What is immunotherapy for cancer?
Immunotherapy is the use of special drugs that help your body fight cancer using your immune system. Different varieties of cancer immunotherapy are available, with more in development. Immunotherapy treatment helps your body destroy invading cancer cells, though different types of immunotherapy use different methods to work. Some types are a form of targeted therapy. They super-charge the “fighter cells” in your immune system to attack specific cancers. Other immunotherapy drugs provide a general boost to your cancer-fighting system. Immunotherapy for lung cancer and several other cancers includes both types of drugs. Immunotherapies can have long-lasting impact, continuing to enhance your immune system and helping it battle cancer after treatment has stopped.
Researchers are continuing to study ways to improve immunotherapy so it can work better for every cancer patient.
Why is immunotherapy performed?
Immunotherapy can be expensive and has only been approved by the FDA for certain cancers, though that number is growing rapidly. To date, immunotherapy has proven most effective in treating melanoma, non-small cell lung cancer, bladder cancer, kidney cancer, stomach cancer, liver cancer, head and neck cancers, and lymphoma. It also is showing promise for small cell lung cancer, ovarian cancer, blood cancers like leukemia and lymphoma, and prostate cancer. Clinical trials are underway with other types of cancers as well.
Because of its expense and its newness, immunotherapy is generally attempted only after more traditional cancer therapies—such as surgery, chemotherapy and radiation—have not been successful. Immunotherapy offers some advantages over these therapies, including less damage to healthy cells and less side effects, although this varies depending on the type of immunotherapy and the person’s response to it. Immunotherapy also may train cancer-fighting cells in the body to continue the battle for years after treatment has been discontinued.
Your doctor can best advise you regarding whether immunotherapy is a good choice for you, and spell out the risks and benefits of this therapy, as well as ways to work around the high costs or lack of access to this therapy in your area. Clinical trials may be an option that your physician can explore with you.
Who performs immunotherapy for cancer?
Oncologists are doctors who specialize in cancer treatment. It’s important to choose an oncologist with significant experience in targeted therapy and immunotherapy (sometimes referred to as immuno-oncology), particularly the type most effective against your cancer. The immunotherapy treatments themselves are often administered by specially trained nurses or technicians. Your care team should work together so that all members share information about your response to treatment and continuously coordinate your care.
How is immunotherapy performed?
Immunotherapy is performed differently depending on the type of therapy that’s being done. Sometimes the immunotherapy drug is delivered directly into your vein (intravenous, or IV administration). Other times, you can take it as pills or rub it onto your skin as a topical cream (this type is used to fight early skin cancer). A type that targets bladder cancer is injected directly into your bladder.
The therapy can be provided in a doctor’s office, clinic, or outpatient department at a hospital.
Duration of treatment also varies depending on your type of cancer, its stage, the type of immunotherapy drugs, and how your body reacts to therapy. You may receive the medicine daily, weekly or monthly. Some kinds of immunotherapy are given in a cycle where you have treatment followed by a period of rest—such as a few weeks—which lets your body recover while building new immune cells. Your doctor will monitor the effectiveness of your treatment through physical exams, blood tests, and scans, measuring the size of your tumor or tumors, plus changes in your bloodwork. Your side effects also will be assessed.
Here are common types of immunotherapy procedures:
- Monoclonal antibody therapy is also targeted therapy. It uses cells grown in a medical laboratory to help your immune system recognize and destroy cancer cells. The cells make a specific type of protein—a monoclonal antibody (mAb)—that flags certain cancer cells. For some mAbs, the interaction with cancer cells serves as a beacon so your immune system can target the cells and fight them off. Others block the pathways, or checkpoints, that cancer cells use to evade your immune system. Another type pairs the mAbs with chemotherapy drugs to deliver toxins to cancer cells. Monoclonal antibody therapy is usually given in an outpatient setting by IV; you go for several sessions over a period of weeks. Cancers targeted by this kind of immunotherapy include certain forms of lymphoma and leukemia, lung cancer, breast cancer, bladder cancer, colorectal cancer, and some types of skin cancer.
