Immunotherapy for Cancer: Is it Right For You?

Immunotherapy (IO) is a type of cancer treatment used in many types of cancer. It works by using your body’s own natural defenses (immune system) to identify, attack, and kill cancer cells. Normally, your immune system can recognize and destroy abnormal cells, but cancer cells learn tricks to hide or shut down immune responses. Immunotherapy helps “wake up” the immune system so it can do its job.

There are different kinds of immunotherapy treatments. They help fight cancer by:

• Boosting the immune system. A “revved up” immune system can be better at fighting cancer.
• “Marking” cancer cells so that your immune system can see them better to find and destroy them. This keeps cancer from being able to hide from the immune system.
• Blocking the “brakes” cancer cells put on the immune system, allowing immune cells to attack the cancer cells again.

How is Immunotherapy Given?

The use of immunotherapy is rapidly increasing as more immunotherapies are approved to treat people with more types of cancer. Most immunotherapy is given using an IV infusion (through a vein). You may receive immunotherapy in a doctor’s office, in a clinic, or as a day patient in a hospital. Different immunotherapies are given on different schedules. Some may be given in combination with other therapies or with a different immunotherapy.

Is Immunotherapy Right for Me?

Most people who get immunotherapy today have cancers that are advanced or metastatic (stage 3 and 4). Their cancers have either returned and spread after initial treatment or were diagnosed in an advanced stage. Some immunotherapy drugs are now approved to treat certain early stage cancers. Researchers are testing immunotherapy in new cancer types and at earlier stages. Some people cannot receive immunotherapy because of serious health problems (like autoimmune disorders) that make it unsafe to take these drugs. Ask your health care team if immunotherapy is right for you.

Types of Immunotherapy

Checkpoint Inhibitors

The immune system has safeguards in place to prevent it from attacking healthy cells. These safeguards are called checkpoints. They slow down or stop the immune system from attacking healthy tissue. Some cancers have learned how to activate these checkpoints to avoid being found and killed by the immune system. They trick the body into turning its own defenses off. Checkpoint inhibitors block these checkpoints, helping the body fight cancer.

Most patients who receive immunotherapy today are on one of two kinds of checkpoint inhibitors: PD1/PDL-1 or CTLA-4 inhibitors. However, not all cancers can be treated with these drugs. Currently, checkpoint inhibitors only work for up to a third of patients who are given them. But that number depends on your cancer type. These drugs may be given in combination with other therapies, such as chemotherapy or other immunotherapy drugs. Researchers are also studying giving checkpoint inhibitors in combination with radiation therapy.

Checkpoint inhibitors have been approved to treat the following:

• Merkel Cell Carcinoma
• Liver Cancer
• Cutaneous Squamous Cell Carcinoma
• Non-Small Cell Lung Cancer
• Small Cell Lung Cancer
• Melanoma
• Kidney Cancer
• Lymphoma
• Bladder Cancer
• Head and Neck Cancer
• Triple Negative Breast Cancer
• Cervical Cancer
• Endometrial/Uterine Cancer
• Esophageal Cancer
• Gastric/Stomach & GEJ Cancers
• Basal Cell Skin Cancer
• Colorectal Cancer
• Mesothelioma

As well as any non-blood cancers that test positive for the biomarkers MSI-high/dMMR or TMB (tumor mutational burden).

Checkpoint Inhibitor Side Effects

We tend to think of immunotherapy as “natural”—as our body’s own defense system. However, immunotherapy can still have side effects. These effects are generally different from those caused by chemotherapy or radiation therapy. In many cases, they are not severe and may be short-lived or easy to manage. Less often, side effects can be very severe and even life-threatening.

Common side effects

• Flu-like symptoms (fever, chills, headache, nausea, cough, loss of appetite)
• Fatigue (some people get extreme fatigue) Rashes, redness, or itching
• Pain or soreness
• Muscle or joint pain
• Infections

Less common side effects

• Colitis or other gastrointestinal problems (stomach pain, diarrhea)
• Problems with the thyroid, liver, kidneys, heart, or other glands or organs
• Lung problems (cough, shortness of breath)
• Other serious autoimmune conditions (such as pituitary disorders or diabetes)

Sometimes the side effects do not occur right after treatment is given. They may show up several months later. Little is known at this time about whether there are any long-term side effects. If you are on immunotherapy, it is important to let your healthcare team know immediately if you notice any change in side effects or symptoms. Most side effects can be managed if they are treated early. 

