- Risks and Benefits of Immunotherapy
- What is immunotherapy?
- What is it?
- The immune system
- Types of immunotherapy
- Monoclonal antibodies (MABs)
- Vaccines to treat cancer
- CAR T-cell therapy
- Immunotherapy for Cancer: What is it & How This Treatment Works
- Immunotherapy: Is It Right for Your Cancer Type?
- How does immunotherapy work?
- Who benefits from immunotherapy?
- Can this therapy work for you?
- Immunotherapy: What Are the Types?
- Immunotherapy for Cancer – National Cancer Institute
- Types of immunotherapies
- How Immunotherapy Is Used to Treat Cancer
- What the immune system does
- Types of cancer immunotherapy
Risks and Benefits of Immunotherapy
Your immune system is made up of your white blood cells plus the organs and tissues of your lymph system, your bone marrow. Its main job is to help your body fight off disease and stay healthy.
Immunotherapy drugs help your immune system work harder or make it easier for it to find and get rid of cancer cells.
Several immunotherapy drugs have been approved to fight cancer, and hundreds more are being tested in clinical trials (research studies that use volunteers to test new medicines). If immunotherapy seems the best way to fight your cancer, your doctor may know of a clinical trial you can join.
If your doctor suggests immunotherapy to fight your cancer, there’s a lot to talk to them about before you decide if it’s right for you.
There are many reasons your doctor might think immunotherapy is a good choice for you:
Immunotherapy may work when other treatments don’t. Some cancers ( skin cancer) don’t respond well to radiation or chemotherapy but start to go away after immunotherapy.
It can help other cancer treatments work better. Other therapies you have, chemotherapy, may work better if you also have immunotherapy.
It causes fewer side effects than other treatments. This is because it targets just your immune system and not all the cells in your body.
Your cancer may be less ly to return. When you have immunotherapy, your immune system learns to go after cancer cells if they ever come back. This is called immunomemory, and it could help you stay cancer-free for a longer time.
Immunotherapy holds a lot of promise as a cancer treatment. Still, it can cause some problems.
You might have a bad reaction. The area where the medication goes into your body could hurt, itch, swell, turn red, or get sore.
There are side effects. Some types of immunotherapy rev up your immune system and make you feel you have the flu, complete with fever, chills, and fatigue. Others could cause problems swelling, weight gain from extra fluids, heart palpitations, a stuffy head, and diarrhea. Most of the time, these ease up after your first treatment.
It can harm organs and systems. Some of these drugs can cause your immune system to attack organs your heart, liver, lungs, kidneys, or intestines.
It isn’t a quick fix. In some cases, immunotherapy takes longer to work than other treatments. Your cancer may not go away quickly.
It doesn’t work for everyone. Right now, immunotherapy works for less than half the people who try it. Many people only have a partial response. This means your tumor could stop growing or get smaller, but it doesn’t go away. Doctors aren’t sure yet why immunotherapy helps only some people.
Your body could get used to it. Over time, immunotherapy may stop having an effect on your cancer cells. This means that even if it works at first, your tumor could start to grow again.
National Cancer Institute: “Immunotherapy.”
American Cancer Society: “What is cancer immunotherapy?”
Cancer Research Institute/I’m the Answer to Cancer: “Benefits of Cancer Immunotherapy.”
Cancer Research Institute: “About Clinical Trials,” “Cancer Immunotherapy: Should You Participate?”
Cancer Support Community: “Frankly Speaking About Cancer: Your Immune System & Cancer
University of Texas San Antonio Cancer Therapy & Research Center: “Immunotherapy.”
University of California San Francisco: “Killing Cancer Through the Immune System.”
Dana-Farber Cancer Institute: “What are the Side Effects of Immunotherapy?”
Vanderbilt University Medical Center: “Study details rare heart risk of certain cancer therapies.”
American Society of Clinical Oncology/Cancer.net: “Immunotherapy 2.0: The 2017 Clinical
Cancer Advance of the Year,” “Understanding Immunotherapy.”
Coalition of Cancer Cooperative Groups: “Learn About Cancer Clinical Trials.”
© 2019 WebMD, LLC. All rights reserved. Side Effects
What is immunotherapy?
Immunotherapy is a standard treatment for some types of cancer, for example melanoma that has spread. And it is in trials for other types of cancer.
What is it?
Immunotherapy uses our immune system to fight cancer. It works by helping the immune system recognise and attack cancer cells.
Some types of immunotherapy are also called targeted treatments or biological therapies.
