Cancer Immunotherapy Use on Cancer Patients

Recent advances in treating cancer patients have resulted in the development of biological therapies that can prove to be a promising alternative to conventional cancer therapies. Immunotherapy harnesses the body’s immune system to identify and fight effectively against cancer cells.

Immunotherapy works by attacking the growth of cancer cells or stimulating the immune system to kill cancer cells. Contradictory to the standard cancer treatment regimes such as chemotherapy, radiation therapy, which act on both normal and cancerous cells, immuno-therapeutic treatments are highly specific. A wide range of cancer immuno-therapy approaches exists such as immune checkpoint blockers, cancer vaccines, immune-modulators, monoclonal antibodies and cell based immuno-therapies have demonstrated to be effective against cancer patients.

The most commonly targeted form of cancer chemotherapy is the use of monoclonal antibodies as they can be tailor-made in the laboratory. They have unique antigen specificity thereby allowing themselves to attach to specific epitopes on cancer cells. This flags the cancer cells and makes it more visible to the immune system so that it can find and destroy those cells. Currently, most of the monoclonal antibodies are undergoing phase 3 clinical trials or awaiting FDA review process. Unlike monoclonal antibodies, non-specific immuno-therapy approaches such as administration of immuno-modulatory cytokines are also being used to treat melanoma. Cytokines are hormones that are endogenously produced by the body to enhance or suppress T-cell response against cancer cells. IFN-α and IL-2 are most commonly characterized cytokines used in cancer immuno-therapy.

The primary cell-based immuno-therapy strategy which is successful these days is the use of T-cell therapy, wherein cancer T cells removed from blood are modified with chimeric antigen receptor (CAR) and is then infused back into the patients to treat metastatic cancer. Another form of cell-based immuno-therapy used is tumor-infiltrating lymphocytes (TIL) therapy, wherein TIL is surgically removed from tumor tissue and is considerably increased in the laboratory by adding cytokines to it and is then re-infused back into the patient.

A promising treatment that has emerged in recent times for treatment of melanoma is the use of immune checkpoint inhibitors. They act by inhibiting the checkpoint receptors on T cells that act as brakes to the immune system thereby mediating anti-tumor responses. Some of the commonly used antibody inhibitors that have been commercialized are PD-1, PDL-1, and CTLA-4. Another more focused approach to cancer immuno-therapy is the use of vaccines to encourage the immune system to generate antibodies that can target tumor specific antigens, thereby eradicating cancerous cells. Cancer vaccines include peptide-based, dendritic cell-based, tumor cell-based and DNA cell based. Cancer vaccines can be broadly classified as preventive or therapeutic. Preventive vaccines are commercially available for against cervical and liver cancer causing viruses such as human Papillomavirus and Hepatitis B virus, respectively.

However, in spite of these advances, limitation such as tumor heterogeneity, unpredictable efficacy and identification of potential markers still exist in the field of cancer immuno-therapy. Therefore, new more targeted cancer immuno-therapies and preventive strategies are being developed and tested, which will deliver novel efficacious therapy against relapsed or refractory cancer patients.

A Pharmacogenomic (PGx) Test Is a Once in a Life Time Taken Test That May Enhance or Save Your Life

What is Pharmacogenomics (PGx)?

Pharmacogenomics is the study of how a patient’s genetic makeup contributes to a positive therapeutic result and/or adverse reactions to prescribed medications. Using pharmacogenomics, physicians can customize treatment plans that minimize adverse side effects or hazards.

Pharmacogenomics provides knowledge that helps physicians prescribe a drug regimen with a greater probability of a positive outcome.

Get the RIGHT dose of the RIGHT drug at the RIGHT time.

Better, safer drugs the first time

Instead of the standard trial-and-error method of matching patients with the right drugs, doctors will be able to analyze your genetic profile and prescribe the best available drug therapy from the beginning. Not only will this take the guesswork out of finding the right drug, it will speed recovery time and increase safety as the likelihood of adverse reactions is eliminated.

More accurate methods of determining appropriate drug dosages
Current methods of basing dosages on weight and age will be replaced with dosages based on a person’s genetics; how well the body processes the medicine and the time it takes to metabolize it. This will maximize the therapy’s value and decrease the likelihood of overdose.

Not all Medication works for everyone…

Many drugs that are currently available are “one size fits all;” but they don’t work the same way for everyone. It can be difficult to predict who will benefit from a medication, who will not respond at all, and who will experience negative side effects (called adverse drug reactions). Adverse drug reactions are a significant cause of hospitalizations and deaths in the United States.

Adverse Drug Reaction (ADR)

According to the Institute of Medicine

There are over 2.2 million avoidable ADR Hospitalizations per year

There are over 106,000 avoidable ADR deaths per year

There are over 350,000 Nursing Home ADRs per year

What are the Chances of an ADR?

The more drugs a patient is taking, the more chance of an ADR.

Patients taking over 11 drugs have a 96% chance of an ADR.

With the knowledge gained from the Human Genome Project, researchers are learning how inherited differences in genes affect the body’s response to medications. These genetic differences will be used to predict whether a medication will be effective for a particular person and to help prevent adverse drug reactions.

A simple non invasive Pharmacogenomic buccal swab test is a once in a life time test that may enhance or even save your life!

Does Your EMS-ED Patient Handoffs Process Need a Hand?

Patient handoffs continue to present challenges and risk to hospitals.
In fact, according to the Joint Commission Center for Transforming Healthcare, “An estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off.” For patients brought to the hospital by ambulance, care actually begins with “first medical contact” by Emergency Medical Services, which adds additional layers to the handoff issue. From the time the 911 call is placed to the time the patient is treated by a physician or specialist team (as is the case for lifesaving time-sensitive acute care such as STEMI, Stroke, Trauma or Sepsis), information has changed hands up to eight times. Each handoff compounds a very large (and very concerning) margin for error. Remember playing “Telephone” as a child? One person whispered a statement to another person, who passed it along to the next… by the time the 4th person received it, it was hilariously different than the original message. Well, in a life or death situation, there’s nothing hilarious about inaccurate or missing information.

Let’s examine the chain of care-related information.
A call is made to 911- a brief background of the patient’s emergency and situation are given to the dispatcher, who passes that info along to the EMS ambulance responding. First responder paramedics and EMTs arrive at the scene, assess the patient, obtain a history and initiate care. They gather additional data and vitals, select the destination hospital and prepare for transport. At some point EMS either consults with a hospital-based nurse or physician for medical direction or simply calls or radios in a summary as a notification to the receiving emergency department. This patient report is (hopefully) passed to other ED staff in advance of the ambulance arrival. That’s handoff number three already and the patient has not yet arrived. Upon arrival, the patient is handed off to waiting nursing staff, who collect a rehash of the care summary from EMS before they leave. As ED providers take over patient care, nurses pass all of this data to arriving physicians, usually reiterated verbally or via jotted notes- from which treatment ensues. For acute care cases, there are yet additional time-sensitive handoffs to CT-Scan or Cath-Lab, and to specialists from cardiology, neurology, and trauma.

Was it a bit tricky to follow all of that?
Seems pretty easy for details to get lost in translation, doesn’t it? This is not a new issue, which is why the patient handoffs between EMS and the ED is termed “a critical moment in patient care” in a recent NAEMSP blog. With today’s emphasis on patient outcomes and reducing cost and risk, the use of Mobile Telemedicine, HIPAA secure notifications, and digital forms are viable, cost-effective tools to drastically reduce that error percentage. Which brings us back to the question. Does your EMS-ED handoff process need a hand?