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Cancer Immunotherapy

WHAT IS CANCER ?

Cancer is a disease caused by abnormal cell growth in various organs of the body forming a lump that has spread to nearby organs or spread to other parts of the body through the blood system or lymphatic system. There are many types of cancer depending on the original location of the disease and the type of cancer. It is a disease with a high incidence of mortality in patients around the world including Thailand. The number of new cancer cases in Thailand is up to 100,000 per year and more than half of all the deaths. The current cancer treatment methods are still not effective enough to be a true cure and not able to satisfactorily reduce the mortality rate of patients.

Cancer treatment “Cancer” is another huge problem in public health which is not only in Thailand, but also spread throughout the world due to the number of patients increasing every year. Currently, there are cancer treatment options as follows:
1.SURGERY  is a traditional cancer treatment technique that is still a standard treatment for many types of cancer, especially in the early stages. Since the lump and distribution are still in the same area, it can be cured through appropriate surgery.

2.RADIOTHERAPY  is a cancer treatment using high-dose X-rays or radioactive waves to inhibit the growth and kill cancer cells. The high intensity radiation can damage cells but there are limitations in the use of radiotherapy because only a few types of cancer respond to radiation and has relatively low specificity, causing the surrounding tissues to be quite affected.

 3.Chemotherapy : After radiation has been used to treat cancer for a period of time, the studies and development of “drugs” that can inhibit the cancer cell growth in the process of cell division and able to kill cancer cells have been executed. These substances are called CYTOTOXIC and used to treat cancer called “Chemotherapy”.

4.Dosing in groups of specific action against cancer cells TARGETED THERAPY With the experience of using chemotherapy for a long time in addition with  the knowledge of the biology of cancer cells, there is a development of “drugs” which can destroy cancer cells without interacting with normal cells or have little effect on normal cells. It is called “Targeted therapy” since it can be chosen specifically to act on cancer cells which may have specific receptors that appear only in cancer cells or suppress chemicals that cancer cells produce to communicate with each other which is necessary for its growth or spread. The advantage is that the drug is effective and  has few side effects. However, it is a new drug using high technology for studying and production, so the medications are expensive.

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5.  Cancer Immunotherapy : With the continuous development of medical technology including research to find approaches to prevent and cure cancer directly in order to improve the patient’s quality of life and have the least side effects, we now have a cancer treatment called “CANCER IMMUNOTHERAPY”.

WHY IS CANCER TREATMENT ACCORDING TO STANDARD TREATMENT GUIDELINES SOMETIME DOES NOT WORK?

This includes surgery to remove abnormal tissue or parts from the patient’s body, radiation therapy to destroy cancer cells, chemotherapy including treatment with TARGETED THERAPY. This method of treatment has started to be used in the treatment of cancer nowadays which is effective in early cancer patients. Nevertheless, it is found that the treatment efficiency is reduced.

In patients with advanced stage cancer, the response to treatment is greatly reduced and the survival rate is low.

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WHAT IS THE IMMUNE SYSTEM AND HOW IMPORTANT?

Before mentioning “Immunotherapy”, let’s get to know the “Immune system” in our body first.

IMMUNE SYSTEM is the mechanism of the body that is responsible for looking after and preventing infection in the human body. It is considered as an important part that helps reduce the risk of illness. The immune system is made up of chemicals createdwithin the body to fight infections together with cells that have special properties such as white blood cells. These cells are created within the bone marrow, then move into the bloodstream and various tissues to monitor the infection. These cells will start workingwhen there are too many pathogens in the body. The immune system will recognize those pathogens so that when such pathogens enter the body again, the immune system can eliminate them quickly.The immunity is divided into 2 types as follows

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  • Innate Immunity: INNATE IMMUNITY is naturally created by the body to protect against various pathogens and keeps humans safe from infection. This type of immunity is a general function including the skin and the lining which also serves to prevent pathogens. When germs or foreign objects pass through the skin, the first barrier, and get into the body, the body also has white blood cells as a second barrier. There are various types of white blood cells. Each one is responsible for searching and destroying germs and foreign material freely without having to wait for help or command such as NATURAL KILLER CELLS.
  • Adaptive Immunity: ADAPTIVE IMMUNITY is the immunity that occurs after experiencing an illness. This adaptive immunity works by recognizing the identity of pathogens or foreign materials called ANTIGEN and immediately forming specific immunity against those antigens such as LYMPHOCYTES.

IMMUNIZATION AGAINST CANCER

“ IMMUNOTHERAPY” is a cancer treatment based on the immune function of the body. When a foreign object gets into the body, the immune system is stimulated to eliminate those foreign objects. This boosts the immune system to work in order to be able to remove or control cancer cells in the body.

NK Cells ( Natural Killer Cells ) – Non-Targeted Immunotherapy

NK CELLS IS AN INNATE IMMUNITY SYSTEM

This immune is derived from the bone marrows. It is considered an important type of white blood cells in the rapid response to the non-specific foreign object which means that if the body detects an abnormal germ or cell, NK CELLS will manage to destroy them immediately without examining whether they have encountered such characteristics before. Also, it can distinguish between normal and abnormal cells. So, NK CELLS are capable of destroying pathogens and able to detect abnormal cells such as viruses and cancer cells. For patients who have physically weak, it may be assumed that the amount of NK CELLS is less than normal or normal but inefficient. Consequently, the body is not able to fight against foreign materials that occur in the body causing whether viruses, cancer cells, or various pathogens a quickly spread.

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HOW IS THE IMMUNE SYSTEM WEAKENED?

What are the factors known to undermine the immune system?