You might have immunotherapy on its own or with other cancer treatments.
The immune system
Our immune system works to protect the body against infection, illness and disease. It can also protect us from the development of cancer.
The immune system includes the lymph glands, spleen and white blood cells. Normally, it can spot and destroy faulty cells in the body, stopping cancer developing. But a cancer might develop when:
- the immune system recognises cancer cells but it is not strong enough to kill the cancer cells
- the cancer cells produce signals that stop the immune system from attacking it
- the cancer cells hide or escape from the immune system
Types of immunotherapy
Cancer treatments do not always fit easily into a certain type of treatment. This is because some drugs or treatments work in more than one way and belong to more than one group. So you might hear the same drug or treatment called different things.
For example, a type of immunotherapy called checkpoint inhibitors are also described as a monoclonal antibody or targeted treatment.
There are different types of immunotherapy:
Monoclonal antibodies (MABs)
MABs recognise and attach to specific proteins on the surface of cancer cells.
Antibodies are found naturally in our blood and help us to fight infection. MAB therapies mimic natural antibodies, but are made in a laboratory. Monoclonal means all one type. So each MAB therapy is a lot of copies of one type of antibody.
MABs work as an immunotherapy in different ways. They might do one of the following:
- trigger the immune system
- help the immune system to attack cancer
MABs trigger the immune system by attaching themselves to proteins on cancer cells. This makes it easier for the cells of the immune system to find and attack the cancer cells. This process is called antibody dependent cell mediated cytotoxicity (ADCC).
Checkpoint inhibitors are MABs that work by helping the immune system attack cancer cells. Cancer can sometimes push a stop button on the immune cells, so the immune system won’t attack them. Checkpoint inhibitors block cancers from pushing the stop button.
- MABs that have an effect on the immune system
Vaccines to treat cancer
Researchers are looking at whether vaccines can be used as a treatment to help the immune system to recognise and attack cancer cells.
Normally, vaccines help to protect us from disease. They are made from weakened or harmless versions of the disease they are being made to protect us from. This means that they don’t cause the disease.
When you have the vaccine, it stimulates the immune system into action. The immune system makes antibodies that can recognise and attack the harmless versions of the disease. Once the body has made these antibodies it can recognise the disease if you come into contact with it again. So you’re protected from it.
Researchers are also testing vaccines to treat cancer. In the same way that vaccines work against diseases, the vaccines are made to recognise proteins that are on particular cancer cells. This helps the immune system to recognise and mount an attack against those particular cancer cells.
- Read more about vaccines to treat cancer
Cytokines are a group of proteins in the body that play an important part in boosting the immune system.
Interferon and interleukin are types of cytokines found in the body. Scientists have developed man made versions of these to treat some types of cancer.
CAR T-cell therapy
This treatment changes the genes in a person’s white blood cells (T cells) to help them recognise and kill cancer cells. Changing the T cell in this way is called genetically engineering the T cell.
It is available as a possible treatment for some children with leukaemia and some adults with lymphoma. People with other types of cancer might have it as part of a clinical trial.
- Read more about CAR T-cell therapy
Ask your cancer specialist about immunotherapy treatment. They can explain:
- whether this treatment is suitable for you
- what the aim of treatment would be
- what it would involve and the side effects
04 Nov 2017
- Recognizing and managing on toxicities in cancer immunotherapyLYang and othersTumour Biology. 2017, Volume 39, Issue 3:1010428317694542
Immunotherapy for Cancer: What is it & How This Treatment Works
The immune system is a powerful weapon against disease, infections and defective cells. Because cancer cells are the body’s own mutated cells, they are not always recognized by the immune system as invaders.
Also, cancer cells have multiple ways to evade, shut down or overpower an immune attack.
Immunotherapy is a broad category of cancer therapies designed to stimulate the body’s immune system to better recognize and fight cancer.
Among immunotherapies used to treat cancer are:
Checkpoint inhibitors work by disrupting the cancer cells' signals, exposing them to the immune system for attack.
Certain protein receptors located on the surface of immune cells help them differentiate healthy cells from cancer cells.
Cancer cells can send signals to the immune cells at certain checkpoints that tell the immune system they are normal cells. Checkpoint inhibitors block those signals and expose the cancer cells for attack.
Learn more about checkpoint inhibitors
Vaccines do not directly prevent cancer but are used to treat specific cancers and prevent conditions that may cause cancer. Vaccines for cancer come in two categories:
- Prophylactic or preventative vaccinesattack viruses that may cause cancer. The HPV vaccine, for instance, targets the specific strains of the human papillomavirus linked to most cases of cervical, throat, anal and other cancers.
