CANCER IMMUNOTHERAPY

Immune system is the mechanism which protects us from hazardous materials and microscopic beings. Immune system can be weakened by factors such as; stress, depression, alcohol use, smoking/addiction, eating disorders, processed food, pollution, heavy metals, genetic disposition, inactive lifesytle, chronic illnesses. A weakened immune system increases the risk of getting cancer.
In recent years, immune system supporting treatments are being developed, due to its role on cancer, is understood to be important.
When used in conjunction, effective and supporting treatments on immune system can yield better results. Unfortunately, when tacking cancer, a single tool usually fails to deliver results, hence the reason why patients have to do their part and certain treatments should be combined to reach success.
In our clinic, the treatments, procedures and vaccines that we apply and track, which support and are effective on immunotherapy, are as follows:

1. Immunotherapy drugs:
Immune system supressing CTLA4, PD-1 protein or PD-L1 ligand, weakens the immune system and prevents it from eliminating cancer cells. The agents which prevent the nagative effects of these elements and classify as immunotherapy drugs are these:
pembrolizumab, nivolumab, ipilimumab, atezolizumab and avelumab.
Their use on many cancers, such as small cell lung cancer, head and neck cancer, kidney cancer, bladder cancer and melanoma, are approved in U.S.A. and Europe (2). In addition to this, their use as a salvage therapy in cases which are resistant to standard treatments, produce good results in many patients. New studies suggest a combination of chemotherapy and immunotherapy can save more lives.
Immunotherapy is more effective and creates less side effects on eligible cases, compared to chemotherapy.

2. Dendritic cell vaccinations (DHA):
These vaccines, often named as dendritic cell treatment, is a newly developed, stronger type of immunotherapy. An example to this treatment is the Sipuleucel-T vaccine, which is approved by FDA for use as a dendritic therapy on prostate cancer in U.S.A.
Dendritic cells identify foreign bodies that are present in human body and then present them to the T cells of the immune system. As a result, a strong immune response to clean foreign bodies, is achieved. The preparation of DHA needs a blood sample of the patient to be taken and then converted into the dendritic cells. These cells are reproduced and then given back to the patient to create a stonger immune response.
In most cases during the preparation of DHA, paraffin blocks sampled from a tumor is processed to seperate the cancer identifiers, which are then used to instruct the dendritic cells for a tumor specific response.
Mesothelioma, which is among the resistant types of cancer, is shown as manageable when a therapy of autologous tumor lysate-loaded dendritic cell vaccine and metronomic cyclophosphamide treatment is applied.
Small cell lung cancers have high risk of making a comeback after surgeries. Chemotherapy reduces the chance of reoccurence. In one study, 103 small cell lung cancer patients are divided into two groups; one group is given the standard chemotherapy treatment, and the other is given a combination of chemotherapy and dendritic cancer vaccine. In a 5 years span, 48 percent of the patients from the chemotherapy group, and 81 percent from the combination group remained alive.
Dendritic cell vaccine prepared from glioblastoma, a very aggressive type of brain cancer, is shown to lenghten the life of patients when given in conjuction with conventional therapy.
In some cancers, DHA can be safely used to lessen the amount of side effects and support the treatment.
3. Lung cancer vaccines:
Ganglioside GM3(Neu5Gc) is a glycosphingolipid that exist in some cancer tissues which is indentified as a tumor-specific antigen. A vaccine named Racotumumab (Vaxira) has been developed in Cuba, against cancer tissues having this antigen.
The aim of Racotumumab cancer vaccine is to teach the immune system to recognize this antigen on cell membranes and identify these cells as cancerous tissue, therefore trigger an immune response for their elimination. GM3(Neu5Gc) does not exist on healthy tissues, which renders the vaccine as side-effects free.
Cancers that Racotumumab is effective on are these(1-9):
Small cell lung cancer
Breast cancer
Food pipe (oesophagus/esophagus) cancer
Stomach cancer
Colon cancer
Rectum cancer
Pancreas cancer
Liver cancer
Kidney cancer
Bladder cancer
Testicular cancer
Uterus cancer
Prostate cancer
Thyroid cancer
Sarcomas
Wilms tumor
Ewing sarcoma
Neuroblastoma

