Immunotherapy

Overview

What is immunotherapy?

Immunotherapy is a cancer treatment that engages your immune system to fight the disease. The treatment is sometimes called biological therapy.

What is the immune system?

Your immune system is made up of various organs, antibodies (proteins) and immune cells that work together to fight disease and infections. Immune cells include:

  • B-cell lymphocytes: These white blood cells produce infection-fighting antibodies.
  • T-cell lymphocytes: These white blood cells target and destroy diseased cells. T-cells also alert other cells to the presence of diseased or foreign cells.
  • Dendritic cells: These immune cells interact with T-cells to stimulate an immune system response.
  • Granulocytes: These white blood cells — neutrophils, eosinophils and basophils — fight infections.

How does immunotherapy work?

Immune cells produce cytokines, protein molecules that act on other cells. Immunotherapy introduces large amounts of these proteins into the body. The treatment:

  • Stimulates the immune system to produce more disease-fighting immune cells.
  • Makes it easier for the immune system to identify and target cancer cells.

What does immunotherapy treat?

Immunotherapy treats different types of cancers , including but not limited to

The main types of immunotherapy that healthcare providers use to treat cancer include:

  • Adoptive cell therapy: Healthcare providers remove, change and then reintroduce a person’s modified immune cells into the body. The modified cells seek out and destroy cancer cells. CAR T-cell therapy modifies T-cells with chimeric antigen receptors (CAR) that fight cancer. Other therapies include natural killer cells (NKs) and tumor-infiltrating lymphocytes (TILs).
  • Cancer vaccines: Vaccines stimulate an immune response to protect the body against certain diseases. The human papillomavirus (HPV) vaccine protects against an infectious disease that causes cervical, anal, throat and penile cancers. There’s also a vaccine for hepatitis B, which causes liver cancer.
  • Immunomodulators: These substances change the body’s biologic response. They stimulate the immune system’s ability to find and kill cancer cells. Treatments include checkpoint inhibitors, cytokines, interferon and interleukins.
  • Monoclonal antibodies: These lab-made proteins attack specific parts of a cancer cell. Monoclonal antibodies can also deliver drugs, toxins or radioactive material directly to tumors.
  • Oncolytic viruses: Specialists change these viruses in the laboratory. The modified viruses infect and kill cancer cells.

Procedure Details

How is immunotherapy performed?

Immunotherapy is performed as infusion. You get an intravenous infusion into a vein at a medical facility.

How long will I get immunotherapy?

You may get immunotherapy daily, weekly, monthly or in a cycle. With cyclic immunotherapy, you take a rest period after treatment. The break gives your body time to produce healthy cells. Treatment length depends on:

  • Cancer type and stage.
  • Type of immunotherapy drug.
  • Your body’s response to treatment.

What should I expect after immunotherapy?

Unlike chemotherapy, immunotherapy may not always cause tumor shrinkage. Rarely, tumors temporarily swell or get bigger as immune cells attack the cancer even when patients are feeling great. This phenomenon is known as pseudoprogression. The term means that a tumor only appears to be worsening and patients may still be deriving benefit.

You’ll need to see your healthcare provider often to track treatment response. You may have frequent physical exams, blood tests and imaging scans.

Risks / Benefits

What are potential risks or complications of immunotherapy?

Side effects from immunotherapy vary depending on the drug and cancer types. You may experience:

  • Infusion-related reactions.
  • Diarrhea or colitis.
  • Bone or muscle pain.
  • Fatigue.
  • Flu-like symptoms, such as fever and chills.
  • Headaches.
  • Loss of appetite.
  • Mouth sores.
  • Skin rash.
  • Shortness of breath or pneumonitis.

Recovery and Outlook

How effective is immunotherapy?

Success rates for any cancer treatment, including immunotherapy, depend on individual factors, including the cancer type and stage. In general, immunotherapy is effective against many cancers. While some cancers are more immunogenic than others, in general, immunotherapy is effective across a wide variety of cancers. Immunotherapy can produce durable responses unlike chemotherapy or radiation, however, these occur only in around 25% patients.

Some research suggests that the immune system may remember cancer cells after immunotherapy ends.

When to Call the Doctor

When should I call the doctor?

You should call your healthcare provider if you experience:

  • Heart palpitations or chest pain.
  • Signs of infection, such as fever and chills.
  • Trouble breathing or swallowing.
  • Diarrhea or colitis.
  • Altered mental status.
  • Skin rash.

A note from Cleveland Clinic

Immunotherapy holds a lot of promise for treating and curing cancers. The therapy treats a wide range of cancers. Many clinical trials are underway to find new ways to engage the body’s immune system to fight cancer. You may receive immunotherapy as a standalone treatment or along with other cancer treatments. Your healthcare provider can discuss whether immunotherapy is the right treatment for you.

Last reviewed by a Cleveland Clinic medical professional on 10/01/2020.

References

  • American Cancer Society. How Immunotherapy Is Used to Treat Cancer. (https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/immunotherapy/what-is-immunotherapy) Accessed 10/2/2020.
  • Cancer Research Institute. What Is Immunotherapy? (https://www.cancerresearch.org/immunotherapy/what-is-immunotherapy) Accessed 10/2/2020.
  • Merck Manual. Immunotherapy for Cancer. (https://www.merckmanuals.com/home/cancer/prevention-and-treatment-of-cancer/immunotherapy-for-cancer) Accessed 8/24/2020.

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