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Episode #6 - Immunotherapy 101

Steve Abbott:

Hello, everyone and welcome back to episode six of our Medical Minute podcast. Today, we would like to focus on things that people are hearing more and more about each and every day with respect to cancer treatment, which is immunotherapy.


Steve Abbott:

Someone who knows a whole lot about immunotherapy is my colleague, Jill Hunt. Jill's our oncology nurse practitioner with more than 20 years of oncology nursing experience. She's also been at the forefront of administering immunotherapy treatment, particularly with respect to melanoma patients. Welcome back, Jill.


Jill Hunt:

Thank you.


Steve Abbott:

So Jill, as I mentioned, more and more people are hearing about immunotherapy and I'd bet you that a lot of the people that are hearing about immunotherapy don't even realize they are. So they see maybe a TV commercial, and there's people frolicking through meadows and holding grandkids and playing basketball and everything else and may not even realize that that drug is an immunotherapy drug. So, and that begs the question. What exactly is immunotherapy? How does that work?


Jill Hunt:

So if you look at just the basic difference, immunotherapy is a medication that amplifies the effect of your immune system to target and kill cancer. The difference between immunotherapy and standard chemotherapy is that chemotherapy kind of poisons that cancer cells and causes damage to the cell. And the difference between a cancer cell and a healthy cell is that a healthy cell has the ability to repair itself where a cancer cell does not. So chemotherapy works more on damaging the cell where immunotherapy works to amplify your immune system and your immune system is actually what is killing the cancer.


Steve Abbott:

That's interesting. I mean, that's actually a really great explanation. I guess I hadn't really thought about the distinction between the two in that way, so it's very good. So in one of our previous podcasts, you had made mention the fact that your body's comprised of literally billions of cells and there's different types of cells clearly, but what are, because whenever I hear about immunotherapy, I hear about T-cells what are T-cells and what do they do?


Jill Hunt:

Okay. So T-cells are a variation of your lymphocytes and lymphocytes are part of your immune system, part of your white blood cell. So it's that part of the immune system that fights cancer. So you kind of have this preliminary phase of the immune response where you have cells that kind of just they're your surveillance team. They're looking for things that are foreign. And when they find what is foreign, they then bring it to the T-cell and they communicate, "Hey, there's something that's foreign here, AKA your cancer cells, and you need to go out and you need to find it."


Jill Hunt:

And so the best description of your T-cell is your T-cell is like your SWAT team. It has been given a communication of what needs to be found and destroyed. And once that communication has been made, then the T-cell then goes and finds what's foreign to destroy it.


Steve Abbott:

Okay. So next question. And so this one might take a little bit longer. So as I think as some people that have been watching know by now we try to answer questions in about a minute. This is probably not going to be one minute at a time, but it's important because this is kind of the, it's the new paradigm for what ultimately could be literally cures that don't exist now.


Jill Hunt:

Right.


Steve Abbott:

And so you basically train these cells to go destroy cancer cells. So two questions. Is it as easy as it sounds? And if so, then why doesn't everybody get immunotherapy? What's the difference? Why do some people get it and other ones don't?


Jill Hunt:

Okay. So training the cells and I guess saying that you're training the cells is one way to look at it, but the reality of what is happening with immunotherapy drugs. So the drugs that you're hearing, those commercials on drugs like Opdivo and Keytruda, Yervoy, those are some of the ones, the big names that you're hearing and seeing the commercials on on TV.


Jill Hunt:

Those drugs fall into a category called checkpoint inhibitors. And what you have to understand is that our body has a checks and balance system, and it keeps our immune system from going completely haywire and just off the rocks and doing things that could be harmful to the body. To give you an example, like when you have an exposure to poison ivy and you get the rash and then it starts spreading and all of the red and the itchy and all of the things that go along with that. That's part of a T-cell response.


Steve Abbott:

Oh, okay. So you're getting a reaction and it's trying to ward off the foreign oils that it was exposed to. Okay? Your body, like I said, has a checks and balance system. And it, at some point, the body's like, "Okay, enough is enough," and it puts the brakes on and it slows down the effect of the T-cell and essentially stops it from continuing.


Steve Abbott:

With the immunotherapy drugs, what they do is with some of those checkpoint drugs, it affects that process earlier on and it takes the break off. And so you just start cranking out T-cells in rapid fashion so you are building this huge SWAT team. And then some of the other checkpoint inhibitors, some of the newer drugs that have come out, what they do is they actually work further down that response. And what people don't understand, and it's something that clinicians have to deal with on a regular basis is cancer is smart. And it figures out how to grow around the treatments that we give.


Steve Abbott:

And so what happens is, as you get further down the response, and like I said earlier, you've got something that communicates to the T-cell that there is something foreign and the T-cells need to go out and find it. Well, when the T-cells actually find the cancer cell, the cancer cell has its own defense and it grabs a hold of the T-cell and shuts down the function. The T-cell is dead in the water. It is completely deactivated.


Steve Abbott:

What the newer drugs like Opdivo and Keytruda, drugs that are PD-1 inhibitors or PD-L1 inhibitors, what they do is they put a glove over that receptor on the T-cell, so that now the cancer cell cannot grab onto the T-cell and the T-cell stays active and so then it still continues to do what it was intended to do by destroying the cancer cell.


Steve Abbott:

Interesting. When you were talking about that before, kind of reminds me of one of my favorite lines from Jurassic park, where Jeff Goldblum says to the now exasperated founder of Jurassic Park. He's like, "Life finds a way." And that's one of the unfortunate things about cancer is cancer seems to always, always find a way.


Jill Hunt:

Yes.


Steve Abbott:

So anyway, hopefully we'll get out in front of that in the near future. So, okay, so I think maybe we'll go ahead and because this is a really important topic and I don't think we want to shortcut it. So I think we'll go ahead and wrap that up as kind of part one for today and next week, I think what we'll want to talk about, talk more about them immunotherapy, but talk more about because where I'd ask about why everybody wouldn't get it. We'll talk more about some of the side effects so that everybody can be well informed about that as well.


Steve Abbott:

So anyway, as we go to wrap up this week, I had made mention last week that we have a big announcement this week, and indeed we do. So WCPO TV meteorologist Sherry Hughes is joining us. Her last day at the station was last week. She will join us beginning January 3rd. Monday, January 3rd. And you will see her bright and smiling face on this podcast from time to time as well. So it's a great addition to our team and will really help take us to the next level in terms of community and engagement as well.


Steve Abbott:

So join us next week and we'll get back into immunotherapy a bit more and if in the meantime, if you have any questions, please just send them to information, information?


Jill Hunt:

Mm-hmm (affirmative).


Steve Abbott:

Yeah. Information@cincinnaticanceradvisors.org. Thanks everybody, and we'll see you next week for episode seven.

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