- Therapeutic or treatment vaccines stimulate the immune system to attack cancer in a specific location of the body. The Bacillus Calmette–Guérin vaccine, for example,is live bacteria injected into the bladder that attracts immune cells to attack cancer cells.
Learn more about vaccines
Cytokines are protein molecules that help regulate and direct the immune system. Cells release cytokines, which act as messengers to other cells, telling them when and where to launch an immune response.
Various types of cytokines are naturally produced by the body. In cancer treatment, cytokines are synthesized in the lab and injected in larger doses than the body would normally produce.
Two common cytokines are used in cancer immunotherapy:
- Interleukin 2 (IL-2) is naturally produced by the body to help fight infection and prevent autoimmune diseases. In cancer treatment, IL-2 is designed to target adaptive immune cells, such as T-cells and B-cells, to respond to tumors. IL-2 may help the body produce antigen-fighting T-cells and stimulate B-cells to produce more antibodies.
- Interferon-alpha (IFN-alpha) is one of several proteins that help the body fend off viruses and bacteria. In cancer treatment, IFN-alpha helps the body generate innate immune cells, such as dendritic cells and macrophages, that are designed to attack unhealthy cells.
Immunotherapy may cause immune cells to attack healthy cells, which cause a variety of side effects, including fatigue, nausea, diarrhea, and flu- symptoms.
Throughout your treatment, your care team may offer supportive care services, including nutrition therapy, naturopathic therapy and mind-body medicine.
These therapies are intended to reduce side effects and improve your quality of life during immunotherapy.
Immunotherapy: Is It Right for Your Cancer Type?
Immunotherapy is revolutionizing the way doctors treat cancer. But it doesn’t work for everyone or for every type of cancer. What makes it a lifesaver for some people and completely ineffective for others? It all depends on the cancer — and on other factors that researchers are still trying to figure out.
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How does immunotherapy work?
“Immunotherapy is a complete change from the standard treatments we’ve used for cancer for a long time,” says oncologist Nathan Pennell, MD.
Traditional treatments target the cancer and try to kill it, or at least stop it from growing. Immunotherapy drugs work differently. They unblock your immune system so that it can target and destroy the cancer.
Immunotherapy can cause cancer to go into remission and, in rare cases, might even cure people who previously might have been incurable, Dr. Pennell says.
Who benefits from immunotherapy?
The main drawback is that it doesn’t work for every patient or every type of cancer. And, determining who will benefit isn’t an exact science.
Cancers that doctors commonly treat with immunotherapy include:
- Lung cancer
- Some skin cancers (particularly melanoma)
- Kidney cancer
- Bladder cancer
- Head and neck cancers
These are some of the most common cancers, which is why researchers have tested immunotherapy on them. Dr. Pennell predicts that eventually researchers will test it for treating all types of cancer.
Even among patients who have cancers that are known to respond, though, it’s hard to predict who will benefit.
“We’re not yet perfect at picking out who will benefit the most,” he says. “But we do have some tools to help us decide.”
For example, doctors now routinely test patients who have non-small-cell lung cancer for a type of protein called PD-L1. Those with cancer containing high levels of PD-L1 tend to respond better to immunotherapy, he says.
One recent study showed that for these patients, immunotherapy significantly improved survival rates. It affected both how much the cancer shrank and how long it stayed under control.
“On average, these patients are now living about two and a half years, whereas with chemotherapy alone they tend to live about a year,” Dr. Pennell says.
For some patients, the benefits are even greater.
About 15 to 20 percent of lung cancer patients taking immunotherapy drugs continue to respond as long as they’re on them — sometimes for longer than five years. For a small number of patients, the treatment may cure the cancer entirely.
Genetic testing also helps doctors determine who will respond well.
“We look at what’s called the tumor mutation burden,” Dr. Pennell says. By sequencing the DNA of the tumor, doctors determine whether the cancer contains a high level of mutated genetic material. If so, it’s more ly to respond, because it’s easier for the immune system to recognize and attack these tumors.
Can this therapy work for you?
For some types of cancer, including melanoma and lung cancer with high PD-LI, immunotherapy is now the standard of care. That means it is ly one of the first-line treatments you’ll receive.
For other cancers, doctors may try immunotherapy after chemotherapy stops working. Talk to your care team to find out whether it could help treat your cancer.