Another cancer vaccine that has been developed in Cuba is the anti VEGF. Certain countries have been issued permits for the use of these vaccines.
Racotumumab and anti VEGF cancer vaccine is applied to the patients with advanced stage small cell lung cancer which is unresponsive to either chemotherapy or radiotherapy (10). We can also evaluate and prescribe the vaccination to certain patients.
There are ongoing clinical trials and case studies concerning the use of Racotumumab vaccine on other types of cancers with the expectation of licensing availability.
The most important advantage of Cuban vaccines is; they lack serious side effects while increasing the quality of life of the patient or providing longevity.

4. Localized deep tissue RF hyperthermia:
The biggest reason why cancer treatments fail is the fact that the cancer tissues can recover from the damage they have been inflicted. Cancerous tissues have certain mechanisms to heal themselves after a treatment. These healing mechanisms can be stopped by the hyperthermia treatment.
Tumor area is pushed to reach a temperature of 42-44 degrees celsius in hyperthermia treatment, which stops the self-healing process. In addition to this, by applying a 13,6 MHz radiofrequency to the same area, the cancerous cells are forced to release HSP70 heat shock protein. HSP70 release helps with signaling the immune system, and to develop a response against the tumor.
Dendritic cancer vaccination and hyperthermia treatment combination increases the cancer specific immune system response and effectiveness.
A case involving a patient with resistant breast cancer and liver metastasis has been treated with the combination of hyperthermia and dendritic vaccine in a six years span with no additional signs of illness and an increased livelihood.
Pushing the tumor to reach 43 degrees celsius with hyperthermia increases the amount of immune system signaling dendritic, and cancerous cell killing CD8+ T cells. Localized hyperthermia is indicated to have a helping anti-metastasis or anti-recovery effect on tumors.
We utilise modern hyperthermia techniques without side effects to treat deep tissue cancers.

5. Interleukin – 2 (cytokine treatment)
Interleukin-2 (IL-2), is a strong immune response triggering cytokine which is used for more than 35 years. It enables the increase of the natural killer NK and anti-cancer T cells.
IL-2 is a leading agent used primarily in cancer and in many other diseases. Used in melanoma and in kidney cancer with effectiveness. Its application is limited by the facts that intravenous administration can cause low blood pressure, capillary leak syndrome, low albumin levels, electrolyte imbalance and organ failure.
Nowadays, the prefered administration method with less side effects is the subcutaneous one with lower dosages. Combining IL-2 with cancer vaccinations can produce a stronger immune response.
IL-2 in combination with stereotactic radiotherapy on metastatic melanoma and renal cell carcinoma have shown to produce great response to therapy. It is considered as an alternative for patients unresponsive to treatments.
A phase 2 study has shown that treating an unresponsive small cell lung cancer with metastasis on its second stage, chemotherapy combined with low dose IL-2 and CSF cytokines, can be helpful. Response ratio and life expectancy in patients treated with chemotherapy and cytokines are much higher compared to the patients treated only with chemotherapy. These results, acquired by adding cytokines to chemotherapy, provide great hope.
Subcutaneous administration of IL-2 combined with zoledronic acid has shown to increase the amount of γδ T cells without serious side effects on resistant kidney cancer, neuroblastoma, or other solid organ tumors.
It is a radiotherapy option, for prostate cancer without metastasis. Research is being conducted to increase the effectiveness of radiotherapy, especially for the patients who fear the side effects of surgical procedures. Radiotherapy in combination with both cancer vaccines and metronomic low dose IL-2 cytokine treatments, has been shown to produce PSA response and be safe.
In some patients with metastatic malign melanoma, including IL-2 into the temozolomide chemotherapy has shown to produce a response.
Longer management of metastatic renal cell carcinoma has been reported with the introduction of IL-2 to low dose vinorelbine treatment.
Especially in cases of osteosarcoma with lung metastasis, it has been proven safe to administer it as an aerosole via respiratory pathway. Further research is being conducted.
As a result, IL-2, which is being used as an immunotherapy drug for many years, is still an option for cancer treatment. Scientific research exists, showing its benefits as a combination with other treatments.

