Clinical Considerations

Clinical Considerations When Evaluating Treatment Options

Differences in Treatment

Immunotherapy vs other system cancer treatment modalities

IMMUNOTHERAPY

TREATMENT

Includes monoclonal antibodies, checkpoint inhibitors, vaccines, and adoptive cellular therapy7,8

MODE OF ACTION

SELECT A TREATMENT TO COMPARE:

CHEMOTHERAPY

TREATMENT

Includes alkylating agents, antitumor antibiotics, topoisomerase inhibitors, and others9

MODE OF ACTION

Cytotoxic for cancer cells or slows their proliferation10

HORMONAL THERAPIES

TREATMENT

Includes selective estrogen receptor modulators, aromatase inhibitors, and luteinizing hormone-releasing hormone (LHRH) agonists and antagonists11

MODE OF ACTION

Blocks the effect of hormones in hormone-sensitive cancers, such as breast, uterine, and prostate cancers12,13

TARGETED THERAPY

TREATMENT

Includes enzyme inhibitors, apoptosis inducing drugs, and angiogenesis inhibitors14,15

MODE OF ACTION

Targets proteins involved in signaling pathways that promote cancer cell growth16

Targeting specific molecules helps avoid damage to normal cells16

Advancing treatment with immunotherapy

The transformative potential of immunotherapy

Combination of immunotherapy with other treatment modalities such as chemotherapy, radiation therapy, and targeted therapy. Adapted from Ribas A, et al. Clin Cancer Res. 2012;18(2):336-341.17

LEARN MORE about combination treatments with immunotherapy

The combination of immunotherapy with other treatment modalities such as chemotherapy, radiation therapy, targeted therapy, or other immunotherapies are being evaluated to determine response rates, duration of response, or provide enhanced survival benefit.17-19

Other considerations

Pseudoprogression

One clinically important and established difference between immunotherapy and chemotherapy or radiation therapy is pseudoprogression.20 While immunotherapy may result in tumor shrinkage consistent with what is seen with conventional chemotherapy, there have been reports of immunotherapy regimens demonstrating a unique response pattern in some patients, known as pseudoprogression, in which there is an initial increase in tumor size, followed by a delayed shrinkage.20

This is believed to be the result of immune and inflammatory cells infiltrating the tumor, which may appear as tumor progression on scans. Therefore, an initial increase in tumor burden while administering immunotherapy may not be indicative of progression. In these cases, therapy should be continued unless true disease progression is confirmed.20

mUC=metastatic urothelial cancer; NSCLC=non-small cell lung cancer; HNSCC=squamous cell carcinoma of the head and neck; PD-L1=programmed cell death ligand-1.

References

1. 2012 novel new drugs summary. https://www.fda.gov/downloads/Drugs/DevelopmentApprovalProcess/DrugInnovation/UCM337830.pdf. U.S. Food and Drug Administration Center for Drug Evaluation and Research. Published January 2013. Accessed July 31, 2017. 1-16. 2. US Food and Drug Administration (FDA). 2013 novel new drugs summary. https://www.fda.gov/downloads/Drugs/DevelopmentApprovalProcess/DrugInnovation/UCM381803.pdf. Published January 2014. Accessed July 31, 2017. 3. 2014 novel new drugs summary. https://www.fda.gov/downloads/drugs/developmentapprovalprocess/druginnovation/ucm430299.pdf. U.S. Food and Drug Administration Center for Drug Evaluation and Research. Published January 2015. Accessed July 31, 2017. 1-20. 4. US Food and Drug Administration (FDA). Novel drugs 2015 summary. https://www.fda.gov/downloads/drugs/developmentapprovalprocess/druginnovation/ucm481709.pdf. Published January 2016. Accessed July 31, 2017. 5. US Food and Drug Administration (FDA). 2016 novel drugs summary. https://www.fda.gov/downloads/Drugs/DevelopmentApprovalProcess/DrugInnovation/UCM536693.pdf. Published January 2017. Accessed July 31, 2017. 6. US Food and Drug Administration (FDA). Novel drug approvals for 2017. https://www.fda.gov/Drugs/DevelopmentApprovalProcess/DrugInnovation/ucm537040.htm. Accessed June 16, 2017. 7. American Cancer Society (ACS). What is cancer immunotherapy? 2016. https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/immunotherapy/what-is-immunotherapy.html. Accessed June 16, 2017. 8. Fry TJ, Mackall CL. T-cell adoptive immunotherapy for acute lymphoblastic leukemia. Hematology Am Soc Hematol Educ Program. 2013;2013:348-353. 9. Palumbo MO, Kavan P, Miller WH, et al. Systemic cancer therapy: achievements and challenges that lie ahead. Front Pharmacol. 2013;4:1-9. 10. American Cancer Society (ACS). Chemotherapy: what it is, how it helps. https://www.cancer.org/content/dam/CRC/PDF/Public/7779.00.pdf. Accessed July 31, 2017. 11. American Cancer Society (ACS). Hormone therapy for breast cancer. 2016. https://www.cancer.org/cancer/breast-cancer/treatment/hormone-therapy-for-breast-cancer.html. Accessed June 16, 2017. 12. American Cancer Society (ACS). Understanding hormone therapy. 2012. https://www.cancer.org/latest-news/understanding-hormone-therapy.html. Accessed June 16, 2017. 13. National Cancer Institute (NCI). Hormone therapy for prostate cancer. 2014. https://www.cancer.gov/types/prostate/prostate-hormone-therapy-fact-sheet#q4. Accessed June 22, 2017. 14. American Cancer Society (ACS). Targeted therapy drugs for non-hodgkins lymphoma. 2016. https://www.cancer.org/cancer/non-hodgkin-lymphoma/treating/targeted-therapy.html. Accessed June 16, 2017. 15. American Cancer Society (ACS). Evolution of cancer treatments: targeted therapy. 2014. https://www.cancer.org/cancer/cancer-basics/history-of-cancer/cancer-treatment-targeted-therapy.html. Accessed June 16, 2017. 16. American Cancer Society (ACS). What is targeted therapy? 2016. https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/targeted-therapy/what-is.html. Accessed June 16, 2017. 17. Ribas A, Hersey P, Middleton MR, et al. New challenges in endpoints for drug development in advanced melanoma. Clin Cancer Res. 2012;18(2):336-341. 18. Kaufman HL, Atkins MB, Dicker AP, et al. The value of cancer immunotherapy summit at the 2016 society for immunotherapy of cancer 31st anniversary annual meeting. J Immunother Cancer. 2017;5:38. https://doi.org/10.1186/s40425-017-0241-6. 19. Melero I, Berman DM, Aznar MA, et al. Evolving synergistic combinations of targeted immunotherapies to combat cancer. Nat Rev Cancer. 2015;15(8):457-472. 20. Chiou VL, Burotto M. Pseudoprogression and immune-related response in solid tumors. Journal of Clinical Oncology. 2015; 33(31):3541-3543.