You may also consider joining a clinical trial.
“There are a lot of clinical trials happening that are combining immunotherapy with chemotherapy, radiation, other types of immune therapies vaccines,” says Dr. Pennell. “Hopefully through this research, we’ll be able to expand the number of people who benefit from immunotherapy.”
Immunotherapy: What Are the Types?
Immunotherapy uses the natural power of your immune system to fight illnesses, including cancer. In the past few decades, it’s become a key part of treatment for many different types of the disease.
But not all immunotherapies work the same way. Some boost your immune system overall, while others try to teach it to attack very specific types of cells found in tumors.
Each has different benefits and risks and is used in different cases.
CAR T-cell is short for chimeric antigen receptor T-cell therapy. It’s also called adoptive cell transfer therapy, or ACT. It’s only used to treat two types of blood cancers:
- Tisagenlecleucel (Kymriah) is used to treat children and adults up to age 25 with acute lymphoblastic leukemia (ALL) and adults with certain types of large B-cell lymphoma whose cancer didn’t respond to chemotherapy or who had the disease come back two or more times after treatment.
- Axicabtagene ciloleucel (Yescarta) is approved to treat adults with some types of large B-cell lymphoma, such as non-Hodgkin's lymphoma, whose cancer didn’t respond to other treatments or who had the disease come back after those treatments.
T cells are a type of white blood cell your immune system makes to fight disease. Antigens are foreign substances your immune system targets. When your immune system senses antigens in your body, it releases T cells as self-defense.
With CAR T-cell therapy, doctors can “reprogram” your T cells to attack cancer cells. First, you go through a process called leukapheresis that takes a couple of hours. Your doctors take blood your body, separate some T cells from other white blood cells, then put your blood back in.
In a lab, technicians add chimeric antigen receptors (CAR) to your T cells so they can seek out and destroy your exact type of cancer cells. This part takes a few weeks because your doctor needs to reprogram a large amount of CAR T cells to do the job.
Before the new T cells are put into your bloodstream, you may need chemotherapy to cut down on the other types of immune cells in your body. This helps clear the path for the T cells to do their work. Once the CAR T cells are ready, your doctor puts them into your bloodstream. CAR T cells multiply, then seek out and destroy your cancer cells.
Because CAR T cells make many copies of themselves to fight your cancer, they can cause serious side effects in some people, very high fever, severe low blood pressure, confusion, headaches, seizures, a weakened immune system, low blood cell counts, or severe infections.
T-cell receptor therapy (TCR) is another type of ACT used to fight cancer. As with CAR T-cell therapy, doctors take T cells from your blood, then reprogram them so they find cancer cells more easily. But TCRs tell the T cells to look for tiny bits of specific antigens inside your cancer cells.
TCR therapy is done in a similar way as CAR T-cell therapy. T cells are taken from your blood and retooled in the lab. After chemotherapy, your doctor puts the re-engineered T cells back in your body.
Though the FDA hasn’t approved any TCR therapies, some are being tested in people who have certain types of synovial sarcoma (a soft-tissue cancer) and metastatic melanoma. So far, it’s shown mixed results. In some people, it seems to have worked for a few months.
In these small trials, people had different reactions to TCR therapy. Some had no side effects, while others had mild to moderate side effects diarrhea, fevers, fatigue, rashes, and nausea. Others had more serious reactions, including high fever, dehydration, and graft-versus-host disease.
Tumor-infiltrating lymphocytes (TIL) is another type of ACT therapy. Un CAR T cells or TCRs, TIL white blood cells are not reprogrammed in a lab. They’re cells made by your immune system. If these cells have gotten inside the cancer cells, it’s a sign that your body is trying to fight the cancer on its own.
First, doctors will take TILs from your tumor tissue and grow a large number of them in a lab. They then turn up their cancer-fighting ability by adding proteins called cytokines. These proteins help your TILs find and destroy cancer cells.
After treatment with chemotherapy to lower the number of other T cells, the TILs are put into your blood in one dose. The idea behind TIL therapy is that this massive amount of “turned up” white blood cells can break through and kill off the tumor.
TILs are being tested in trials of people who have colorectal, kidney, ovarian, or skin cancers melanoma. Early results have been promising. One big challenge is that it’s hard to get TILs from some people.
