Immunotherapy Cancer Immunology - allergy, specific allergen immunotherapy

It has long been recognized that the cellular immune system is a powerful weapon against cancer. Activation of the immune system using bacille Calmette-Guérin (BCG) for bladder cancer or interleukin-2 for renal cancer induces responses in 60% and 10% of patients respectively. More recently, immunotherapy has become more refined. Firstly, certain antigens that are specific to cancer cells, such as sequences of tumour immunoglobulin from B cell lymphomas or melanoma antigens have been used as tumour vaccines. Antigen-presenting cells (dendritic cells) from the patient can be genetically engineered to present both antigen and cytokines such as interleukin-2 or granulocyte macrophage colony-stimulating factor, and clinical responses have been observed. Another approach has used dendritic cells to further improve the vaccination strategy by engineering them to display the full range of HLA and B7 costimulatory molecules.

The use of non-myeloablative haemopoietic stem cell and donor lymphocyte infusions, while losing some of the specificity, has produced the strongest evidence for the efficacy of immunotherapy at the risk of the greatest toxicity.

Gene therapy

Antisense oligonucleotides are short sequences of DNA bases which specifically inhibit complementary sequences of either DNA or RNA. As a result, they can be generated against genetic sequences which are specific for tumour cells. Their clinical development has been hampered by poor uptake by tumour cells and rapid degradation by natural endonucleases. However, one antisense sequence directed against the Bcl-2 oncogene has been shown to have an antitumour effect in patients with non-Hodgkin's lymphoma and others are likely to follow. Creation of reliable vectors for the transfection of tumour cells in vivo still forms a major barrier to the greater application of this modality.

The recognition that many cancer cells are transformed by the activity of the protein products of oncogenes has led to the search for peptides or other compounds which inhibit these proteins, or their intracellular signal pathways. An example is the tyrosine kinase inhibitor STI571, which specifically inhibits the fusion oncoprotein BCR-ABL . This compound is an extremely effective treatment for chronic myeloid leukaemia, a disease characterized by the presence of the BCR-ABL fusion protein. Many other similar molecules, inhibiting enzymes involved in cell cycling or cytokine signalling, are in preclinical or early clinical development. Examples include farnesyl transferase inhibitors, which inhibit ras proteins, inhibitors of the platelet-derived growth factor receptor, and drugs which inhibit matrix metalloproteinases.

Cancer Tip Remember you are receiving drugs (chemo-therapy) already. Alcohol and other drugs mayinterfere with the treatment(s) you are receiving.Your kidneys and liver are already working extrahard to deal with chemotherapy. Don’t over-stress them with more drugs.

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