- T-cell therapy including CAR (chimeric antigen receptor) T-cell therapy, focuses on fighter cells in your immune system called T-cells. Your blood is drawn and lab personnel modify your own T-cells to recognize and bind to a marker protein (antigen) only on the type of cancer cells in your body. The lab can make many more copies of this extra powerful CAR T-cell and inject the cells back into you. The CAR T-cells work to find and identify the cancer cells so the T-cells can destroy them. This is also targeted therapy. CAR T-cell treatment is usually given to you just once, but researchers are finding it stays in your system fighting cancer for years—perhaps for the rest of your life.
- Nonspecific immunotherapies. Rather than targeting a specific type of cancer cell, this kind of immunotherapy is designed to improve your immune system’s general response to cancer. There are various kinds of nonspecific immunotherapies. One of them is based on the action of normal immune system substances called cytokines. Two kinds of cytokines—interferon or interleukin-2—can be developed in the lab. Cytokine immunotherapy helps strengthen your immune response. Sometimes doctors combine this treatment with other cancer-fighting drugs, but side effects can be severe.
- Treatment vaccines fight existing cancers, unlike preventive vaccines given before cancer takes hold. Therapeutic vaccines help the immune system recognize and destroy specific cancers. Some are produced from a sample of your own tumor; others use antigens known to be associated with your cancer type. The FDA has approved a vaccine to fight advanced prostate cancer. Researchers are testing vaccines for bladder cancer, brain cancer, breast cancer, cervical cancer, colorectal cancer, kidney cancer, lung cancer, melanoma, pancreatic cancer, prostate cancer, leukemia, lymphoma and myeloma. One limitation is they may suppress the immune system, making you vulnerable to other diseases. Researchers are working to counter this possible effect.
- Oncolytic virus therapy uses genetically modified viruses to kill cancer. This is targeted therapy too. The virus is injected directly into the tumor causing the release of antigens; this awakens your immune system to defend itself. In 2015, the FDA approved the first oncolytic virus therapy, which injects a version of the herpes simplex virus (T-VEC) directly into areas of melanoma that can’t be cut out by a surgeon. Patients receive injections until no melanoma tumors are left.
Your oncologist can guide you on your immunotherapy options based on the specific type of cancer.
What to expect the day of your immunotherapy
One common way immunotherapy is administered is to slowly infuse the medicine into your veins. The process can take several hours. You will go to a hospital’s outpatient department or other medical facility for the infusion. Sometimes, you can even have treatment at home. In general, this is what happens the day of your immunotherapy appointment:
- If you are receiving immunotherapy via IV infusion, a nurse will start the IV in your hand or arm.
- You may receive drugs before the treatment begins to reduce certain side effects such as nausea.
- If you have the treatment as part of an infusion, you can expect it to take up to three or four hours. The treatment needs to be given slowly rather than all at once, which could cause an allergic reaction.
- Some people bring a buddy with them during these sessions. Check with your health team to see if this is allowed.
- Your nurse will monitor you for immediate side effects or adverse reactions. If there is no reaction after the infusion, your nurse will detach the IV and you can leave the facility.
What are the risks and potential complications of immunotherapy?
Immunotherapy risks and potential complications differ for each type of therapy. In general, immunotherapy has fewer side effects than traditional therapies like chemotherapy or radiation. This is because it doesn’t affect as much healthy tissue. Instead, immune-based therapies target primarily cancer cells.
Most common side effects of immunotherapy for cancer
Some side effects are worse at the beginning of therapy because your body is adjusting to the medicine. Other effects are cumulative, building up over time or starting after treatment has ended. Side effects and complications vary, but some common ones include:
- Fatigue
- Fever
- Chills
- Nausea
- Reaction at the infusion site
- Mouth sores
- Skin reactions, such as redness, blistering, and very dry skin
Potential complications of immunotherapy
More severe but less common potential side effects include:
- Inflammation of the lungs, colon, liver, and other internal organs
- Skin rashes
- Endocrine disorders, such as thyroid abnormalities
- Increased risk of infection
- Allergic reaction
- High blood pressure
- Nervous system reactions, such as hallucinations or seizures
Reducing your risk of complications
You can reduce your risk of certain complications by taking prescribed medications as directed and informing your doctors and nurses of known medication allergies or reactions. Tell your care team immediately of any side effects or unexpected symptoms, such as bleeding, fever, or increase in pain.
How do I prepare for immunotherapy?
