There carrying out my research the main problem

There are many ways in which future treatments will be
relying on our own immune systems to fight cancer cells without having to use harmful
treatments such as radiotherapy and chemotherapy which have catastrophic side
effects. Some major chemotherapy side effects include: hair loss, infection,
anaemia, mouth tongue and throat problems which results in difficulty
swallowing and fertility problems (there may be other symptoms, but symptoms
vary person to person.) (The American Cancer Society medical and editorial
content team 2016) Some major side effects due to radiotherapy include: sex and
fertility issues, stiff joints and muscles, lymphoedema and even increased risk
of getting another type of cancer after the treatment has finished (NHS, n.d.).
Therefore, many alternatives are still being experimented on and are waiting
approval. There are a lot of treatments which have been developed and are
proving to be successful by manipulating our immune systems to target these
cancerous cells. The following treatments I will be focusing on are: Dendritic
cell therapy (Sipuleucel-T cancer vaccine), CAR-T therapy, Cytokine therapy and adoptive T-cell therapy.

Through carrying out my research the main problem with most
of the treatments is that in clinical trials the main issues were side effects
and the rate of remission. As cancer is still a progressing issue for many
individuals and there are not many treatments yet approved by the FDA for human
convention, I comprehended that there is still much more research to be done
for the best treatments to be used with less severe side effects and much
higher rates of remission. Therefore, in future, as new breakthrough drugs and
therapies are established we may not rely on our immune systems if a better
alternative is found. Although in the event of finding better therapies which
utilise our immune systems with much higher percentages of remission then our future
may still be dependent upon immunotherapy.

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Car-T cell therapy involves taking a sample of the patient’s
T cells and manipulating them in a laboratory to make them attack cancer cells.
They do this by using a disarmed virus to genetically engineer the T cells of
the patient to produce receptors on their surface called chimeric antigen
receptors (National Cancer Institute Dictionary Of Cancer Terms, n.d.) These
receptors allow the T cells to attach onto a specific protein or antigen on the
surface of cancer cells. The T cells are then expanded to produce more of these
T cells with the specific chimeric antigen receptors. These T cells are then
infused into the patient. There have been many promising clinical trials using
this specific therapy. One of these people who have conducted clinical trials
is a man named Dr. Grupp. Dr. Stephan A. Grupp, MD is the director of: cancer
immunotherapy, translational research for the centre for childhood cancer
research at Children’s Hospital Of Philadelphia and the stem cell laboratory
(unknown n.d.) Dr. Stephan A. Grupp retrieved from www.chop.edu/doctors/grupp-stephan-a  – therefore is a highly accredited and
reliable source as this person has a lot of experience in this field. Dr. Grupp
has conducted several CAR-T cell clinical trials which have involved patients
with a variety of different age groups who have either had their cancer come
back after taking the traditional treatments or who have not responded to the
treatments at all. In one of the earlier trials all signs of the cancer in
27/30 had receded and many of the symptoms had never came back. After these
findings had been reported a larger trial using CD19 targeted T cell therapy
had commenced. Children and adolescents with ALL (Acute Lymphoblastic
Leukaemia) in this study all had complete and long-lasting remissions (Unknown,
n.d.) CAR T Cells: Engineering Patients’ Immune Cells to
Treat Their Cancers was originally published by the National Cancer Institute
retrieved from  https://www.cancer.gov/about-cancer/treatment/research/car-t-cells. The
results from the trials all show a good rate of remission which is very positive,
however this lacks any side effects which patients showed and also doesn’t
state what happened to the other 3 people. Judging from this there is no reason
why this could not be the future of cancer treatments as remission rates are
extremely high meaning this is a very successful treatment and can continue to
improve as more research is done.

One clinical trial for CAR-T was conducted by the University
Of Pennsylvania which started December 10, 2009 with the results first posted
on February 28,2017 and last updated on November 9. 2017. This study was using
CART 19 to treat CLL (Chronic Lymphocytic Leukaemia) and ALL that are resistant
or refractory to chemotherapy and only used adults. 14 CLL subjects and 6 ALL
subjects were analysed. For the CLL subjects only 21.4% went through complete
and partial remission whilst a staggering 57.1% went through no remission. For
the ALL subjects 83.4% went through complete remission and 16.7% went through
no remission. However, for both conditions all participants had serious adverse
effects which included anaemia, myocardial infarction and more with Cytokine
Release Syndrome (CRS) being the most frequent side effect. Consequently, this
clinical trial has similar remission rates to Dr. Grupp for people with ALL but
it also included all the side effects which came with this treatment which
resulted in 100% of people getting a serious adverse effect which outweighs the
advantages of this treatment as all of the ones shown are life threatening and
very serious which may even cause more health problems alongside cancer if it
comes back. From watching a documentary (Leukaemia & Lymphoma Society. “CAR
T-cell Therapy: A Hopeful Option in Cancer Treatment (Full Video).” YouTube,
Apr 20 .2017, https://www.youtube.com/watch?v=P-bG99OehBE Date
accessed 03/01/2018.) I came to the conclusion that different treatments work
for different types of people as the child didn’t respond to bone marrow
transplantation or any other form of cancer treatment. Therefore, if CAR-T
cells work on specific individuals, we need more research done on the
specificity of this treatment and what kind of specific people will have high
rates of remission. My conclusion is somewhat supported by Shannon L. Maude,
MD, PhD -Physician in the Cancer Centre at The Children’s Hospital of
Philadelphia, highly reliable as she is a qualified doctor with many awards
such as Mary Ellis Bell Prize for medical research. (Children’s Hospital Of
Philadelphia, N.D., Date accessed: 11/01/2018) In the documentary she states
“It’s too early to know if this will be a cure for many patients, or some
patients. Wherever we are hopeful as there are many patients that remain in
remission for several years receiving this therapy raising the hope and
possibility that this may potentially be a cure for some patients.”

Cytokine therapy involves the use of cytokines (which are
signalling proteins involved in the immune response and haematopoiesis.
Currently only two are used in treatment which are interleukins and
interferons. This therapy is only a last resort if existing therapies are
proven to not have any signs of remission in patients. There have been clinical
trials executed involving the administration of interferon-gamma,
interferon-alpha, Interleukin-2, tumour necrosis factor-alpha, and
Interleukin-12 (Sino biological, n.d., date accessed). Cytokine therapy has had
many problems with advancements as they’re hugely toxic leading to awful side
effects. This has been successful in many clinical trials showing complete or
partial removal of tumours despite this the maximum dosage given with the least
side effects is still problematic as not enough research has been done. As more
research is being done a more developed understanding of the right dosage is
being proposed. One of the most successful approaches is blocking or
neutralizing cytokine action with monoclonal antibodies for example drugs which
block inflammatory cytokines for example tumour necrosis factor A. The most
important interferon to date is type 1 (IFN ? & ?) which is involved in immune
responses against things like infections. Type 1 IFNs are responsible for
activation of macrophages and t cells. These IFNs can inhibit the growth and
angiogenesis of tumours and cause apoptosis which eradicates cancer cells.

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