“Growing Your White Blood Cells to Treat Your Cancer”

fer a treatment option to nearly every cancer patient because they are neither targeted to a specific “tissue of origin”, like

“Growing Your White Blood Cells to Treat Your Cancer” (Matthew Dons) [#79] lung cancer or colon cancer, nor are they targeted to a biomarker, a protein that your cancer cells overexpress, like BRCA or EGFR. The medical term for growing your white blood cells to treat your cancer – autologous adoptive cell transfer – is a mouthful of medical jargon.

Let’s break it down: ●Autologous: using your cells to treat your disease, a Latin term meaning “from your body” ●Adoptive cell transfer : taking your healthy cells, e.g.

, white blood cells, growing them in a lab, then putting them back into your blood ●Apheresis: the name for the process that takes your blood, runs it through a machine to separate out one or more constituents, and returns the remainder back to you For example, in the treatment Matthew Dons has received in Japan, he’s gotten a huge number of extra white blood cells of various types (T-cells, NK cells, and dendritic cells) that were taken from him using apheresis, then grown in a lab, then reinfused into him.

Another example is an autologous dendritic cell therapy called Provenge (Sipuleucel-T) for metastatic prostate cancer, which has shown a four-month increase in mean survival in clinical trials, and greater than one year in real world experience. Growing your white blood cells is different from other immunotherapies you may have heard of and considered, such as (1) immune checkpoint inhibitors (e.

g., Keytruda/pembrolizumab, OPDIVO/nivolumab), (2) CAR-T (chimeric antigen receptor T-cell) therapy, or (3) personalized neoantigen vaccines. 1.Immune checkpoint inhibitors : Immune checkpoints stop your immune system from attacking yourself. Immune checkpoint inhibitors remove these brakes on your immune system. Keytruda is one checkpoint inhibitor that was approved in the U.S.

in 2016 for skin cancer. Then in 2017, it was approved in the U.S. for all tumor types and all cancer origins, if you have what's called “MSI high”, microsatellite instability high, which means your cancer is quite mutated.

If you are an advanced cancer patient, checkpoint inhibitors are less likely to be effective because you have a very poor immune system, and removing the brakes generally won’t help. (For more on checkpoint inhibitors and MSI, please see our discussion with Heather Tomlinson, “How MSI and Other Tests Can Guide Immunotherapies for Cancer Treatment” here.) 2.

CAR-T cell therapy: CAR-T cell therapy is also an adoptive cell transfer therapy, i.e., it is also putting T-cells, a type of white blood cell, into your blood. In the CAR-T process, they take a commercial cell line, and then genetically engineer T-cells to match the genetics of your cancer, which means they're very highly targeted.

ell, into your blood. In the CAR-T process, they take a commercial cell line, and then genetically engineer T-cells to match the genetics of your cancer, which means they're very highly targeted. However, because they are engineered foreign cells (not autologous), your body has a high chance of reacting against the therapy.

And the T-cells are only able to attack cancer cells that they recognize as cancer cells by an antigen or neoantigen label. (For more on CAR-T, please see our discussion with Andrew Rech, “Immunotherapy in Prostate Cancer - CAR-T and the Tumor Microenvironment” here.) 3.

Personalized cancer vaccines : Personalized cancer vaccines can be used to introduce or stimulate selected T-cells to attack cancer cells.

“Growing Your White Blood Cells to Treat Your Cancer” (Matthew Dons) [#79] to produce enough of the right T-cells, and then combine it with things like checkpoint inhibitors or whatever makes sense to make sure that those T-cells can do their job and win the battle against your tumor.

(For more on personalized cancer vaccines, please see our discussion with Willy Hoos, “Personalized Cancer Vaccines” here and with Lisa Butterfield, “Cancer Vaccines” here.) By using three kinds of immune system white blood cells, Matthew Dons had a better chance of a response than these other immunotherapies.

While T-cells need to recognize labels on the cancer cells, NK cells can attack cancer cells without labeling, while dendritic cells help identify and present antigens. NK cells can attack cells that are not labeled as cancer cells, are not presenting an antigen, or not labeled with a neoantigen.

This is very important for late stage patients, because NK cells are able to attack cells that they recognize as being cancer, but not because of the labeling. As a late stage patient, many of the cancer cells that you have are these unlabeled ones. NK cells show good uptake in bones, even for late-stage cancer patients like Matthew Dons.

Why might you not want to consider growing your white blood cells to treat your cancer? ●Hyper progression : A theory in immunotherapy, citing patient experience. Immune system weakening and cancer's ability to evade immune responses are major factors in hyper progression. ●Evidence: NK cell therapies don’t have much clinical evidence. What are principles for long-term survival from cancer? 1.

Access new treatments as quickly as possible : Do not wait for the approval. If the science seems sound, and early results seem good – go for it. 2.Combine treatments : For example, combine immunotherapy and hyperthermia, which increases blood flow and enhances immune response. 3.Get as much treatment as your body can take : Choose a combination of gentler treatments. 4.

Choose treatments that cause less immune suppression . For example, if you're going to have radiotherapy, find the one which causes the least bone marrow suppression. 5.

and enhances immune response. 3.Get as much treatment as your body can take : Choose a combination of gentler treatments. 4.Choose treatments that cause less immune suppression . For example, if you're going to have radiotherapy, find the one which causes the least bone marrow suppression. 5.Choose clinics carefully: Clinics should own their labs for quality control.

How can immunotherapies be enhanced? ●Combine with targeted drugs : For example, before your immunotherapy is administered, you can get a low dose of a targeted cancer drug (like cetuximab, which is used to treat advanced bowel cancer and head and neck cancers), which will mark the cancer cells, a bit like a neoantigen, making the cancer cells more visible to the T-cells.

●Combine with radiofrequency ablation : A minimally invasive procedure that shrinks the size of tumors procedure by the heat generated from medium frequency alternating current. It has been successfully applied in liver cancer before checkpoint inhibitors. ●Combine with high-intensity focused ultrasound .

This is meant to be a drop-in replacement for radiotherapy, just like radiofrequency ablation was, to ablate the tumors.

“Growing Your White Blood Cells to Treat Your Cancer” (Matthew Dons) [#79] ●Condition dendritic cells for cancer treatment : For example, promising results in primary brain cancer. ●Combine with “cryoablation”: (extreme cold) to freeze and kill abnormal cancerous and precancerous cells.

●Inject therapies into the tumors : The alternative the Japanese have come up with is to take dendritic cells and inject them in between your ribs because there's loads of lymph nodes there.

●Condition with heat shock proteins ●Use the tumor tissue to condition the dendritic cells ●Analyze white blood cell activity in blood samples ●Get metronomic chemotherapy : a low dose of chemotherapy given continuously, with no breaks Why should you consider getting your immunotherapy in Japan? ●Advanced treatments: The standard care in Japan is very high for cancer.

It's probably a few years ahead of the US, and maybe 10 years ahead of the UK. ●Access: Matthew Dons got his experience with immunotherapy in Japan, including tumor lysate-pulsed autologous dendritic cell therapy. ●Low Cost: Healthcare in Japan is far less expensive than in the US.

It’s because of how the Japanese health system is regulated and with the buying power of Japan because there's a large, elderly population. For example, for Matthew Dons, the standard, intensive treatment was around $25,000. ●Safety: In Japan, medical mistakes are very rare. In the US, medical mistakes are the third biggest killer.

When you are getting cancer treatment you are often looking at treatments that give you a few percent advantage over standard care. Medical mistakes eat away at that advantage. What can you do to help with the global effort to cure cancer? There’s no serious global effort to cure cancer.