Sciences, 11741-5. doi:10.1111/j.17496632.2009.05060.x Van der Most, R. (2009). Combining immunotherapy with chemotherapy to treat cancer. Discovery Medicine, Retrieved from http://www.discoverymedicine.com/Robbert-GVan-der-most/2009/07/25/combining-immunotherapy-with-chemotherapy-to-treatcancer/