Adoptive Immunotherapy
DESCRIPTION
The spontaneous regression of certain cancers supports the idea that an individual’s immune system is sometimes capable of delaying tumor progression and, on rare occasions, can eliminate tumors altogether. These observations have led to research into various immunologic therapies designed to stimulate the individual’s own immune system. Adoptive immunotherapy is a method of activating lymphocytes and/or other types of cells for the treatment of cancer and other diseases. Cells are removed from the individual, processed, and reinfused.
These therapies can be categorized into active specific (e.g., increasing select populations of cytotoxic T lymphocytes with specific reactivity to tumor antigens), active non-specific (i.e., the use of interleukin-2 to increase the number of activated lymphocytes), and passive immunotherapy (i.e., transfer of specific immune cells such as cytotoxic T-lymphocytes or lymphokine-activated killer cells to produce antibodies). Protocols vary, but usually include these common steps:
Lymphocyte harvesting (either from peripheral blood or from tumor biopsy)
Propagation of tumor-specific lymphocytes in vitro using various immune modulators
Selection of lymphocytes with reactivity to tumor antigens with enzyme-linked immunosorbent assay
Lymphodepletion of the host with immunosuppressive agents
Adoptive transfer (i.e., transfusion) of lymphocytes back into the tumor-bearing host
POLICY
Adoptive immunotherapy, using adoptive cellular therapy for the administration of cytotoxic T lymphocytes, cytokine-induced killer cells, tumor-infiltrating lymphocytes, antigen-loaded autologous dendritic cells, or genetically engineered T cells for treatment of malignancy, is considered investigational. (Note: except for therapies (e.g., axicabtagene ciloleucel (Yescarta™) and tisagenlecleucel (Kymriah®) that are addressed separately in BCBST pharmacy policies as medically necessary)
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ADDITIONAL INFORMATION
The evidence for adoptive immunotherapy in individuals with various types of cancer includes randomized controlled trials (RCTs), nonrandomized comparative studies, and uncontrolled trials. The impact of adoptive immunotherapy on health outcomes (e.g., increased survival, improved quality of life) has yet to be clarified. Current guidelines from the National Comprehensive Cancer Network (NCCN) do not include recommendations for adoptive immunotherapy.
SOURCES
BlueCross BlueShield Association. Evidence Positioning System. (11:2022). Adoptive immunotherapy (8.01.01). Retrieved August 16, 2023 from http://www.evidencepositioningsystem.com/. (55 articles and/or guidelines reviewed)
Chen, C., Ma, Y.H., Zhang, Y.T., Zhang, F., Zhou, N., Wang, X., et al. (2018). Effect of dendritic cell-based immunotherapy on hepatocellular carcinoma: a systematic review and meta-analysis. Cytotherapy, 20 (8), 975-989. Abstract retrieved December 27, 2019 from PubMed database.
Dafni, U., Michielin, O., Lluesma, S.M., Tsourti, Z., Polydoropoulou, V., Karlis, D., et al. (2019). Efficacy of adoptive therapy with tumor-infiltrating lymphocytes and recombinant interleukin-2 in advanced cutaneous melanoma: a systematic review and meta-analysis. Annals of Oncology, 30 (12), 1902-1913. (Level 1 evidence)
Li, Y., Zhao, L., Wu, J., Qu, C., Song, Q., & Wang, R. (2016). Cytokine-induced killer cell infusion combined with conventional treatments produced better prognosis for hepatocellular carcinoma patients with Barcelona clinic liver cancer B or earlier state: a systematic review and meta-analysis. Cytotherapy, 18 (12), 1525-1531. Abstract retrieved December 28, 2016 from PubMed database.
Mi, D., Ren, W., & Yang, K. (2016). Adoptive immunotherapy with interleukin-2 & induced killer cells in non-small cell lung cancer: a systematic review & meta-analysis. Indian Journal of Medical Research, 143 (Suppl 1), S1-S10. (Level 1 evidence)
Qian, H., Wang, H., Guan, X., Yi, Z., Ma, F. (2016). Adoptive immunotherapy combined chemoradiotherapy for non-small-cell lung cancer: a meta-analysis. Anticancer Drugs, 27 (5), 433-438. Abstract retrieved December 28, 2016 from PubMed database.
Shen, D., Liu, Z., Xu, J., Xu, F., Lin, Q., Lin, F., & Mao, W. (2016). Efficacy of adoptive cellular therapy in patients with gastric cancer: a meta-analysis. Immunotherapy, 8 (8), 971-981. Abstract retrieved December 28, 2016 from PubMed database.
Son, J., George, G., Nardo, M., Krause, K., Jazaeri, A., Biter, et al. (2022). Adoptive cell therapy in gynecologic cancers: a systematic review and meta-analysis. Gynecologic Oncology, 165 (3), 664–670. (Level 1 evidence)
Wang, X., Tang, S., Cui, X., Yang, J., Gent, C., Chen, C., et al. (2018). Cytokine-induced killer cell/dendritic cell-cytokine-induced killer cell immunotherapy for the postoperative treatment of gastric cancer. A systematic review and meta-analysis. Medicine, 97 (36), e12230. (Level 1 evidence)
Zeng, Y., Ruan, W., & He, J. (2016). Adoptive immunotherapy in postoperative non-small-cell lung cancer: a systematic review and meta-analysis. PLoS One, 11 (9), e0162630. (Level 1 evidence)
ORIGINAL EFFECTIVE DATE: 10/11/2008
MOST RECENT REVIEW DATE: 10/12/2023
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