How to Improve Immunotherapy Response & Checkpoint Inhibitor Effectiveness
Featuring: Vikas Sukhatme, MD, ScD, Vidula Sukhatme, MS
In short
Oncologist Vikas Sukhatme and researcher Vidula Sukhatme walk through low-cost, evidence-backed ways patients on immune checkpoint inhibitors may improve how well those drugs work — covering nutrients, timing, diet, and medications to avoid. Checkpoint inhibitors help only about 20–40% of patients depending on cancer type, so even modest gains from these add-on strategies could matter. The Sukhatmes focus on approaches that are available today and do not require new or expensive treatments.
- •Ask your doctor to test your magnesium, vitamin D, and plasma histamine levels — correcting deficiencies in these may support how well checkpoint inhibitors work.
- •If you take a proton pump inhibitor, certain antibiotics, steroids, H2 blockers (like famotidine), or regular acetaminophen, ask your oncologist whether any of these could be reducing your immunotherapy's effectiveness.
- •If you receive checkpoint inhibitor infusions, ask whether scheduling them in the morning is possible — studies suggest early-morning timing may improve response compared to later in the day.
- •Eating more than 20 grams of fiber per day and avoiding off-the-shelf probiotic supplements (while discussing the specific probiotic Clostridium butyricum with your doctor) are dietary steps that may support treatment response.
Watch on Cancer Patient Lab YouTube
Ask anything about this — free, no signup
Instant answers grounded in real guidelines, not the internet.
“You are probably familiar with checkpoint blockade. This is clearly one of the biggest developments of the last 10 years or so. Durable responses have now been seen in many different solid tumor types. That's the good news. The bad news is these are very expensive, and there are serious immune related adverse events that do occur at fairly high frequency.
The efficacy typically ranges around 20% to 40% depending on tumor type, but for the most part, it's on the lower side of that number. The question that we asked ourselves is: ‘Can we do better? Can we do better now? ’ And the answer I'd like to posit to you is ‘Possibly.
Meeting Summary
Cancer patients and caregivers face challenges with immune checkpoint inhibitors. Immune checkpoint inhibitors are some of the most widely prescribed cancer drugs, representing over $40 billion in annual sales. While immune checkpoint inhibitors have revolutionized the treatment of many cancers, a significant portion of patients do not respond -- roughly 20% to 40% respond.
Increasing the effectiveness of immune checkpoint inhibitors can have significant impacts.
Vikas Sukhatme, MD, ScD, professor of medicine at Emory University and the founding director of the Morningside Center for Innovative and Affordable Medicine at Emory University , and his wife, Vidula Sukhatme, MS, co-founder and CEO of GlobalCures, are uniquely qualified to lead a discussion about complementary therapies that can increase the effectiveness of immune checkpoint inhibitors.
The Morningside Center was created to address the lack of financial incentives that inhibit the promotion of potentially effective and affordable medical treatments -- "financial orphans". Dr. Sukhatme completed a bachelor's degree and then a doctorate (ScD) in theoretical physics at Massachusetts Institute of Technology, and he received an MD from Harvard Medical School in the Harvard-MIT program in Health Sciences and Technology.
He spent two years at Stanford in immunology research. Vidula Sukhatme is an Instructor in the Rollins School of Public Health, Emory University.
She is a co-founder of the Morningside Center and is the founding CEO of GlobalCures, which searches published scientific papers to identify and prioritize generic existing drugs that could be repurposed for cancer use, as well as nutritional products and lifestyles that may be of value to cancer patients. How have immune checkpoint inhibitors revolutionized cancer treatment?
Immune checkpoint inhibitors have been one of the biggest developments in cancer treatment in the last 10 years. They enable durable responses across multiple solid tumor types, which was “Increasing the Effectiveness of Immune Checkpoint Inhibitors” (Vikas Sukhatme, MD, ScD, and Vidula Sukhatme, MS ) not previously possible.
However, their effectiveness is still limited - ranging typically from 20- 40% depending on tumor type, with most outcomes on the lower end of that range.
•Ability to create long-lasting immune responses against cancer
•Potential for treatment across different cancer types
•Mechanism of "unleashing" T-cell responses against tumors The main challenges remain:
•High cost
•Serious immune-related adverse events
•Relatively low overall efficacy rates Should you consider getting an immune checkpoint inhibitor? Checkpoint inhibitors are most often used in advanced (metastatic) cancer settings and in specific cancer types where durable responses have been observed. There is also increasing usage prior to surgical removal of tumors. How might you increase the effectiveness of immune checkpoint inhibitors?
