Immunotherapy aids your immune system to fight off cancer. There are five types of immunotherapy: treatment vaccines, immune checkpoint inhibitors, T-cell transfer therapy, monoclonal antibodies, and immune system modulators. While there have been no treatment vaccines approved for colorectal cancer (CRC) yet, BioNTech’s mRNA-based treatment vaccine has recently reached phase 2 clinical trials for CRC. The vaccine, individualized to each patient, is being developed as a treatment for CRC as well as to prevent relapse in those who have undergone CRC surgery. 

How Does Immunotherapy Work?

The immune system is built to detect and destroy abnormal/mutated cells. Tumor-infiltrating lymphocytes are often found around tumors and they are an indication that the immune system is working to eliminate the tumor. Cancer cells typically undergo genetic changes that allow them to escape the immune system—they often have proteins on their surface that inactivate immune cells, and they can even change cells surrounding them to interfere with the immune system. Therefore, a therapy that can train the immune system to identify and destroy cancer cells capable of defying the immune system is important.

Cancer Treatment Vaccines

Cancer treatment vaccines are designed for people who already have cancer, and trains their body’s immune system to find well-hidden cancer cells. These vaccines can be made in three different ways. 

  1. From the patient’s own cancer cells to cause an immune response against features that are unique to their cancer.
  2. From tumor-associated antigens that are found on cancer cells. These are made for cancer subtypes.
  3. From dendritic cells, which are a type of immune cell that respond to an antigen on tumor cells. This type of a vaccine is already being used for treating prostate cancer.

Matias Riihimäki et al. in their 2016 epidemiologic study published in Scientific Reports found that up to 18% of all CRC patients have recurrence and up to 25% have metastasis. A treatment vaccine would be able to help prevent recurrence and help patients with metastasis suppress small tumors that are often difficult to remove surgically.

BioNTech Chief Medical Officer and Co-founder Özlem Türeci, M.D., noted in a press release, “This trial is an important milestone in our efforts to bringing individualized immunotherapies to patients. Many cancers progress in such a way that the patient initially appears tumor-free after surgery, but after some time tumor foci that were initially invisible grow and form metastases. In this clinical trial in patients with colorectal cancer, we aim to identify high-risk patients with a blood test and investigate whether an individualized mRNA vaccine can prevent such relapses.”

Gargi Patel is a Colon Cancer Prevention Intern at the Colon Cancer Foundation.

A recently conducted systematic electronic search investigated keywords relating to colorectal cancer (CRC) and nutrition to define the association between diet and CRC. We summarize their findings here. 

What Can Change in My Dietary Habits?

According to the World Cancer Research Fund and American Institute of Cancer Research, 50% of CRC cases can be prevented by dietary and lifestyle modifications. While previous research studies concluded that high-fat and high-calorie diets had a carcinogenic effect, new research is showing that there is a specific role for nutrients such as fiber, vitamins, and minerals on intestinal metabolism. Consuming whole grains, dietary fiber, and dairy products decreases the risk of CRC, while consuming red and processed meats and fats increases the risk of CRC. Dietary interventions have increasingly been used over the past decade to reduce the occurrence and progression of CRC.

While there are some dietary habits that can reduce the risk of CRC, others can increase that risk. High-risk diets include those with red and processed meats, and diets made up of high fats and high carbohydrates. 

  • Processed meats are categorized as Group 1, meaning they are carcinogenic 
  • Red meats are categorized as Group 2A, meaning they are most likely to be carcinogenic 

Growth hormones in red and processed meats may be responsible for their carcinogenic effects. It is recommended that individuals limit the intake of red meats to 12-18 oz each day, and processed meats should be completely avoided. Many components of our diet may help prevent CRC: dietary fiber intake, for example, is inversely related to CRC development. Vitamins and minerals also play an important role in CRC prevention. 

  • Vitamins E and C have been shown to have a direct tumor suppressing effect on CRC 
  • Vitamin D has been shown to reduce the risk of developing CRC 
  • Calcium and selenium have also been shown to have an inverse effect on CRC

However, more research is needed to fully understand the role that fiber, vitamins, calcium, and selenium play in CRC development. 

There has also been significant interest in the role of gut microbiota (the bacteria in our gut) on CRC development. Research findings so far indicate that the microbiome and microbial metabolite health is pivotal to the prevention of several diseases such as CRC. The Mediterranean diet has positive effects on protecting individuals against CRC. Thus, nutritional therapies that are based on epigenetically active nutrients are likely to represent a good research direction.

In summary, dietary factors have a strong influence on CRC development. Consuming whole grains, dietary fiber, and dairy products can reduce the risk of CRC. Evidence also points to a role for vitamins in preventing CRC development. Ultimately, it is important to remember that future dietary recommendations will need to consider each person individually—looking at their cultural identities, risk factors, and the interaction between nutrients and the microbiota.

 

Abigail Parker is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

The month of November is designated as National Hospice and Palliative Care Month. While the terms are often used interchangeably, it is important for patients and their caregivers to understand the difference and realize the value of these services in the care journey.

Palliative care is offered to those suffering from serious illnesses such as cancer, stroke, or heart failure, with a focus on providing relief from the symptoms and stress because of the illness. Palliative support can be integrated into the care plan of both life-threatening as well as curable conditions and can be offered during active treatment. It is supportive care that can be offered to young and old patients, early-stage and advanced-stage patients. 

Hospice is specialized palliative care for people who are at the end of their life who may have less than 6 months of life expectancy. Hospice is focused on patient care and comfort while maintaining a decent quality of life close to the end. It is designed for when a serious health condition is not curable or when a patient chooses to not undergo certain treatments. The hospice care team does not attempt to slow disease progression. Rather, the sole focus is to manage symptoms so that the person’s last days are spent with dignity. Hospice care can be provided at home, in a hospital, or at an extended-care facility. 

 

Patient Perceptions of Hospice and Palliative Care 

A 2014 study published in British Medical Journal, which looked at 594 text responses of patients documenting their experience with palliative care, found that the emotional experience of care was the most significant and the most important to patients. A majority of patients said the emotional care they received for themselves and their families allowed them to cope with the newfound challenges with their illness. Another study that evaluated patient perceptions of palliative care quality in hospice inpatient care, daycare, and nursing homes found that “honesty”, “atmosphere”, and “respect and empathy” were the most important aspects of hospice care that they appreciated.

Insurance Coverage for Hospice and Palliative Care

Whether insurance covers hospice and palliative care, or how much is covered, depends on the insurance plan. Most insurance plans cover palliative care, but coverage may vary. It’s best to speak with your insurance plan for details. 

Most private insurance plans cover hospice care. Medicare and Medicaid provide complete coverage for hospice services. Medicare-certified hospice care is usually provided at home. Details on Medicare-covered hospice care can be found here and Medicaid coverage information is available here

 

Gargi Patel is a Colon Cancer Prevention Intern with the Colon Cancer Foundation.