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15 January, 2024 by Anshul (neobio)
The landscape of cancer treatment has dramatically evolved over the last few decades. Today, scientists and clinicians are moving away from the traditional, one-size-fits-all, cytotoxic treatments towards a more personalized approach. At the heart of this transformation are two powerful treatment modalities: Targeted Therapy and Immunotherapy. The comparison of ‘targeted therapy vs immunotherapy’ has become critical in understanding the mechanism and success rates of different cancer treatments, their side effects, and how we can combine them for enhanced efficacy.
Targeted therapy works on the principle of precisely identifying and inhibiting the molecular pathways crucial to tumor growth. These therapies seek out and modulate specific biochemical pathways or mutant proteins, thus arresting tumor progression.
Immunotherapy, on the other hand, operates a bit differently. It seeks to bolster our body’s natural defenses, stimulating a robust host response that can potentially lead to long-lived tumor destruction.
Targeted therapy differs significantly from traditional chemotherapy, which indiscriminately attacks rapidly dividing cells. Instead, targeted therapy is designed to interact with specific molecular targets that are associated with cancer cells. These targets are often proteins that are overexpressed or mutated in cancer cells, making them attractive targets for therapy.
A key aspect of targeted therapy is its ability to alter the inner workings of the cancer cell. It focuses on the part of the cancer cell that makes it different from the normal, healthy cell. This precise targeting allows for fewer side effects compared to standard chemotherapy treatments. Targeted therapy can work in various ways, such as inhibiting the development of new blood vessels that feed the cancer cell, triggering the immune system to attack the cancer cell, changing proteins within the cancer cell, and blocking or turning off signals telling the cancer cell to grow or divide.
On the other hand, immunotherapy leverages the body’s immune system to fight cancer. In this case, the body’s natural defenses are either stimulated or provided with artificial immune system proteins to enhance their ability to detect and destroy cancer cells.
Immunotherapy treatments may also include immune checkpoint inhibitors and cancer vaccines. These treatments work differently to either block the signals that allow cancer cells to hide from the immune system or stimulate an immune response against cancer cells.
The choice between targeted therapy and immunotherapy often relies on genetic testing. By mapping the human genetic code, scientists can identify genetic mutations or changes that cause cancer. The information gleaned from these tests can guide doctors in deciding whether a patient would benefit from targeted therapy, immunotherapy, or a combination of both.
Targeted therapy is an increasingly popular form of treatment for various types of cancer. It boasts a remarkable success rate compared to conventional chemotherapy. While chemotherapy offers a success rate of around 30%, targeted therapy can be successful in up to 80% of cases. This high rate is due to the treatment’s ability to alter proteins within cancer cells that cause those cells to die, prevent new blood vessels from forming, thus cutting off blood supply to the tumor, and delivering toxins that kill cancer cells without harming healthy cells.
Immunotherapy, specifically immune checkpoint inhibitors, represents another breakthrough in cancer treatment. It’s known for producing durable responses in a significant percentage of patients. In some cancers like non-small cell lung cancer (NSCLC), durable responses have been observed in up to 25% of patients. In the salvage setting, immunotherapy has shown marked superiority over chemotherapy. Furthermore, long-term survival has been observed with combination therapies in other cancers, such as melanoma.
Several factors can influence the success rates of both targeted therapy and immunotherapy. One of the most critical factors is the type of cancer being treated. Some cancers respond better to these therapies than others. For instance, certain types of lung, breast, and colorectal cancers have shown positive response rates to targeted therapies.
The genetic makeup of the cancer cells also plays a significant role. The presence of specific genetic mutations can make the cancer cells more susceptible to these therapies. That’s why genetic testing is often conducted to identify the most effective treatment approach.
The overall health of the patient, including their immune system function, can also influence the success of these therapies. Patients with stronger immune systems may respond better to immunotherapy. Similarly, those with fewer comorbidities may have better outcomes with targeted therapy.
Targeted treatments can cause certain adverse effects, including problems with blood clotting and wound healing, high blood pressure, fatigue, mouth sores, nail changes, the loss of hair color, and skin problems such as rash or dry skin. In rare cases, a hole might form through the wall of the esophagus, stomach, small intestine, large bowel, rectum, or gallbladder.
Another significant drawback of targeted therapies is the development of resistance by cancer cells. This can happen when the target itself changes and the treatment is no longer able to interact with it, or when cancer cells find alternative ways to grow that do not depend on the target.
Side effects of immunotherapy can often resemble symptoms of the flu, including fever, fatigue, and body aches. More serious side effects can include inflammation in the lungs, liver, and other organs.
One of the major challenges with immunotherapy is that it does not work for everyone. In some cases, it can even cause the immune system to attack normal cells, leading to autoimmune diseases.
Despite these potential side effects, there are many ways to manage them and improve the quality of life for individuals undergoing these treatments. Most side effects of targeted therapy go away after treatment ends, and there are many medications available that can prevent or treat these side effects once they occur.
Similarly, the side effects of immunotherapy can often be managed with medication, and in some cases, by adjusting the dose or schedule of treatment.
Contemporary research is exploring the potential of combining targeted therapies and immunotherapies to improve clinical outcomes. These combined treatment strategies aim to utilize the advantages of each modality while compensating for their limitations. While targeted therapies aim to inhibit molecular pathways critical to tumor growth, immunotherapies stimulate a host response for long-lived tumor destruction. The goal is to create a synergistic effect that surpasses the capabilities of each treatment alone.
The potential of combined therapy is immense. The targeted approach can arrest tumor progression and induce striking regressions, especially in molecularly defined subsets of patients. Immunotherapy, on the other hand, can elicit long-term, durable responses, even in the face of acquired resistance to targeted therapy. This combination could prolong the period of disease control and improve overall survival in patients.
However, it’s important to remember that the success of combined therapy largely depends on individual patient factors, including the type and stage of cancer, the patient’s overall health, and the genetic makeup of the tumor. Therefore, genetic testing plays a crucial role in determining the most effective treatment approach.