6. High-Dose vitamin C
It has been proven in clinical and preclinical studies that intravenous administration of high dose vitamin C shortens the infection period in cancer patients. It gets altered in a way that damages the DNA, when uptaken into cancer cells. This cripples cancer tissues, which supports chemotherapy and radiotherapy treatments.
In clinical studies of some unresponsive cases, energy levels, appetite and physical wellbeing had been improved and long term illness control was possible.

7. Phytotherapy (Herbal therapy) and nutritional supplements:
One of the most used areas of herbal and natural elements is immune system support. Their suppport has been reported in many scientific articles and reviews. Certain herbal/natural products such as; mushroom polysaccharides, astragalus, bee propolis, garlic, probiotics, ginseng polysaccharides, nigella sativa, beta-glucans, asparagus, cardamom, chlorella, zinc, selenium, capparis orientalis are being used to support immune system. One of the biggest mistakes is to use all supplements simultaneously.
We plan supportive herbal treatments for individual patients in line with their medication and treatments.

8. Alkali treatments:
The metabolism of cancer tissues, causes an increase in lactic acid production. Cancer cells discharge this acid build up to survive. As a result of this, an acid layer forms around the cell. This layer prevents many medications from entering the cancerous tissue, reduces the effectiveness of it and weakens the immune system.
In some clinical trials, administering drugs, combined with sodium bicarbonate, also using agents that prevent cancerous tissues from discharging the acid build up, have been shown to support certain cases. In addition to this, using buffering solutions orally increases the effectiveness of immunotherapy drugs.
Alkali support can not be utilised with all types of cancer. Alkali support reduces the chances of recovery by impairing the effectiveness of some drugs such as; capesitabine and tyrosine kinase inhibitor.
We evaluate the patients and plan supportive alkali treatments if their medication is suitable for combinations.

9. Anti-inflamation (counter infection) diet:
Chronic infections can cause the immune system to collapse, by exhausting it. They also increase tissue damage. This condition can cause cancer in healthy individuals and shorten the life span of cancer patients.
The diet of the patient is adjusted to increase the consumption of anti-inflamatory foods and limit the inflamatory ones. As an example; after a diagnosis of breast cancer, introducing an anti-inflamatory diet which is rich in whole grains, healthy fats, spices and vegetables, decreases the chances of mortality due to cardiovascular disease in women. More unsaturated fats, more fiber, and more antioxidant foods such as; vegetables rich in flavonoids, fruits, ginger, garlic, and green tea is suggested compared to lower amounts of saturated fats.
Patients who follow a healthy diet after recovering from cancer are less likely to see a reoccurence of their condition. Basic adjustments in a diet play an as important role as the cancer treatment itself.
We plan custom-tailored anti-inflamatory diets considering the patients lifesytle and eating habits.

10. Low dose chemotherapy:
Cancerous tissues contains regulatory T cells (Tregs) which block immune system responses. The more Tregs a cancer has, the less amount of immune response can develope which shortens the life span of the patient.
Especially increasing the response to cancer vaccines, supports applying certain chemotherapy drugs metronomically to reduce the number and the function of Treg cells.
Including metronomic chemotherapy into standard chemotherapy treatment increases the immune response. It is suggested that the immune system gets stronger when these treatments are combined with other therapies.

11. Exercise and meditation:
Practices like; regular exercise, stress reducing meditation, prayer, religious belief are known to support the immune system.
Exercising patients tolerate treatments better and have a higher chance of survival. This is why it is advised for cancer patients to have an execis