Immunotherapy

Immunotherapy derives from an observation in the 19th century that cancer sometimes regressed after acute bacterial infections, i.e. in response to nonspecific immunostimulant effect. But, in general, it appears that the immune response to cancer appears to be attenuated. Attempts have been made to stimulate the host's own immune system aspiring more effectively to kill cancer cells. Exploration of immunotherapy has involved:

• Nonspecific stimulation of active immunity with vaccines, e.g. BCG (Bacille Calmette-Guerin9) instilled into the urinary bladder for bladder cancer. More modern approaches involve the injection of tumour cells or tumour cell extracts combined with an immune stimulant such as BCG.

• Passive immunotherapy strategies with monoclonal antibodies raised against specific tumour-associated antigens. Targeted antibodies have the advantage of high cancer specificity and low host toxicity. Examples include rituximab, an anti-CD20 monoclonal antibody licensed for the treatment of low-grade, follicular lymphomas and trastuzumab (Herceptin), which specifically binds to the her2/neu (erbB2) receptor, which is overexpressed by some breast cancers. In combination with conventional cytotoxic chemotherapy, trastuzumab significantly improves the survival of advanced breast cancer patients when compared to cytotoxic chemotherapy alone.

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