Immunotherapy and IRE

Immunotherapy and IRE—synergy in prostate cancer treatment

New hope for patients with metastatic prostate cancer: immunotherapy in combination with NanoKnife

Prostate cancer, which has formed metastasesdeposits of tumor nodules, each made up of millions of cancer cellsthroughout the body, is considered as not curable any more. Although the survival time of those affected can be extended by hormone therapy (anti-androgen therapy, chemical castration), the cancer cells adapt sooner or later, leaving the disease in a state known as CRPC (Castration-Resistant Prostate Cancer). A new cancer therapy, which is even then still effective, is based on the combination of two new approaches: an immunologically stimulating ablation of the primary tumor (IRE, IR-ECT or cryotherapy) in combination with a class of drugs which stimulate the immune system (immunomodulation), called monoclonal antibodies.

CRPC (Castration-Resistant Prostate Cancer): so far, the end of the road

According to the treatment guidelines for prostate cancer, a blockade of the male sex hormone testosterone is performed at the latest when a metastasis is detected (also called antihormonal therapy or chemical castration).

As the growth of prostate cancer cells is induced by testosterone, this stops the growth for the moment. Unfortunately, sooner or later the cancer adapts itself to all available hormone blocks and the prostate cancer continues to grow, with or without testosterone: we speak of a hormone refractory or CRPC (Castration-Resistant Prostate Cancer). Every other therapy is considered to be palliative, as the goal is not healing anymore, but a certain extension of survival time.

Prostate cancer and immunotherapies: endogenous defense as highly effective therapy

Until recently cancer and the immune system were regarded as two independent and unconnected topics of the human body by a large part of the medical profession. Cancer cells were often described as invisible and invulnerable to the immune system. Therefore, little attention was given to the immune system in the prognosis and therapy of cancer.

Ribbon chart of a monoclonal antibody (PD-1, pembrolizumab)

With improvements in cell- and microbiology as well as in genetics, a clearer understanding of the interaction between the body’s immune system and cancer is rapidly emerging. Based on this progress, the first effective immunotherapies have been developed.

The increasing understanding of the importance of immune effects in cancer therapy has also led to the detection of secondary immune effects unleashed by focal therapies treatments such as Irreversible Electroporation (IRE) and cryotherapy, to a lesser extent, by others.

These methods do not only kill cancer cells locally, but also activate the immune system, which after an IRE treatment increasingly attacks and kills cancer cells. The effect is comparable to a vaccination against cancer.

Based on the findings from cancer research, in the meantime the first drugs for the treatment of cancer were approved, so-called monoclonal antibodies, also known as checkpoint inhibitors (PD-1, PD-L1, CTLA-4, etc.). Recent researches demonstrate that the combination of immunotherapy with focal ablation techniques such as IRE leads to significant potentiation of efficacy and opens new paths for the treatment of CRPC (Castration-Resistant Prostate Cancer).

Lymphocytes of the immune system attack a cancer cell.

Synergistic use of focal tissue ablation and immunotherapy: a new era of cancer therapy

Researchers at the renowned US Johns Hopkins University in Baltimore determined that the focal treatment of prostate cancer in combination with so-called PD-1 checkpoint inhibitors allows a much more effective treatment of patients with advanced prostate cancer than was possible previously.

After initial studies on an animal model, patients are now treated in a clinical trial with a combination of cryoablation and immunotherapy [1]. Similar studies are ongoing about breast cancer [2].

Even better than cryoablation is the focal therapy IRE, since it causes stronger secondary immune effects. In the US, however, IRE cannot be used yet for this purpose for regulatory reasons.

At Vitus, we have been observing the secondary immune effects of IRE for years. The usefulness of our therapeutic approach was confirmed by the results of the research from the USA.

Our team of urologists, oncologists and interventional radiologists are the world leading team for the treatment of prostate cancer with NanoKnife. Thanks to our oncological experts, we have unique expertise in the field of the combination of immunotherapies with IRE.

All therapies, especially combined immunotherapies, are planned and performed on an individual basis for each of our patients. Whilst most other institutions are at best talking about "individualized medicine", at Vitus we have been following its principles for years, determining and carrying out the optimal therapy for each patient.

