Steve:
Hello everyone, and welcome back to episode seven of our Medical Minute podcast series. Last week we did immunotherapy 101, where we introduced this exciting new treatment development. It's hard to even overstate how important it is. And so, today we are going to continue our discussion with immunotherapy 102, and we've got our in-house immunotherapy expert here with us today again, Jill Hunt. Welcome, Jill. And we're going to see if Jill can't... Two things. One is, this is her favorite time of the year, so we're going to try to keep her from making us look increasingly silly throughout the holiday season, as I refuse to wear hats, just so you know.
Jill:
What about a vest?
Steve:
I don't know about a vest, either. Certainly not one of those cotton ones, those weird ones.
Jill:
Could we maybe get some Santa figurines?
Steve:
Okay. We can do that. We can do that.
Jill:
Okay.
Steve:
All right. So, anyway, we're going to see if Jill can top her SWAT team analogy from last week. That was pretty good, I got to say. And so, anyway, Jill, so immunotherapy. And we got into this a little bit last time. It sounds like a silver bullet, but before people go coo-coo for Cocoa Puffs over it, we probably ought to address some of the potential problems.
Jill:
Right.
Steve:
Which also ties into why it's really not for everyone yet. So, with that in mind, can we talk about some of the side effects?
Jill:
Yeah.
Steve:
And try not to scare people to death like the TV commercials do if you listen all the way to the end.
Jill:
Oh yeah. If you listen to that low voice at the very end that they really don't want you to hear.
Steve:
Right.
Jill:
So, in all honesty, the toxicities that come along with immunotherapy, the incidence in which it happens is actually very low. Across the board, each individual toxicity happens in less than 10% of patients. However, the thing that's difficult is that everybody's immune system is different, and you can give immunotherapy to 10 different people, and they will have 10 different reactions to it.
Steve:
Okay.
Jill:
It gets really difficult because you also can't identify who's going to have the side effects and who's not. So, unfortunately, everybody is treated like they're guilty until proven innocent, and so you have to be just unbelievably detail oriented when you're taking care of patients that are getting immunotherapy, to make sure that there's a very clear communication between the patient and the clinician whenever there are any changes in the patient's condition.
Steve:
Okay.
Jill:
So the way that these toxicities happen, or these side effects, is that... We talked last week about how we're taking the brake off of the immune system. And by taking the brake off... The whole goal is that you're using the immune system to kill the cancer cells. The problem happens when there is something communicated to that T-cell, or to your SWAT team, that isn't the cancer cell, and it's a cell in the body that is actually part of your cell.
Steve:
Okay.
Jill:
And with the immune system, it can be anything. It can be a rash, because it's identified part of the skin as foreign. It could be inflammation in the lungs, inflammation in the kidneys, inflammation in the liver. It can cause inflammation anywhere in the body. So, with that, there's a whole list of common side effects. And you can look at the package inserts, and you can look at the websites, and it can be daunting.
Jill:
And the big thing is that with patients who are getting immunotherapy, the number-one rule is you have to communicate with your medical team if there are any changes. And I almost tease my patients a little bit, and I tell them the words, "Well, I just thought..." do not get to come out of your mouth anymore, and I need to know any change. And I'm a little bit overbearing, maybe.
Steve:
No. No. No.
Jill:
Maybe a little helicopter. And, I mean, to the point where I've told patients, if your nose typically runs out of the right side of your nose, and it starts running out of the left side of your nose, I need to know. Let your medical professional be the one that decides if what is going on with you is serious or not.
Steve:
Gotcha. Now, there's a little bonus question, because this is coming out something you just said. Will the side effects... I mean, is there typically a process where maybe a drug therapy comes out, and then there's there's side effects, but then those get better with time because they find out ways to manage the side effects better?
Jill:
So, with immunotherapy, the most common treatment for the side effects is the use of steroids, because the steroids shut down the T-cell function and get rid of the inflammation. So, almost all of the toxicities that are related to immunotherapy are reversible.
Jill:
The ones that are not are the ones that relate to the endocrine system. So, if you have your thyroid that's been affected, or if you have your adrenal glands been affected, or your pituitary gland that has been affected.
Jill:
The thing about those side effects is that, although they're not reversible, they're manageable. And so, the patients often go on some form of replacement. And the problem is that usually with that replacement, it's a lifelong replacement.
Steve:
Oh, okay.
Jill:
So-
Steve:
Okay. Got it. So, what are the cancer types, at least now, that benefit most from immunotherapy? I know melanoma was one of the early ones, but I know it's moved on to other things.
Jill:
The list is lengthy.
Steve:
Lung?
Jill:
You've got melanoma, you've got lung, you've got bladder, you've got renal cell. It's used in some of the heme malignancies. It can be used in triple-negative breast cancer.
Steve:
Okay.
Jill:
And for all of the cancers that it's not currently approved in, it's being studied in. So, there aren't very many cancer types, both solid tumor and blood malignancies, that don't have some sort of research being done regarding immunotherapy.
Steve:
Okay. You just broke a Medical Minute rule, by the way. You said heme.
Jill:
I did.
Steve:
Probably should explain what that is.
Jill:
So, a heme malignancy is a blood malignancy.
Steve:
There we go.
Jill:
Heme is short for hematology.
Steve:
All right. We'll give you an A- for today.
Jill:
Sorry, sorry, sorry.
Steve:
Yeah, no worries. So, anyway, with all that said, is it reasonable to think that someday immunotherapy could work for any type of cancer, or are there some physiological barriers where maybe that would never be the case?
Jill:
The hard part is that, do I think that there are going to be patients with any type of cancer that immunotherapy could be helpful to? The answer to that is yes.
Steve:
Okay.
Jill:
However, do I think that you're going to be able to blanket treat everybody with a specific type of cancer and expect the same response out of everybody? No.
Steve:
Yeah. That's kind of what I suspected. Okay. Well, we'll decide whether we do immunotherapy three next week.
Jill:
Mm-hmm (affirmative).
Steve:
There's still a lot more we could talk about, but there's a whole lot of other topics we could talk about, too.
Jill:
Yeah.
Steve:
So, I hope that anybody watching this will continue watching. Tell your friends, pass it around, get people to subscribe and sign up. And because we've got an endless array of topics to talk about over time. So, anyway, thanks, and join us back here next week for episode eight. And we'll see what Jill's wearing, and what she's making the rest of us wear around the office. But no Santa hats, I'm telling you right now. Take care, everyone.