An antibody is a molecule that flags proteins in your body as invaders. It then recruits other parts of your immune system to destroy any cells that contain those proteins. Researchers can make antibodies in the lab. They’re called “monoclonal” antibodies. Different ones work in different ways:
- Naked monoclonal antibodies, the most common type for cancer treatment, don’t have anything attached to them. They tell your immune system to attack cancer cells or block proteins within tumors that help the cancer grow.
- Conjugated monoclonal antibodies have a chemotherapy drug or radioactive particle attached to them. The antibodies attach directly to cancer cells. That means they deliver these drugs where they’re needed the most. This lowers side effects and helps treatments chemotherapy and radiation work their best.
- Bispecific monoclonal antibodies are designed to bind to two different proteins at once. Some attach to both a cancer cell and an immune system cell, helping promote immune system attacks on the cancer.
Most people get this type of medication through a vein. Your doctor might also pair it with other treatments chemotherapy or hormone therapy. How often you get it depends on your cancer type. Research is underway to see how monoclonal antibodies work for many cancer types.
To keep you healthy, your immune system has to spot invading molecules bacteria and viruses. It also has to know which of your own cells not to attack.
To keep control, your immune system has molecular brakes called checkpoints. Cancer cells sometimes take advantage of them by turning them on or off so they can hide.
Immune checkpoint inhibitors are drugs designed to release these brakes and let your immune system do its job. They include:
- PD-1 or PD-L1 inhibitors: They target checkpoints called PD-1 or PD-L1 that are found on T cells in your immune system. These inhibitors treat melanoma, non-small-cell lung cancer, kidney cancer, bladder cancer, head and neck cancers, stomach cancer, colorectal cancer, breast cancer, cervical cancer, and Hodgkin's lymphoma.
- CTLA-4 inhibitors turn off a checkpoint called CTLA-4, which is also found on T cells. These inhibitors are used for melanoma, colorectal, and certain other cancer types.
Since these drugs rev up your immune system, they can cause a range of side effects, including fatigue, cough, nausea, loss of appetite, rash, and problems in your lungs, kidneys, intestines, liver, or other organs.
You probably think of a vaccine as something you get to prevent an infection the flu. But it can be any compound that’s put into your body to start an immune reaction. Vaccines treat cancer by spurring your immune system to attack tumor cells.
They can be made of dead cancer cells, proteins or pieces or proteins from cancer cells, or immune system cells. Researchers are working on several right now, but only one is fully approved.
Sipuleucel-T (Provenge) is used to treat advanced prostate cancer that doesn’t respond to other treatments.
Other immunotherapies work by boosting the activity of your immune system in general without targeting a tumor. A more active immune system can better fight cancer. General immunotherapies fall into a few different classes of drugs:
- Interleukins are a type of cytokine, a molecule produced by some immune cells to control the growth and activity of other immune cells. A man-made version of an interleukin called IL-2 is approved to treat advanced kidney cancer and metastatic melanoma. Researchers are studying others.
- Interferons are a type of cytokine that can change the way your immune system works. An interferon called IFN-alfa is used to treat cancers, including:
- Hairy cell leukemia
- Chronic myelogenous leukemia (CML)
- Follicular non-Hodgkin's lymphoma
- Cutaneous (skin) T-cell lymphoma
- Kidney cancer
- Kaposi sarcoma
- Colony stimulating factors strengthen your immune system by boosting the production of white blood cells in your bone marrow. This can help your immune system return to normal activity after chemotherapy.
- Other drugs including imiquimod (Zyclara), lenalidomide (Revlimid), pomalidomide (Pomalyst), and thalidomide (Thalomid) kick-start immune system reactions and are used to treat some cancers.
American Cancer Society: “Cancer Vaccines,” “Immune checkpoint inhibitors to treat cancer,” “CAR T-cell Therapy,” “Monoclonal antibodies to treat cancer,” “Non-specific cancer immunotherapies and adjuvants,” “What is cancer immunotherapy?” “What’s new in cancer immunotherapy research?”
Disease Models and Mechanisms: “Genetically modified T cells in cancer therapy: opportunities and challenges.”
Immunotherapy: “Current status for engineered T-cell therapy for synovial sarcoma.”
National Cancer Institute: “CAR T-cell Therapy Approved for Some Children and Young Adults With Leukemia,” “Immunotherapy,” “Immunotherapy: Using the immune system to treat cancer.”
Mayo Clinic: “What cancers may be treated with monoclonal antibody drugs?”
Rambam Maimonides Medical Journal: “Adoptive T Cell Immunotherapy for Cancer.”
University of Texas M.D. Anderson Cancer Center: “Immunotherapy.”
