Types of Immunotherapy

Adoptive T-cell transfer (ACT) strengthens the natural cancer-fighting power of your body’s T cells, or T-cell lymphocytes. These special white blood cells can destroy cancer cells.

T cells are removed from your blood in a process very much like a blood donation. The cells are then grown in a laboratory so that there are millions of them. They may also be “re-engineered,” or changed, to make it easier for them to track down and destroy cancer cells. Then the super-charged T cells are returned to your body through an intravenous (IV) infusion so they can get to work fighting your cancer.

There are four types of adoptive T-cell transfer:

• Chimeric Antigen Receptor (CAR) T-cell therapy: Your T cells are collected from your blood and sent to a laboratory, where a gene is inserted to help them locate specific antigens, or proteins, on the surface of the cancer cells so they can launch an attack. These super-charged T cells are multiplied into an army of millions and returned to you through an infusion. Then the re-engineered T cells hunt down and destroy the cancer cells.

  About CAR T-cell therapy

  Roswell Park Comprehensive Cancer Center offers the only three FDA-approved CAR T-cell therapies:

• Yescarta™, for adults with diffuse large B-cell lymphoma (DLBCL) that has either relapsed (gone into remission and then returned) or is refractory (has not gone into remission despite treatment).

• Kymriah™, for either: 1) patients 25 and younger with B-cell acute lymphoblastic leukemia (B-cell ALL) that has either relapsed (gone into remission and then returned) or is refractory (has not gone into remission despite treatment), or 2) adults with large B-cell lymphoma that has either relapsed (gone into remission and then returned) or is refractory (has not gone into remission despite treatment).

• Tecartus™ (brexucabtagene autoleucel), for patients with mantle cell lymphoma that has relapsed (come back after remission) or is refractory (does not respond to treatment).

In addition, Roswell Park researchers are evaluating newer types of CAR T cells that have been re-engineered to target other types of cancers. Click here to search for any current clinical trials involving CAR T-cell therapy.

• Tumor-Infiltrating Lymphocyte (TIL) therapy: Your T cells are collected from your tumor tissues, sent to a laboratory, multiplied into an army of millions, and returned to you through an infusion.
• In Vitro Sensitized (IVS) T-cell therapy: Your T cells are collected from your blood and sent to a laboratory, where they are “taught” to recognize your cancer cells through ex vivo activation (without any genetic changes). Then they are multiplied into an army of millions, and returned to you through an infusion.
• T-Cell Receptor (TCR) therapy: Your T cells are collected from your blood and sent to a laboratory, where a gene is inserted to help them find and attack specific antigens, or proteins, inside your cancer cells so they can launch an attack. The altered T cells are multiplied into an army of millions and returned to you through an infusion.

Roswell Park’s Division of Translational Immuno-Oncology has developed promising new methods of adoptive T-cell transfer. In 2017 we offered the world’s first clinical trial to re-engineer cells using a two-gene combination. We have also launched innovative ACT clinical trials to treat:

• Metastatic melanoma
• Lymphoma
• Leukemia
• Neuroblastoma and synovial cell sarcoma
• Ovarian cancer

Adoptive T-cell transfer is currently being studied for use in other solid tumors and blood cancers.

Cancer vaccines stimulate your body’s own immune system to target cancer cells. This form of immunotherapy can be used to initiate an immune response that could recognize tumor markers, called antigens, which are present either on the surface of, or inside, cancer cells.

Roswell Park researchers have discovered and developed several next generation cancer vaccines that are currently in clinical trials here at the Center for Immunotherapy.

While common vaccines such as the flu shot help prevent disease, cancer vaccines are considered a class of therapeutic immunotherapy, meaning that they can treat disease that already exists or possibly prevent its recurrence. Cancer vaccines work through arming you body’s own natural immune system and educating cells such as Lymphocytes, T cells or producing antibodies that can attack and destroy tumor cells. Roswell Park offers the following, and other investigational vaccines, for several cancer types either through clinical trials or FDA approved usage:

• Brain (SurVaxM)
• Lung (CIMAvax®)
• Multiple Myeloma (SurVaxM)
• Prostate (Provenge®, FDA-approved)
• Melanoma (hsp110 chaperone complex vaccine)
• Ovarian (CDX-1401, MIS416)

Oncolytic viruses are viruses that directly kill cancer cells and also activate cells of the immune system, such as dendritic cells and T cells, to target and eliminate cancer. Researchers in Roswell Park’s Center for Immunotherapy are actively pursuing strategies to modify oncolytic viruses to target specific cancer cells. Although oncolytic virus immunotherapies are not yet FDA-approved, we are currently conducting clinical trials for a number of cancers, including:

• Bladder (CG0070)
• Prostate, colorectal, ovarian, lung, and breast (Reolysin)
• Melanoma (CAVATAK, T-VEC)
• Multiple Myeloma (MV-NIS)
• Ovarian (JX-594 )
• And many more

Some proteins in immune cells act as "checkpoints,” or brakes, on the immune system response. Drugs known as checkpoint inhibitors can be used to release the brakes on the immune system, allowing a stronger immune attack against cancer. We also use immune modulators — drugs that essentially "step on the gas" of the immune response:

• CTLA-4 inhibitors: Yervoy® (ipilimumab) is currently FDA-approved 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) and Opdivo® (nivolumab) are currently FDA-approved for the treatment of melanoma after a patient has failed prior treatment with Yervoy. Opdivo® is also FDA-approved for the treatment of non-small cell lung cancer.
• Other PD-1/PD-L1 inhibitors include MPDL3280A (atezolizumab) and MEDI4736 (durvalumab), which 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.

Bacteria, viruses and other illness-causing invaders carry proteins called antigens. When they enter your body, your immune system tries to protect you by producing antibodies —proteins that latch onto the antigens and alert the rest of the immune system to destroy them.

Different types of cancer produce different types of antigens. Monoclonal antibodies are treatments designed to zero in on the specific antigens associated with a certain type of cancer. Different monoclonal antibodies work in different ways: They can kill cancer cells, cut off blood supply to the tumor, carry chemotherapy drugs straight to the cancer cells, block proteins that enable cancer cells to grow, and “show” the immune system where cancer cells are hiding. Because the antigens on the cancer cells are not produced by healthy cells, only the cancer cells are targeted by this treatment.

The FDA has approved several monoclonal antibodies to treat cancer, and many more are being developed every day.

The white blood cells in your body produce special proteins called cytokines, which help control your immune system. Cytokines called interferons and interleukins may be used to treat cancer.

Interferons stimulate your immune system’s natural killer cells and dendritic cells. They may also alter the environment in which the cancer cells are growing, making it impossible for them to survive and grow.

Interleukins encourage the growth of your body’s cancer-killing T cells and natural killer cells. They also encourage your body to produce antibodies to help your immune system target the cancer cells.

The FDA has approved cytokine therapies for the treatment of:

• Bladder cancer
• Kidney cancer
• Leukemia
• Lymphoma
• Melanoma

In some cases, a treatment plan may combine two types of immunotherapy or an immunotherapy with chemotherapy.