Immunotherapy – The new hope in the fight against cancer
There is a great feeling of euphoria: almost every day new reports emerge of success from the use of immunotherapy. Many cancer patients are already benefiting from such treatment; some have even been cured. However, in others the resulting immune responses in the body cause additional complications. Nevertheless, there is no doubt that the treatment offers new possibilities – both in medical science and in the insurance sector.
In Germany alone, around 1.5 million people suffer from some form of cancer. Elvira was one of them. In 2005, at the age of 36, the estate agent was diagnosed with Hodgkin's disease. After undergoing chemotherapy things were initially looking good – until the cancer returned a year and a half later. That was a shock for Elvira, who found she now belonged to a group of patients for whom hitherto there had been little hope of finding a cure.
Revolutionising cancer treatment
Given these results, some observers are talking of a revolution in cancer treatment. This may be true for Hodgkin's disease, but no generalisations can be deduced from this statement. On the contrary: treatment outcomes differ considerably depending on the type and severity of the cancer and can vary widely from patient to patient. It works for some, but in others it triggers additional and sometimes severe complications. How can such an enormous spectrum be explained and what is immunotherapy actually all about?
The body's own immune system is the key
The activity of the T cells is controlled via immune molecules. These have either an activating (stimulatory) or blocking (inhibitory) effect on the immune cells – and exert an effect precisely at those sites where our T cells interact with cancerous cells, for example. In medicine, the sites where these interactions take place are called immune checkpoints. Each T cell has hundreds of such checkpoints and uses them to routinely investigate the molecules of other cells to verify their identity. If all immune checkpoints register endogenous, i.e. immunosuppressive molecules, the T cell remains in resting mode. It is activated, however, as soon as the first immune checkpoints identify harmful molecules – the force of the immune response increases relative to the number of immune checkpoints sounding the alarm simultaneously per T cell.
Conquering cancer with its own strategies
Immunotherapy now uses a similar strategy – but with opposite objectives. Medical and pharmaceutical research is now able, for the first time, to develop customised antibodies using new molecular genetic methods. They are either designed in such a way that they are falsely identified by the immune checkpoints as specific tumour molecules, thereby strengthening the immune reaction, or they block certain receptors for inhibitory molecules at the immune checkpoints and thus increase the defence mechanisms of the T cells.
Advantages and current limitations of immunotherapy
It is also true, however, that science cannot yet predict what type of immunotherapy is suitable for which patients, and which cancers it is actually qualified to treat. This issue, along with the efficacy and success of treatment in each individual, will be determined by molecular mechanisms that are still largely unknown. Questions concerning the therapeutic substances themselves are just as weighty: the precise effect they have on the immune system is still not properly understood. A lot of questions have yet to be answered.
Challenges for the insurance sector
However, costs are only one aspect. The anticipated changes in mortality and morbidity are a second major aspect, as more and more cancers develop from terminal illnesses into chronic impairments. The insurance industry must monitor this positive development very closely and regularly amend and update the way in which it assesses risks and losses. This necessitates profound medical and actuarial expertise to a greater extent than previously. Only then is it possible to rapidly expand insurability and keep up to speed with medical research in the future.