This contrasts with and often exceeds the standard urological treatment guidelines (e.g. S3 Guidelines Prostate Cancer of the Germany Urological Society), which are based on clinical studies with large cohorts of patients, in which differences between individuals (e.g. genetic differences, different life expectancy, personal preferences, etc.) are not taken into account.

Also, standard treatment guidelines most of the time do not reflect the latest developments in science and are restricted by considerations of cost, since they regulate reimbursement in public healthcare systems. Many leading healthcare institutions and government health agencies, such as the FDA (US Food and Drug Administration) and NIH (National Institutes of Health) are now beginning to differentiate between individualized, precision and socialized imprecision medicine.

Since many patients do not want toor cannotwait until new therapies are included in the catalogue of standard procedures, we are implementing these new therapies on an individual basis, if applicable and if favored by the patient, into individual treatment plans.

Radiologists, urologists, hematooncologist, biologists, physicists, and the worldwide largest experiencethis is the right place for the latest prostate cancer therapies

In case you, or a relative of yours, is affected by a metastatic and/or hormone-refractory prostate carcinoma, we suggest that you obtain a second opinion from us. In addition to our complete and high-quality diagnostics, we counsel you comprehensively concerning all the latest advances in immunotherapies for prostate cancer.

New hope for patients with metastatic prostate cancer: immunotherapy in combination with NanoKnife

Prostate cancer, which has formed metastasesdeposits of tumor nodules, each made up of millions of cancer cellsthroughout the body, is considered as not curable any more. Although the survival time of those affected can be extended by hormone therapy (anti-androgen therapy, chemical castration), the cancer cells adapt sooner or later, leaving the disease in a state known as CRPC (Castration-Resistant Prostate Cancer). A new cancer therapy, which is even then still effective, is based on the combination of two new approaches: an immunologically stimulating ablation of the primary tumor (IRE, IR-ECT or cryotherapy) in combination with a class of drugs which stimulate the immune system (immunomodulation), called monoclonal antibodies.

CRPC (Castration-Resistant Prostate Cancer): so far, the end of the road

According to the treatment guidelines for prostate cancer, a blockade of the male sex hormone testosterone is performed at the latest when a metastases are detected (also called antihormonal therapy or chemical castration).

As the growth of prostate cancer cells is induced by testosterone, this stops the growth for the moment. Unfortunately, sooner or later the cancer adapts itself to all available hormone blocks and the prostate cancer continues to grow, with or without testosterone: we speak of a hormone refractory or CRPC (Castration-Resistant Prostate Cancer). Every other therapy is considered to be palliative, as the goal is not healing anymore, but a certain extension of survival time.

Prostate cancer and immunotherapies: endogenous defense as highly effective therapy

Until recently cancer and the immune system were regarded as two independent and unconnected topics of the human body by a large part of the medical profession. Cancer cells were often described as invisible and invulnerable to the immune system. Therefore, little attention was given to the immune system in the prognosis and therapy of cancer.

Ribbon chart of a monoclonal antibody (PD-1, pembrolizumab)

With improvements in cell- and microbiology as well as in genetics, a clearer understanding of the interaction between the body’s immune system and cancer is rapidly emerging. Based on this progress, the first effective immunotherapies have been developed.

The increasing understanding of the importance of immune effects in cancer therapy has also led to the detection of secondary immune effects unleashed by focal therapies treatments such as Irreversible Electroporation (IRE) and cryotherapy, to a lesser extent, by others.

These methods do not only kill cancer cells locally, but also activate the immune system, which after an IRE treatment increasingly attacks and kills cancer cells. The effect is comparable to a vaccination against cancer.

Based on the findings from cancer research, in the meantime the first drugs for the treatment of cancer were approved, so-called monoclonal antibodies, also known as checkpoint inhibitors (PD-1, PD-L1, CTLA-4, etc.). Recent researches demonstrate that the combination of immunotherapy with focal ablation techniques such as IRE leads to significant potentiation of efficacy and opens new paths for the treatment of CRPC (Castration-Resistant Prostate Cancer).

