Cancer treatment: Interventional Oncology and Immunotherapy - a new era of gentle cancer treatments
Traditional cancer treatments were based on either surgery, radiation or chemical poisoning. It literally took centuries to deeper understand the cellular mechanisms of cancer and develop suitable methods. While it will probably take several more decades until cancer can be "cured" in every case, recent advances represent nothing less than a new era of cancer treatments. At Tumortherapy-Center we have the mission to offer the most relevant and promising minimally invasive treatment combinations medical science has to offer.
Cancer is a systemic disease which effects the whole body and needs to be treated at a cellular level to get long-lasting control. With this, the approach towards fighting cancer is changing: Interventional oncology, integrative oncology, immunotherapy, cancer as a chronic and not deadly disease, individualized and monitored treatment concepts are just some of the new concepts. At the Tumortherapy-Center in Germany, under the supervision Prof. Dr. Stehling, we specialised on treatments and treatment combinations with minimal impact on the body but with maximum impact on the tumour.
Precise strikes against cancer on a cellular level
The methods of interventional oncology offer new treatment options against cancer with more precise, yet fewer side effects and quick recovery time. Treatments are limited to cancerous tissue whilst preserving healthy structures or at least doing minimal harm to them.
Several new methods have been established over the past years, which allow gentle treatment of a wide range of cancer. In the forefront are new treatment modalities based on Pulsed Electric Fields (PEFs) like Irreversible Electroporation (IRE) or Electrothemotherapy (ECT). But also Cryoablation and the new generation of radiosurgery methods like the Cyberknife allow us to fight an ever wider range of previously untreatable types of cancer locations. In many cases this can be done in out-patient procedures, with better results than large operations where the effect/side-effect ratio is often disappointing.
Precise diagnostic - the key to successful minimally invasive therapy
Successful focal treatments of cancer require high quality diagnostic, using all state of the art diagnostic and imaging technologies. The Tumortherapy-Center here in Offenbach has all state of the art imaging technologies like MRI, ultrasound and 3D-CT in-house.
Especially Magnetic Resonance Imaging (MRI) plays an essential role in today's tumour care. Its wide range of modalities allows for the most sensitive and specific diagnostic, but it also allows for treatment monitoring and screening, because it has no radiation and can hence be repeated indefinitely. Also, recent studies suggest that it is possibly better than PET-CT , which was standard of care, though with high doses radiation.
However, MRI is an extremely complicated technology which is rarely used to it's full potential. Prof. Michael Stehling (M.D. Ph.D.), the founder of the Tumortherapy-Center, was researcher in the group of Sir Peter Mansfield who got the Nobel Prize for discoveries concerning MRI and completed a doctorate of physics in this field.
Therapy response monitoring
Individualized cancer treatment has multiple aspects. One essential aspect is the therapy response monitoring. Whilst the guideline normally prescribe one and the same approach for every patient, this very solution is rarely the optimum for the individual. This is mainly because tumours vary greatly in their genetic expressions and our genome is highly individual in respect to the immune system. No response to any medication or treatment is perfectly predictable.
But there are new ways to monitor treatment success of systemic and local therapies. While it used to be treat-and-wait it is now treat-monitor-adapt: New biomarkers and diffusion weighted MRI imaging allows to monitor response on chemotherapy, immunotherapy but also the local success of a focal therapy or radiation treatment. At Tumortherapy-Center we make use of response monitoring using MRI and biomarkers to explicitly adapt the therapy to the needs of the patient and spare unnecessary side effects from ineffective treatments.
Immunotherapy, Immunomodulation and Immune supporting therapies
Cancer is a disease that needs to be seen and addressed systemically. The view that cancer is primarily local and only in late stages systemical has been revised radically over the past few years. Circulating Tumour Cells (CTC) are found already in very early stages, which is easy to prove because blood markers would not be possible otherwise.
The fight between the cancer and the immune system is a complex one and neither a full picture exists nor is there any treatment that fully solves the problem. However, there has been significant movement in the field.
The secret lies in smart therapy combination: The first and essential step to treat tumours and metastases is a tumour mass removal or tumour mass reduction. This is a required step to give the immune system a chance to deal with the remaining tumour (micro) metastasees and circulating tumour cells.
While surgical removal and radiation is still sometimes the only viable option, new minimally invasive treatments, with pulsed electric fields at the forefront, quickly gained importance: Irreversible Electroporation (IRE, NanoKnife) and Electrothemotherapy (ECT) allow a wide range of gentle tumour mass reduction treatment triggering a significant immune response. This inherent immune response is attributed to the special kind of cell death these treatments induce.
The video shows how modulated antibody therapies, also known as immunotherapies, modulate the Immune response on cancer cells]
Studies show that especially after these cellular level based therapies immune modulating and intensifying therapies show effect.
As an example for an immune enhancing therapy, Fig. 2 shows the effect of Dendritic Cell (DC) injection as an addition to treatment.
a. Typical progression without DCs: After a first phase of tumor mass reduction, the secondary immune reaction (light blue) can slow the progression only for a short while. A Recurrence will come soon and one or several re-treatments the cancer wins over resulting in death.
b) Expected disease progression with the addition of DCs: The additionals DCs will enhance the immunological effects and hold the immunsystem in tact for longer.
c) Goal of continuous DC treatment: By continously enhancing the Immunsystem using DC injections, the total amout of tumor cells in the body shrink continously resulting in a complete and lasting remission.
There might never be a one-fits-all cancer treatment, because of the huge variety of cancer types, genetic expression and highly individual immune system responses. Therefore the near future lies in treatment combinations, individualized cancer treatment and minimally invasive procedures.
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- Xu, G. Z., et al. "Comparison of FDG whole-body PET/CT and gadolinium-enhanced whole-body MRI for distant malignancies in patients with malignant tumors: a meta-analysis." Annals of oncology (2012): mds234.
- Imhof, Marianne, et al. "Interaction of tumor cells with the immune system: implications for dendritic cell therapy and cancer progression." Drug discovery today 18.1 (2013): 35-42.