There are steps you can take before your treatment to help improve your comfort and the overall outcome of your therapy. You can prepare for immunotherapy by:
- Following your doctor’s instructions concerning medications or diet
- Setting up a journal or other method to keep track of your treatments including side effects
- Arranging your support team—friends and caregivers who can help take you to and from therapy appointments or help you at home afterward if necessary
- Attending pre-treatment appointments and having any tests your doctor requires prior to your treatment date
- Preparing a “visit kit” to keep you occupied during the infusion (which can last for several hours). Items to consider include books, headphones, a tablet or other device loaded with TV shows or music, and a sweater, blanket and socks to keep you warm and comfortable.
- Keeping a running list of questions for your care team as they occur to you. You can bring the list with you to your next appointment.
- Eating well, sleeping well, and—if your doctor says it’s OK—exercising, all of which can help your overall health
Questions to ask your doctor
Immunotherapy is a complex type of treatment for cancer. It’s not available for all types of cancer, and there are also limitations. If you have questions or concerns about immunotherapy treatment, your oncologist is the best person to ask. Bring a list of questions when you visit your doctor so you won’t forget to address something that’s concerning you. Also consider bringing a friend or asking if you can record the visit. Don’t be afraid to ask for clarification if you don’t understand an answer. Some questions you might ask include:
- Why do you recommend this type of immunotherapy for me?
- How effective is it? What results do you typically see with patients like me?
- How will I receive immunotherapy?
- Is there anything I need to do to prepare? Should someone bring me to and from the appointment?
- What side effects are likely? When are they likely to occur?
- What should I do if I experience side effects?
- For what symptoms should I call you? Ask for numbers to call during regular and after-business hours.
- What foods should I eat or not eat, both before and after the treatment?
- What medications should I keep on-hand?
- Am I at risk for infection? Are the infections potentially fatal?
- Do I need to wear a mask around people?
- Can I be around pets?
- When will I be able to resume my normal activities after therapy?
What can I expect after immunotherapy?
Understanding what’s likely to happen after immunotherapy will help you prepare for what’s ahead. It may give you better sense of control and help you experience a successful recovery.
How long will it take to recover?
Your recovery from therapy depends on several factors, including the type of immunotherapy you had, what (if any) side effects occurred, and the type and stage of cancer. Some kinds of immunotherapy—such as CAR T-cell therapy—may destroy healthy immune cells as well as cancer cells. Your body may need time to recover and rebuild its defenses. You may also experience cumulative or delayed side effects after you finish active therapy. Some effects can linger or occur months to years later.
Will I feel pain?
You may experience a burning or stinging sensation if you receive immunotherapy by injection into your skin. For infusions, you may feel mild pain in your arm or hand when the nurse inserts the IV line. However, the nurse can use numbing creams or sprays to ease the pain if necessary.
Some side effects of immunotherapy can be painful, such as irritation at the infusion site, mouth sores, blistering skin, joint pain, and stomach pain. Your health team will monitor you for side effects. There are medications and palliative strategies to help ease your discomfort from these and other side effects.
When should I call my doctor?
You will likely set up a follow-up appointment with your doctor before your immunotherapy appointment, but you should call him or her or seek immediate care if you have any new side effects or concerning symptoms afterward, such as:
- Shaking chills with or without a fever
- Chest pain
- Shortness of breath or difficulty breathing
- Confusion
- Severe headache with stiff neck
- Cloudy or bloody urine
- Extreme fatigue
- Drop in blood pressure
- Seizures
- Hallucinations
- Trouble speaking
How might immunotherapy affect my everyday life?
Immunotherapy may help reduce your tumors or cause them to disappear. In some patients and with certain cancers, immunotherapy has cured the cancer. The greatest success is seen with melanoma, kidney cancer, and some blood cancers, but treatment is constantly evolving for many other cancers. Even if it cannot cure the cancer, immunotherapy can be an effective part of an overall treatment plan and lengthen survival time.
Potential side effects from immunotherapy can remain a challenge for you and your health providers. You may benefit from a renewed focus on mind-body health, supportive therapies (palliative medicine), exercise, and diet to better cope with any ongoing difficulties. Ask your doctor about palliative cancer care .
You may need to avoid certain supplements that could reduce immunotherapy’s effectiveness. Some types of immunotherapy—such as CAR T-cell therapy—may require you to periodically have immune-boosting treatments, such as gamma globulin infusions to bolster your system’s ability to fight disease. Your doctor will discuss any short-term or long-term limitations of your treatment with you, as well as what you can do to improve your health going forward.
