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IRE and immunotherapy

IRE and immunotherapy - the future of prostate cancer therapy

The body’s immune system

the best therapy for cancer

The body’s immune system is so far the only way to cure cancer. This is because even after the removal of a locally occurring tumor – e.g. a prostate carcinoma – tumor cells are present throughout the patient’s body. These microscopic cells cannot be visualized by imaging and have not yet been treated. They can remain inactive in the body for years and decades and form the basis for the later growth of metastases and larger clusters of tumor cells. The vast majority of men with prostate cancer die from metastases rather than their primary tumor in the prostate.

Nevertheless, established therapies for prostate cancer are focused on treating the primary tumor. Surgery, radiation and chemotherapy damage the immune system instead of supporting it. Treatment of cancer cells scattered throughout the body has not routinely taken place.

Immunotherapy

supports the body’s immune system in the fight against tumor cells

However, it has been known for many years that there are also treatment fractions for cancer that support the body’s own immune system in fighting tumor cells. These procedures have in common the way they kill tumor cells, namely by apoptosis and necrosis. These include procedures such as irreversible (IRE) and reversible electroporation (ECT = electrochemotherapy), but also photodynamic therapy (PDT), a much older procedure that has been well studied scientifically in terms of its antitumor immune effects 1 .

Making prostate cancervisible” to the immune system

Tumors are recognized by the immune system via tumor antigens, recognition molecules that are located, for example, on the surface of tumor cells. During treatment with tissue ablation procedures such as IRE, ECT and PDT, these tumor antigens are released en masse and recognized by the immune system – just like a vaccination in which inactive viruses are injected.

As a result, even tumors that are difficult for the immune system to detect, such as prostate carcinoma, can be made “visible”.

Enhancement of the immune response by immunotherapy

The resulting immune response against the tumor and cancer cells scattered throughout the body can be enhanced by immunotherapeutics. A wide variety of substances play a role in this.

It has been known for about 100 years that inflammation occurring simultaneously with tumors can lead to spontaneous remission1 . For bladder tumors, inducing infection with the tuberculosis vaccine Bacillus Calmette-Guérin (BCG) is established as standard therapy. Also oncolytic viruses2, dendritic cells, cytokines such as interleukin-6, and suppression of T-regulatory cells by low-dose cyclophosphamide3 can enhance the immune response against tumor cells.

Modern immunotherapeutics such as check-point inhibitors (e.g. PD1 inhibitors – Keytruda©) act more specifically by enhancing the body’s immune response by blocking specific receptors.

Our most important message: Let one of our experts advise you and make your personal consultation appointment today. It could change your life.

VITUS Immunotherapy

Pioneering integrated therapy concepts for better survival in prostate cancer

At the VITUS Prostate Center we use the modern possibilities of immunotherapy to destroy prostate cancer not only locally in the prostate but cancer cells throughout the body, to prevent the formation of metastases and tumor recurrence.

Figure 1: Photodynamic therapy (PDT) and electroporation treatments (IRE, ECT) cause cancer cell death through apoptosis and necrosis. While PDT is the older and better-studied ablation procedure in terms of immune effects, electroporation procedures are newer and more precisely controllable and therefore more suitable for the treatment of the primary tumor in the prostate, for example, in prostate cancer.

Shown is the combination of treatment of a primary tumor (here with PDT) with immunostimulants. Intratumoral injection of various Toll-like receptor (TLR) ligands: Bacillus Calmette-Guerin (BCG), Mycobacterial cell-wall extract (MCWE), OK432, Zymosan, Schizophyllan (SPG), or Corynebacterium parvum (CP), effectively activates dendritic cells (DCs) and increases antigen presentation and local inflammation. Injection of various cytokines, such as granulocyte-macrophage colony-stimulating factor (GMCSF), granulocyte colony-stimulating factor (GCSF), and tumor necrosis factor-α (TNFα), results in enhanced

Infiltration by macrophages, activation of neutrophils and direct destruction of tumor vessels.

References
  1. Ana P. Castano AP, Mroz P, Hamblin MR. Photodynamic therapy and anti-tumour immunity. Nat Rev Cancer. 2006 July ; 6(7): 535–545. doi:10.1038/nrc1894.
  2. Challis GB, Stam HJ. The spontaneous regression of cancer. A review of cases from 1900 to 1987.
  3. Acta Oncol 1990;29:545–550. [PubMed: 2206563] A collection of 744 cases of spontaneous regressions of cancer in humans, showing the theoretical justification for immunotherapy.
  4. https://www.cancer.gov/news-events/cancer-currents-blog/2018/oncolytic-viruses-to-treat-cancer
  5. North RJ. Cyclophosphamide-facilitated adoptive immunotherapy of an established tumor depends
  6. on elimination of tumor-induced suppressor T cells. J. Exp. Med 1982;155:1063–1074. [PubMed:
  7. 6460831]