The tumor not only feeds on negative emotions, but also “exploits” them to protect itself from attacks by the immune system that try to stop it. This is why stress, anxiety and depression can compromise the outcome of immunotherapy treatments, making them less effective and treating the emotional state becomes as central as the use of other therapies. This is demonstrated by a study conducted by the Netherlands Cancer Institute in Amsterdam and recently published in the journal Nature Medicine. The results will be discussed on the occasion of the ninth edition of Immunotherapy and Melanoma Bridge, a double international event which will end today in Naples and which will host the author of the work, Christian U. Blank.
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«The study by the Dutch colleagues clearly confirms the existence of a close link between the emotional and psychological state of a patient with cancer and the immune response, even when ‘potentiated by specific immunotherapy treatments – comments Paolo Ascierto, president of the conference and director of the department of melanoma oncology, oncological immunotherapy and innovative therapies of the National Cancer Institute IRCCS Pascale Foundation of Naples -. Stress can promote the growth and resilience of the tumor, both through the production of a series of hormones (such as cortisol) that nourish it, and by promoting the creation of a microenvironment advantageous for the proliferation of metastases and by “weakening and” co-ruptured the cells of the immune system. Psychological support from the beginning of the treatment process can therefore have a triple function: on the one hand it can improve the patient’s quality of life, on the other it can reduce the “nourishment” of the tumor and on the other it can support and protect the response to immunotherapy treatments”.
In the Dutch research, the data of approximately 90 patients among those who took part in the PRADO project were analysed, a study which effectively “promoted” neoadjuvant immunotherapy, i.e. before surgery, in patients with melanoma. At the beginning of the research, all participants completed a questionnaire designed to evaluate the quality of life, in order to identify those who had emotional distress even before the therapy based on immune checkpoint inhibitors, i.e. drugs aimed at the “brakes” which prevent the immune system from effectively attacking the tumor. The patients were then followed for approximately 28 months.
«Our results showed that emotional distress can negatively influence the immune response against cancer – explains Blank -. In particular, patients with emotional distress present before neoadjuvant immunotherapy treatment showed a reduced response to therapy of approximately 20% compared to patients without obvious signs of stress, anxiety or depression (46% versus 65%).” Not only that: emotional distress was linked to a higher risk of recurrence at 2 years (91% versus 74%) and to greater metastases at 2 years (95% versus 78%). Given the numerous evidence in favor of the administration of neoadjuvant immunotherapy, which could soon become a standard of care for melanoma and other tumors, clarifying the factors that can influence its effectiveness is of fundamental importance. «Not to mention that stress, anxiety and depression are widespread in cancer patients» highlights Ascierto. These studies aren’t just about melanoma. «Indications in this sense also come from research on non-small cell lung cancer and colon cancer, for example – concludes Ascierto -. It is therefore essential that the emotional and psychological state of the patient is not neglected, but must be considered to all intents and purposes an integral part of the treatment process.”