Immune to Cancer: The CRI Blog



Exploring the Impact of Substance Use on Cancer Immunotherapy

Alcohol and illicit drugs are common carcinogens that immunotherapy research is actively seeking to more thoroughly detail when it comes to their connections to cancer occurrence. Immunologists are keen to increase public awareness of the cancer-causing properties of these substances, particularly when it comes to abuse and how alcohol and drug use can interfere with immunotherapy treatments. 

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According to the Dana-Farber Cancer Institute, opioids, legally used for pain management with cancer patients, can increase the likelihood of a person contracting hepatitis B or C. In turn, this can lead to liver damage and hepatocellular carcinoma, a type of liver cancer. Additionally, illicit drugs such as cocaine can lead to multiple cancer types because of the cutting agents they are sometimes mixed with. When abused, anabolic steroids can lead to an increased risk of prostate cancer in men and endometrial (uterine) cancer in women. 

Additionally, the Centers for Disease Control and Prevention (CDC) asserts that having three or more drinks per day can contribute to the development of stomach and pancreatic cancer. The CDC are not the only ones who want to illuminate how substance abuse can lead to a cancer diagnosis. Assistant professor of oncology at the Johns Hopkins University School of Medicine and CRI Clinical Innovator Marina Baretti, MD, recently sat down with CRI to discuss her research and what immunotherapy has to say about substance abuse and cancer. The interview has been edited for conciseness. 

Can you tell us about your current research? What are your thoughts about the correlation between alcohol, drugs, and cancer, and immunotherapy’s role here? 

“I work very closely with (more) laboratory-based researchers to really try to (give) patients clinic, novel drugs, especially (regarding) immunotherapy, to try to improve their outcome while preserving their quality of life. If you think about primary liver cancer, especially hepatocellular carcinoma, (it is) clearly related to exposure to high alcohol, because (it) can induce what we call the cirrhosis, which is basically a chronic inflammation, fibrosis of the liver, and that can become liver cancer.”  

Can you speak to what recent immunotherapy research has to say about the connection between alcohol, drugs, and cancer occurrence? 

“There is still, if you will, a dearth of information about this specific role of substance abuse and how alcohol can interact with immunotherapy-based drugs. I think probably the most common type of substance that is also legal in many jurisdictions is cannabis. More and more data are emerging (suggesting) that perhaps (cannabis) can have a negative impact on the immune system. There have been a couple of studies (that are) more retrospective, but I think very much thought-provoking, that show that patients that received immunotherapy and at the same time were exposed to cannabis had a (lessened) response to the immunotherapy. I think it is always important that patients are very transparent with their oncologists about what they use (and) what they do not, so that we can be aware of potential interactions and interference with our treatments.”

Are there any specific drugs or types of alcohol that are most correlated with cancer occurrence? 

“This is not my direct research field, but there is not a correct and direct link between cocaine (or) heroin, but the problem is that a lot of these drugs are often mixed with other substances. Those substances’ additions can be carcinogenic. We need to include also tobacco, which is probably the leading cause for lung cancer.” 

Can you speak to a specific correlation between cancer and more casual substance use, or if there is increased risk specifically with abuse of more serious amounts of drugs and alcohol? 

“This is very hard to quantify. What do we know is that the less you drink the better it is for you. The recommendation is really to either stay away or (have) no more than two drinks per day for a man (and) no more than one drink per day for a woman. The moment that you start to increase that, I think you are exposing yourself and increased risk not only of cancer, but also of other health related problems. I think the same goes with drugs. The more you are exposed, the higher the risk.” 

What does the general public potentially not know about alcohol and drug use that you think they should, specifically pertaining to links with cancer? 

“Unfortunately, the fact that you have survived a cancer does not eliminate the risk for you to either have a recurrence of the same one or to develop a novel cancer. There was a study a couple of years ago (where) they looked at more than 200,000 cancer survivors. For this new (study), they were focused on alcohol exposure in terms of abuse, (alcohol) is associated with up to almost 20% risk of cancer recurrence and almost 10% more of (a) risk of cancer death. For drugs (and) alcohol, they (negatively) impact all the stages of cancer treatment. There have been very clear studies now showing a negative impact on surgery, patients tend to have more complications, longer hospital stays, higher mortality after surgery, more complication from radiation, especially if you are radiating the area of the head and neck, (and further complications).”

Is there anything else you would like to say about alcohol use, drug use, and cancer immunotherapy that we have not touched on? 

“There is probably still a little more research that we need to do to really understand the intricate interrelationship (here). For instance, when it comes to cannabis, (it) can help with some things, but it might be detrimental in (another) aspect. To me, your oncologist-patient relationship needs to be a safe place. What I really encourage is every patient to be very transparent (and) honest with their oncologists about what they do. Maybe your team of caregivers and physicians can help to address potential abuse.” 

Substance abuse is a sensitive issue that involves both scientific and social nuances. What is clear is that drug and alcohol use have the potential to increase an individual’s risk of developing cancer. With increased public awareness, honesty between patients and oncologists, and additional research in this area, we are confident we can create a world immune to cancer. 

Want to do something big for cancer immunotherapy research? Make a donation today to the Cancer Research Institute.

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