Lymphocytes of the immune system attack a cancer cell.

Synergistic use of focal tissue ablation and immunotherapy: a new era of cancer therapy

Researchers at the renowned US Johns Hopkins University in Baltimore determined that the focal treatment of prostate cancer in combination with so-called PD-1 checkpoint inhibitors allows a much more effective treatment of patients with advanced prostate cancer than was possible previously.

After initial studies on an animal model, patients are now treated in a clinical trial with a combination of cryoablation and immunotherapy [1]. Similar studies are ongoing about breast cancer [2].

Even better than cryoablation is the focal therapy IRE, since it causes stronger secondary immune effects. In the US, however, IRE cannot be used yet for this purpose for regulatory reasons.

At Vitus, we have been observing the secondary immune effects of IRE for years. The usefulness of our therapeutic approach was confirmed by the results of the research from the USA.

Our team of urologists, oncologists and interventional radiologists are the world leading team for the treatment of prostate cancer with NanoKnife. Thanks to our oncological experts, we have unique expertise in the field of the combination of immunotherapies with IRE.

All therapies, especially combined immunotherapies, are planned and performed on an individual basis for each of our patients. Whilst most other institutions are at best talking about "individualized medicine", at Vitus we have been following its principles for years, determining and carrying out the optimal therapy for each patient.

This contrasts and often exceeds the standard urological treatment guidelines (e.g. S3 Guidelines Prostate Cancer of the Germany Urological Society), which are based on clinical studies with large cohorts of patients, in which differences between individuals (e.g. genetic differences, different life expectancy, personal preferences, etc.) are not taken into account.

Also, standard treatment guidelines most of the time do not reflect the latest developments in science and are restricted by considerations of cost, since they regulate reimbursement in public healthcare systems. Many leading healthcare institutions and government health agencies, such as the FDA (US Food and Drug Administration) and NIH (National Institutes of Health) are now beginning to differentiate between individualized, precision and socialized imprecision medicine.

Since many patients do not want toor cannotwait until new therapies are included in the catalogue of standard procedures, we are implementing these new therapies on an individual basis, if applicable and if favored by the patient, into individual treatment plans.

Radiologists, urologists, hematooncologist, biologists, physicists, and the worldwide largest experiencethis is the right place for the latest prostate cancer therapies

In case you, or a relative of yours, is affected by a metastatic and/or hormone-refractory prostate carcinoma, we suggest that you obtain a second opinion from us. In addition to our complete and high-quality diagnostics, we counsel you comprehensively concerning all the latest advances in immunotherapies for prostate cancer.

What immunotherapies for cancer are there?

Cancer immunotherapy is a wide term which includes lots of fundamentally different approaches. The only common feature is their influence on the cancer via a modulation of the immune system.

Cellular immunotherapy for prostate cancer

Therapy with Dendritic Cells:

In dendritic cell therapy, an immunological tumor response is induced by the injection of antigen-presenting dendritic cells. It activates lymphocytes, which are programmed to attack other cells with the same or a similar antigen throughout the whole body.

There are several different methods to activate the dendritic cells and to adjust to the appropriate antigens. A study about the best version in prostate cancer is not yet available. (State 2017)

Killer Cell Therapy: 

NK-cells, LAK cells and T-killer-cells can be specifically directed for a tumor cell type ex-vitro (in the laboratory) and get re-injected.

Monoclonal Antibody Immunotherapy for prostate cancer

Monoclonal antibodies bind at different “checkpoints” for which they were developed specifically. Potential checkpoints with relevance to the prostate carcinoma are PD1 (pembrolizumab, nivolumab), PD-L1 (atezolizumab) and CTLA4 (ipilimumab). Probably the combination with a tumor mass reduction such as NanoKnife increases the effect.

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Cytokine immunotherapy for prostate cancer

Interferon:
Interferons (Type I, II, III) are normally produced by the body to request a response of the immune system. However, these also play a role in cancer immunology. Injections (local, systemic and possibly under local reversible electroporation) trigger immune reactions against some types of cancer.

Interleukin:
Interleukins affect the formation of T killer cells as well as regulatory T cells and can be used for immunotherapy. 

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