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Chief of Hematology/Oncology and Medical Director at Memorial Cancer Institute, and Clinical Associate Professor of Medicine at Florida International University

Chief of Hematology/Oncology
Medical Director of Memorial Cancer Institute

Lung Cancer Video Library - Spanish Language: Video #24 What are Immune Checkpoint Inhibitors, and How Can They Treat Cancer?
Wed, 02/01/2017 - 12:03
Author
Luis Raez, MD FACP FCCP, Faculty, Board Member
 
 

¿Cuáles son los inhibidores de los puntos de control? Y ¿Cómo pueden tratar el cáncer?

Cuando hablamos de inmunoterapia es algo muy emocionante para nosotros, porque inmunoterapia es algo nuevo que después de estar usando quimioterapia por cancer pulmón por más de 30 años, finalmente tenemos.

Inmunoterapia se refiere a los inhibidores de los checkpoints o puntos de control, es importante destacar esto porque la inmunoterapia abarca muchas cosas, abarca vacunas y estos inhibidores de checkpoint no son vacunas, también habla de transferencia de células T o los CAR-T cells en enfermedades hematológicas. Por eso les quiero recordar que la inmunoterapia son muchas cosas y la que particularmente se aplica para cancer de pulmón son los inhibidores de los checkpoint.

Los inhibidores de los checkpoint son los que actúan cuando el linfocito T va a atacar al tumor, entonces el linfocito T tiene el receptor PD1 y el tumor tiene el ligando PDL1. Entonces cuando el linfocito T va atacar al tumor y este ligando y receptor se unen, hay una inhibición de la actividad del linfocito, entonces el linfocito no puede destruir al tumor.

Básicamente esta interacción entre PD1 del linfocito y el PDL1 del tumor causa que el tumor este protegido y que el linfocito no lo pueda atacar. Por eso lo que tenemos que hacer con estos inhibidores de checkpoint es bloquear el receptor del linfocito o bloquear el ligando del tumor, de manera que estos dos no se encuentren y si no se encuentran el linfocito va a ir y destruir el tumor. Por eso es tan importante esta inhibición de esta interacción.

Ahora, esto es mucho más complicado porque no solamente hay receptor PD1, hay receptores PD1, PD2, ligando PDL1 y PDL2, pero en palabras generales es una forma de como el tumor se defiende uniendo PD1 con PDL1 y hay que inhibirlo. Gracias a la tecnología, ahora tenemos muchos anticuerpos, tenemos más de 7 anticuerpos de diferentes casas farmacéuticas que inhiben el PD1 del linfocito o inhiben el PDL1 del tumor y de esa forma el linfocito puede destruir el tumor y causar una regresión del cáncer.


What are the checkpoint inhibitors? And, how can they treat cancer?

Talking about immunotherapy is exciting for us because it’s something new that we finally have, after 30 years of only using chemotherapy.

Immunotherapy includes the checkpoint inhibitors, but it’s important to discuss this because it includes other areas like vaccines or CAR-T cells therapy. It’s important to remember that immunotherapy includes different treatments, but the one that is used in lung cancer is the checkpoint inhibitors.

The checkpoint inhibitors act when the T lymphocyte is about to attack the tumor, so in that time the T lymphocyte has the PD1 receptor and the tumor has the PDL1 ligand. So, when the T lymphocyte is going to attack the tumor, the ligand and the receptor interact with each other, if there’s a lymphocyte inhibition, then it cannot destroy the tumor.

Basically this interaction between PD1 on the lymphocyte and the PDL1 on the tumor causes the tumor to be protected because the lymphocyte cannot eliminate it. That is why, we have the checkpoint inhibitors. They will block the lymphocyte receptor or the ligand in the tumor, so as a result they will not find each other, and that way the lymphocyte can kill the tumor.

Now, this is more complicated because there is not only the PD1 receptor, there are PD1, PD2, PDL1, PDL2, but in general, that is way the tumor defends itself by binding PD1 to PDL1, so we have to inhibit that step. Thanks to the technology, now we have many antibodies. We have more than 7 different antibodies from different pharmaceutical companies that inhibit the PD1 of the lymphocyte or that they inhibit the PDL1 on the tumor. That way, the lymphocyte can destroy the tumor and cause a regression on the disease. 

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