Immune checkpoint inhibitors: An innovation in immunotherapy for the treatment and management of patients with cancer

Abstract

Cancer survival rates are generally increasing in the United States. These trends have been partially attributed to improvement in therapeutic strategies. Cancer immunotherapy is an example of one of the newer strategies used to fight cancer, which primes or activates the immune system to produce antitumor effects. The first half of this review paper concisely describes the cell mechanisms that control antitumor immunity and the major immunotherapeutic strategies developed to target these mechanisms. The second half of the review discusses in greater depth immune checkpoint inhibitors that have recently demonstrated tremendous promise for the treatment of diverse solid tumor types, including melanoma, non-small cell lung cancer, and others. More specifically, the mechanisms of action, side effects, and patient and family management and education concerns are discussed to provide oncology nurses up-to-date information relevant to caring for cancer-affected patients treated with immune checkpoint inhibitors. Future directions for cancer immunotherapy are considered.

Addressing New Diagnostic and Treatment Challenges Associated With a New Age of Cancer Treatment

“…Checkpoint inhibitors disrupt cell-signaling pathways between T cells and antigen-presenting cells to effectively activate the patient’s immune response, thereby preventing cancer cells from evading the patient’s immune system. 8,9 Because of this novel mechanism of action, the therapy triggers an immune response to the malignancy. As a result, the expected adverse effects vary significantly from those of cytotoxic chemotherapeutic agents and frequently mimic autoimmune responses, which can affect any organ system and are labeled immune-related adverse events.…”

Implications of Immunotherapy in Hepatobiliary Tumors

“…Immunotherapies possess distinct mechanisms of action and primarily fall into the following categories: adoptive T-cell transfer, oncolytic viruses, cancer vaccines, and monoclonal antibodies [18]. It has been shown in numerous clinical HCC trials that monoclonal antibodies targeting checkpoint molecules have strong antitumor efficacy with an acceptable safety profile.…”

“…Currently approved checkpoint inhibitors for several tumor entities are CTLA-4, PD-1, and PD-L1 inhibitors. ICPIs prevent receptors and ligands from binding to each other, thereby disrupting signaling [18] (and thus inhibiting the T-cell inhibition). Currently approved ICPIs for HCC treatment are the anti-PD-1 agents, nivolumab, and pembrolizumab.…”

“…Lately, immune-based approaches have shown great promise in the treatment of various solid malignancies, having been associated with survival benefit and long-term disease control in melanoma, lung cancer, renal cell carcinoma, and other tumors [18]. …”

Current management of advanced bladder cancer

“…12 These immunotherapy treatments have demonstrated impressive results in melanoma, renal cell, lung, and head and neck cancer, as well as Hodgkin lymphoma. 13 The immunogenicity of bladder cancer was shown 40 years ago when the use of Bacillus Calmette-Guerin (BCG) was shown to prevent recurrence in localised nonmuscle-invasive bladder cancers.…”