•Correct magnesium deficiencies
•Ensure adequate vitamin D levels
•Maintain a high-fiber diet (>20g/day)
•Time your infusions in the morning, if possible, at least for the first four infusions
•Delay immunotherapy 3-4 days after chemotherapy when both are being used concurrently
•Use antihistamines (specifically histamine 1 receptor blockers) if you have high histamine levels
•Correct vitamin deficiencies
•Avoid medications that might antagonize checkpoint inhibitors (steroids, antibiotics, proton pump inhibitors, histamine 2 receptor blockers, acetaminophen)
•Avoid off-the-shelf probiotics (but consider clostridium butyricum) How can you access these complementary therapies?
•Over-the-counter options: vitamin D supplements, magnesium supplements, antihistamines (such as loratadine), high-fiber diet, probiotic clostridium butyricum
•Prescription-required interventions: time-of-day infusion scheduling and 3-4 day delay of immunotherapy after chemotherapy
•Get appropriate testing (such as plasma histamine, magnesium, and vitamin D levels)
•Always consult with your medical team regarding any of these interventions “Increasing the Effectiveness of Immune Checkpoint Inhibitors” (Vikas Sukhatme, MD, ScD, and Vidula Sukhatme, MS ) How can you learn more about complementary therapies for immune checkpoint inhibitors?
•Visit the Morningside Center's website for ongoing research and information and join their patient cancer registry to contribute and learn about emerging therapies
•Consult with oncologists who are open to exploring complementary approaches
•Review the scientific literature
•If you are going to get immune checkpoint inhibitors, talk with your medical team about the complementary interventions discussed.
•Contact Vidula Sukhatme at Vidula@Global-cures.org or Vikas Sukhatme at vsukhatme@emory.edu
•See other discussions that touch on complementary therapies and immune checkpoint inhibitors:
•• • •
•The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action. You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health. For the video recording of this conversation, please see here. For a transcript of the conversation, please see here. For the slides, please see here. “Increasing the Effectiveness of Immune Checkpoint Inhibitors” (Vikas Sukhatme, MD, ScD, and Vidula Sukhatme, MS ) Meeting Notes KEYWORDS Immune checkpoint inhibitors, complementary therapies, Morningside Center, financial orphans, cancer registry, magnesium deficiency, vitamin D, dietary fiber, histamine blockade, time of day effect, low dose chemotherapy, patient advocacy, clinical trials, repurposed drugs, cancer immunity cycle. SPEAKERS Vikas Sukhatme (47%), Vidula Sukhatme (29%), Chris Apfel (9%), Roger Royse (7%), Richard Anders (4%), Allen Morris (2%), Russ Hollyer (2%) CHAT CONTRIBUTORS Richard Anders, Roger Royse, David Plunkett, Russ Hollyer, Rick Davis, Chris Apfel, Allen Morris, Vidula Sukhatme SUMMARY Vikas Sukhatme and Vidula Sukhatme discussed complementary therapies to enhance the effectiveness of immune checkpoint inhibitors (ICIs). They highlighted the Morningside Center's efforts to create a database of financial orphans, focusing on optimizing dosing, scheduling, and efficacy. Key interventions include correcting magnesium and vitamin D deficiencies, using antihistamines, beta blockers, and delaying ICIs by 3-4 days post-chemo. They presented data showing improved outcomes with early morning infusions and specific dietary interventions. The Sukhatmes emphasized the need for a national patient cancer registry to collect and analyze outcomes data, aiming to improve ICI efficacy and reduce adverse events. OUTLINE Introductions and Overview of the Morningside Center
•Vikas Sukhatme introduced the Morningside Center's mission to bring new treatment options to patients, focusing on financial orphans like off-patent drugs, nutraceuticals, and lifestyle modifications.
•The center aims to create a clinical impact through a database of financial opportunities, sponsor trials, and create a cancer registry, with a focus on optimizing dosing and scheduling and increasing the efficacy of checkpoint blocking.
•The three major buckets of financial orphans are: off-patent FDA-approved drugs, nutraceuticals, and lifestyle modifications.
•Increasing the efficacy of checkpoint blocking is expensive and associated with serious immune-related adverse events.
•Various studies show the impact of magnesium, vitamin D, dietary fiber, histamine blockade, and time of day on the efficacy of checkpoint blocking. Specific Interventions and Evidence “Increasing the Effectiveness of Immune Checkpoint Inhibitors” (Vikas Sukhatme, MD, ScD, and Vidula Sukhatme, MS )
•Magnesium has a role in enhancing immunotherapy, according to a paper in Cell that outlines its mechanism.
•Patients with normal magnesium levels had better outcomes than those with hypomagnesemia.
•Vitamin D has a role in increasing PD-1 blockade efficacy, citing a paper in Melanoma.
•Data on dietary fiber intake show that patients with high fiber intake had better outcomes in a study from MD Anderson. Histamine Blockade and Time of Day Effects
•Histamine blockade improves checkpoint blockade efficacy, according to studies in non- small cell lung cancer.
•Data show that patients on H1 blockers had better outcomes than those on H2 blockers or without blockers.