Other Monoclonal Antibodies

Checkpoint inhibitors are one type of monoclonal antibody (mAb). Other types let the immune system find and destroy cancer cells using targets that aren’t checkpoints. Others take radiation or chemotherapy drugs directly to cancer cells. Each mAb is made to find and attach to a specific protein that occurs in cancer cells. Not all mAbs are immunotherapies; some are targeted therapies. Most mAb treatments that aren’t checkpoint inhibitors are used in blood cancers.

Cell Therapies

In cell therapy, the body’s own immune system cells (T-cells) are removed from a patient taken to a lab and modified. Once returned to the patient, these modified cells can find and destroy cancer cells. The most common form of this treatment is CAR T-cell therapy.

Researchers are also studying cell therapies called TIL (tumor-infiltrating lymphocytes), TCR-T (engineered T-cell receptors), and CAR NK (engineered natural killer cells).

Bispecific Antibodies

Bispecific antibodies are lab-engineered proteins designed to bind to two different targets at the same time — one on a cancer cell and one on an immune cell. (The name reflects this: bi = two, specific = targets.) This makes them different from standard antibodies, which attach to only one target.

By latching onto both a cancer cell and a nearby immune cell at the same time, these drugs physically bridge the two together. This makes it easier for the immune system to recognize and attack the cancer. Some bispecific antibodies — often called T-cell engagers — work specifically by bringing T-cells to the cancer cell.

Treatment Vaccines

Cancer vaccines are designed to “teach” T-cells to find and attack cancer cells that have specific proteins. They are made from the patient’s own tumor cells, immune cells, or common antigens. These cells are sent to a lab where their ability to recognize and fight cancer cells is boosted. They are then re-infused into the patient. 

Oncolytic Virus Therapy

Oncolytic means “something that destroys cancer cells.” Oncolytic virus therapy uses viruses to fight cancer cells. Doctors inject a weakened or modified virus into your tumor. This virus infects and multiplies inside the cancer cells. The copies build up until the cancer cells burst and die. These bursting cancer cells signal the immune system to join the attack on cancer cells throughout the body. 

Learn more about bispecific antibody immunotherapy 

Cytokines

Cytokines have been used for years. They do not target cancer cells like some newer treatment methods. Rather, they work by speeding up the growth of T-cells and activating other immune cells, boosting the immune system generally. Researchers are exploring the next generation of cytokine therapies.

Side Effects

We tend to think of immunotherapy as “natural” — as our body’s own defense system. However, immunotherapy can still have side effects. These effects are generally different from those caused by chemotherapy or radiation therapy. In many cases, they are not severe and may be short-lived or easy to manage. Less often, side effects can be very severe and even life-threatening.

Common side effects 

• Flu-like symptoms (fever, chills, headache, nausea, cough, loss of appetite)
• Fatigue (some people get extreme fatigue)  
• Rashes, redness, or itching
• Pain or soreness
• Muscle or joint pain
• Infections 

Less common side effects 

• Colitis or other gastrointestinal problems (stomach pain, diarrhea, constipation)  
• Problems with the thyroid, liver, kidneys, heart, or other glands or organs – Blood tests can identify issues within these organs.
• Lung problems (ongoing cough, shortness of breath) – A visit with a pulmonologist may help answer questions related to these issues.
• Other serious autoimmune conditions (such as pituitary disorders or diabetes)  
• CRS (cytokine release syndrome), including fever, low blood pressure, or low oxygen
• ICANS (neurotoxicity), including confusion, word-finding trouble, or seizures 

Sometimes the side effects do not occur right after treatment is given. They may show up several months later. Let your healthcare team know immediately if you notice any changes in side effects or symptoms. Most side effects can be managed if they are treated early.  

What Does It Cost?

Many new treatments and treatment-related costs, including immunotherapy, can be very expensive. If you are being treated through a clinical trial, you may have those costs covered. Talk to your health care team upfront about the financial issues involved in your treatment. Also, talk to your insurance company before beginning treatment to find out what the cost will be. Many treatment centers have resources to help patients obtain insurance coverage or will help you access grant programs designed to help cover costs of treatment. 

Learn more about managing treatment costs

Is a Clinical Trial Right for Me?

Be sure to ask your care team about any available clinical trials that you may be eligible for. Clinical trials are research studies that test new treatments or explore better ways to use existing treatments, including for different types of cancer. Ask about the potential benefits and risks. 

Even if you can’t get standard immunotherapy right now, joining a clinical trial might allow you to try new treatments that are being researched and developed, including different types of immunotherapy. Ask your doctor about all of your options, including whether a clinical trial may be right for you

Current Immunotherapies by Cancer Type

• Leukemia & Lymphoma
• Melanoma
• Non-small cell lung cancer
• Prostate
• Small cell lung cancer