In addition to diseases that directly affect the immune system, there are other factors as follows:

  1. Insufficient rest: when the body does not get enough rest according to its need for each day for a long time,
    it will cause more stress hormones to the body resulting in adverse effects on the immune system and an increase in the risk of inflammation and infection.
  2. Lack of exercise: exercise is a way to 4. stimulate the immune system. On the other hand, lacking exercise can weaken the immune system since it helps the body to create chemicals that help us become stronger, feels refreshed, and increases immunity.
  3. Eating unhealthy food: consuming a lot of sugar, grilled food, fermented foods, and junk food will negatively affect the function of immune system because the body does not get enough minerals and vitamins that help strengthen the immune system.
  4. Cumulative stress: stress directly impacts the immune system because when the body has high stress, the stress hormones will weaken the immune system and make the body more vulnerable to infections.

The studies show that NK CELLS performance decreases due to aging which is related to the occurrence of cancer that is mostly found in the elderly.

Besides, there are other factors that weaken NK CELLS’s ability.

(1) Credit : https://www.thaihealth.or.th/Content/41378-ปัจจัยเสริมสร้างภูมิคุ้มกัน.html

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How many NK cells are in the body and how does it work?

Normally, the body has approximately 2,000-5,000 million NK cells. When foreign materials invade, NK CELLS will respond immediately and fight against them within 24 hours by creating the 2 following types of chain reactions:

1. NK CELLS will deal with foreign cells with a direct killing called CYTOTOXICITY.

2. NK CELLS will work while releasing protein in the bloodstream called CYTOKINE calling other cells in the immune system to help NK CELLS kill foreign cells (or help prevent tumor growth.)

(1) Credit By: http://www.nirvaxis.com/blog/2019/01/nk-cells/

HOW DO WE KNOW THAT OUR NK CELLS IS      INSUFFICIENT OR INEFFICIENT?

We can check the number of NK CELLS by collecting blood and measuring the amount of NK CELLS called NK COUNT. Measuring the performance of NK CELLS can be managed by taking a blood test which we call NK ACTIVITY.

How to determine the number and effectiveness of NK Cells

One of the most accurate and fastest NK CELLS counting methods is FLOW CYTOMETRY technique or cell analysis by using lasers.

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How does the immune system and NK cells increase?

We can multiply the amount of NK CELLS in our bodies by the following methods:

Increasing NK CELLS by yourself

  1. Have meals at the right time with all 5 food groups. Eat healthy foods, especially green leafy vegetables, meat, and soy milk
  2. Exercise regularly
  3. Abstain from smoking and drinking alcohol
  4. Get enough rest, try to relax your mind, and do not stress

The methods described above may not give explicit results since it depends on the response of the individual’s body including other factors as well. Another method is application of technology in aquaculture in the laboratory. This method cultures NK CELLS in the laboratory in order to increase both of its amount and performance. This will take around 2-3 weeks. NK cells will be injected back into the body when they are ready.

NK cell-based immunotherapy approaches?

  • Patients meet experienced doctors to assess health and plan treatment in detail
  • Collect blood to test NK COUNT and NK ACTIVITY, and then isolate NK CELLS from patient blood
  • Culture NK CELLS in CLEAN ROOM CLASS 100 to increase the amount as required
  • Monitor and evaluate the treatment
  • Inject the cells back into the body through a vein
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CAR T Cells – Targeted Immunotherapy

Cancer immunotherapy in the form of CAR-T CELLS

is a cancer treatment based on the principles of immune system. T CELLS of LYMPHOCYTES will be genetically modified by using specific proteins on the surface of cancer as a model for creating TARGET or target groups to recognize cancer cells. This makes CAR-T CELLS accurate in destroying cancer cells.

CAR-T CELLS is the latest innovation and technology in cancer treatment. United States Food and Drug Administration has officially announced the use of this treatment technique in patients with leukemia and lymphoma.

CAR-T CELLSbased immunotherapy approaches?

  1. Patients meet experienced doctors to assess health and plan treatment in detail
  2. Analyze the specific protein value of biopsy, also known as PROTEOMIC
  3. After receiving the result from step 2 indicating patient’s type of specific protein, 10-15 ml. of blood will be collected to extract LYMPHOCYTES:
    T CELLS and genetically engineered to make T CELLS target or kill cancer cells
  4. Culture CAR-T CELLS in the laboratory to grow suitable numbers of cells for treatment
  5. Inject the cells back to the patient through a vein
  6. Receive follow-up care to evaluate and analyze the next treatment
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Who is eligible to receive CAR T-cell therapy?

  1. Patients who do not respond to chemotherapy and radiotherapy
  2. Patients who receive CAR-T CELLS treatment in combination with chemotherapy
  3. Patients who wish to completely remove cancer cells and / or patients with remaining cancer cells in the body and wish to prevent cancer recurrence
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Why choose CAR-T CELLS immunotherapy?

  • High accuracy in targeting because CAR-T CELLS treatment is a genetic modification of T CELLS (white blood cells) to produce receptors on their surface, be able to detect cancer cells hiding inside the body, and destroy cancer cells efficiently.
  • High safety since CAR-T CELLS treatment can bind to specific cancer cell and do not damage normal cells causing less side effects.
  • Support the immune system to be effective as the CAR-T CELLS injected into the body will remain and become IMMUNE CELLS of the immune system.
  • The treatment process is not complicated.

Possible side effects after being treated with CAR – T CELLS?

  • Fever and chills
  • Nausea and vomiting
  • Diarrhea
  • Body pain which may occur between 1-3 days after receiving CAR – T CELLS

How to behave after being treated with CAR-T CELLS ?

  • Avoid intense exercise
  • Abstain from spicy food
  • Eat 5 main food groups in suitable portions as doctor’s advice
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