•Morning infusions are better, according to a review paper showing a two- to threefold- effect on overall survival.
•Data from a randomized control trial show that early time of day infusions led to better progression-free survival and overall response rates. Delaying Immunotherapy and Combination Studies
•Delaying immunotherapy is better for patients receiving concurrent therapy, according to animal data and a retrospective study.
•Data show that delaying immunotherapy led to a 50% increase in progression-free survival and disease control.
•Combining interventions is better.
•A clinical trial to test the hypothesis that simultaneous interventions increase efficacy is needed.
•These interventions can improve the efficacy of chemotherapy and other treatments. Adverse Events and Mechanisms
•Research is being done on reducing side effects and toxicity of checkpoint inhibitors and monitoring adverse events.
•H1 and H2 blockers have different mechanisms.
•Probiotics can potentially enhance checkpoint inhibitor efficacy. Patient Registry and Advocacy Efforts
•A patient cancer registry to collect data on interventions and outcomes is needed.
•There are ongoing efforts to convince physicians to adopt these interventions and the need for legal protection for physicians.
•Conducting clinical trials presents challenges; a separate infrastructure to repurpose approved drugs is needed. “Increasing the Effectiveness of Immune Checkpoint Inhibitors” (Vikas Sukhatme, MD, ScD, and Vidula Sukhatme, MS )
Full transcript
Roger Royse Welcome to the Cancer Patient Lab webinar. We're going to talk about how to increase the effectiveness of immune checkpoint inhibitors. Our speakers today are Vikas and Vidula Sukhatme. Vikas is a professor of medicine at Emory and a founding director of the Morningside Center for Innovative and affordable medicine at Emory University. And Vidula, who is his wife, is a co-founder and CEO of Global Cures.
They are going to lead a discussion about complementary therapies that can increase the effectiveness of immune checkpoint inhibitors. Vikas Sukhatme 0:43 This is a group of individuals that's one of the smartest groups I've ever met. I've been watching a number of your videos. I really appreciate what you're doing. Thank you again for this opportunity. I want to say a few words first about the Morningside Center.
This is a center within Emory University that we co-founded a few years ago, and we exist fundamentally to bring new treatment options to patients. In that sense, we are similar to pharma. We're not opposed to what pharma does, but we recognized a few years ago that when pharma tries to bring new drugs to the market, the underlying premise is that there is a financial incentive to do that.
We came to the realization that there are many potential interventions that we refer to as “financial orphans”, that are implementable today and for which there is no unified advocate. We're creating a database of these financial opportunities, largely in the cancer field. We aim for clinical impact.
We're sponsoring trials as well and have created a cancer registry, which we'll talk about very briefly, and we're involved in a number of advocacy efforts.
“Increasing the Effectiveness of Immune Checkpoint Inhibitors” (Vikas Sukhatme, MD, ScD, and Vidula Sukhatme, MS ) Financial orphans fall into three major buckets: (1) off-patent, FDA-approved drugs that could be repurposed for other uses, (2) nutraceuticals, and (3) lifestyle modifications such as diet and exercise.
The major reason that these are financial orphans is there's usually little intellectual property or no intellectual property, or an unenforceable intellectual property situation. There are other reasons here cited on the left hand side of the slide. “Increasing the Effectiveness of Immune Checkpoint Inhibitors” (Vikas Sukhatme, MD, ScD, and Vidula Sukhatme, MS ) The Morningside cancer programs are evolving.
Our website doesn't have all of this yet on board. It has some of it. The first is optimizing dosing and scheduling. This will not only save cost and decrease toxicity without we hope changing outcomes, or in some cases, we hope improving outcomes. A second major bucket, which is the topic for today, is increasing the efficacy of checkpoint blocking.
Many of the ideas here could be used both in the advanced setting and in the neoadjuvant setting, where I'm sure many of you know checkpoint blockade has now been adopted for a number of diseases.
I'll talk primarily about simple measures listed here, such as correcting any magnesium or vitamin D deficiencies in getting infusions in the morning, potential use of antihistamines, beta blockers and delaying immune checkpoint blockade by three to four days after chemo, when the two are being given, quote, unquote together.
I'll also tell you about an even broader landscape for what I refer to as multimodal priming, targeting, and all aspects of the cancer immunity cycle. I'll be happy if we want to spend some time on preventing cancer recurrence. That's the third program. But today I'm going to highlight the second of these programs. That's the good news.
The “Increasing the Effectiveness of Immune Checkpoint Inhibitors” (Vikas Sukhatme, MD, ScD, and Vidula Sukhatme, MS ) efficacy ranges between 15 or 20% to 50% depending on tumor type, but for the most part, it's on the lower side of that number.
Want to learn more about your specific case?
Upload your medical records and ask Navis questions tailored to your diagnosis.