2018 Nobel prize in Medicine Awarded to 2 Cancer Immunotherapy Researchers
The Nobel prize in Physiology or Medicine was awarded on Monday to James P. Allison of us and Tasuku Honjo of Japan for his or her work on unleashing the body’s immune system to attack cancer, a breakthrough that has led to a completely new class of drugs and brought lasting remissions to several patients who had run out of options.
Their success, which came after many researchers had given upon the idea, “brought immunotherapy out from decades of skepticism,” said Dr. Jedd Wolchok, a cancer a specialist at Memorial Sloan Kettering Cancer Center in NYC. It has, he said, “led to human applications that have affected an untold number of people’s health.”
Before Dr. Allison’s and Dr. Honjo’s discoveries, cancer treatment consisted of surgery, radiation, chemotherapy, and hormonal treatments. A statement from the Nobel committee hailed their accomplishments as establishing “an entirely new principle for cancer therapy.”
The drugs supported their work belong to a category called checkpoint inhibitors, with tongue-twisting names that have nonetheless become familiar to several patients. The first ones approved were ipilimumab (brand name Yervoy), nivolumab (Opdivo) and pembrolizumab (Keytruda). Others have since come to the market.
Earlier attempts by other researchers to recruit the immune system to fight cancer sometimes worked but more often did not. Dr. Allison and Dr. Honjo succeeded where others had failed by deciphering exactly how cells were interacting so they could finetune methods to control the immune system.
Checkpoint inhibitors do not work for everyone and they have only been approved for some cancers.
They can have severe side effects, and they are expensive, costing more than $100,000 a year.
But the approach, known as immunotherapy has become a the mainstay of treatment for a number of types of cancer and a great deal of research is underway — including work by Dr. Allison and Dr. Honjo — to find the best ways of combining checkpoint inhibitors with one another and with standard treatments to help more patients.
The checkpoint inhibitors now on the market are used for cancers of the lung, kidney, the bladder, head, and neck; for the aggressive skin cancer melanoma; and for Hodgkin lymphoma and other cancers.
T-cells are a kind of white blood corpuscle which will identify and kill infected, damaged or cancerous cells.
Each T-cell has clawlike receptors on its the surface which will recognize and lock onto antigens, foreign or abnormal protein fragments on the surface of infected or cancerous cells.
ACTIVATING A T-CELL
The T-cell must be activated before it can find and attack cancer cells.
A specialized cell presents the T-cell with an antigen from a neoplastic cell, alongside a co stimulator 2/11 protein. The T-cell begins to seek out and kill any cells that are covered with an equivalent antigen.
CANCER AND CHECKPOINTS
Cancer cells can avoid destruction by taking advantage of a turn on the T-cell called an immune checkpoint.
The checkpoint can pack up the T-cell and suppress the immune response, allowing cancer to grow undisturbed.
Drugs referred to as checkpoint inhibitors can physically block the checkpoint, which frees the immune system to attack cancer. A single T-cell can kill thousands of cancer cells.