FDA: “FDA Approves CAR-T cell therapy to treat adults with certain types of large B-cell lymphoma.”
New England Journal of Medicine: “T-Cell Transfer Therapy Targeting Mutant KRAS in Cancer.”
© 2020 WebMD, LLC. All rights reserved. Combination Care
Immunotherapy for Cancer – National Cancer Institute
Immunotherapy is a type of cancer treatment that helps your immune system fight cancer. The immune system helps your body fight infections and other diseases. It is made up of white blood cells and organs and tissues of the lymph system.
Immunotherapy is a type of biological therapy. Biological therapy is a type of treatment that uses substances made from living organisms to treat cancer.
Immunotherapy: How the Immune System Fights Cancer
Learn about nonspecific immune stimulation, T-cell transfer therapy, and immune checkpoint inhibitors, which are 3 types of immunotherapy used to treat cancer.
As part of its normal function, the immune system detects and destroys abnormal cells and most ly prevents or curbs the growth of many cancers. For instance, immune cells are sometimes found in and around tumors.
These cells, called tumor-infiltrating lymphocytes or TILs, are a sign that the immune system is responding to the tumor. People whose tumors contain TILs often do better than people whose tumors don’t contain them.
Even though the immune system can prevent or slow cancer growth, cancer cells have ways to avoid destruction by the immune system. For example, cancer cells may:
- Have genetic changes that make them less visible to the immune system.
- Have proteins on their surface that turn off immune cells.
- Change the normal cells around the tumor so they interfere with how the immune system responds to the cancer cells.
Immunotherapy helps the immune system to better act against cancer.
Several types of immunotherapy are used to treat cancer. These include:
- Immune checkpoint inhibitors, which are drugs that block immune checkpoints. These checkpoints are a normal part of the immune system and keep immune responses from being too strong. By blocking them, these drugs allow immune cells to respond more strongly to cancer. Learn more about immune checkpoint inhibitors.
- T-cell transfer therapy, which is a treatment that boosts the natural ability of your T cells to fight cancer. In this treatment, immune cells are taken from your tumor. Those that are most active against your cancer are selected or changed in the lab to better attack your cancer cells, grown in large batches, and put back into your body through a needle in a vein. T-cell transfer therapy may also be called adoptive cell therapy, adoptive immunotherapy, or immune cell therapy.Learn more about T-cell transfer therapy.
- Monoclonal antibodies, which are immune system proteins created in the lab that are designed to bind to specific targets on cancer cells. Some monoclonal antibodies mark cancer cells so that they will be better seen and destroyed by the immune system. Such monoclonal antibodies are a type of immunotherapy. Monoclonal antibodies may also be called therapeutic antibodies.Learn more about monoclonal antibodies.
- Treatment vaccines, which work against cancer by boosting your immune system’s response to cancer cells. Treatment vaccines are different from the ones that help prevent disease. Learn more about cancer treatment vaccines.
- Immune system modulators, which enhance the body’s immune response against cancer. Some of these agents affect specific parts of the immune system, whereas others affect the immune system in a more general way. Learn more about immune system modulators.
Immunotherapy can cause side effects, many of which happen when the immune system that has been revved-up to act against the cancer also acts against healthy cells and tissues in your body.
Learn more about immunotherapy side effects.
Different forms of immunotherapy may be given in different ways. These include:
- Intravenous (IV) The immunotherapy goes directly into a vein.
- Oral The immunotherapy comes in pills or capsules that you swallow.
- Topical The immunotherapy comes in a cream that you rub onto your skin. This type of immunotherapy can be used for very early skin cancer.
- Intravesical The immunotherapy goes directly into the bladder.
You may receive immunotherapy in a doctor’s office, clinic, or outpatient unit in a hospital. Outpatient means you do not spend the night in the hospital.
How often and how long you receive immunotherapy depends on:
- Your type of cancer and how advanced it is
- The type of immunotherapy you get
- How your body reacts to treatment
You may have treatment every day, week, or month. Some types of immunotherapy given in cycles. A cycle is a period of treatment followed by a period of rest. The rest period gives your body a chance to recover, respond to the immunotherapy, and build new healthy cells.
You will see your doctor often. He or she will give you physical exams and ask you how you feel. You will have medical tests, such as blood tests and different types of scans. These tests will measure the size of your tumor and look for changes in your blood work.
Researchers are focusing on several major areas to improve immunotherapy, including:
- Finding solutions for resistance. Researchers are testing combinations of immune checkpoint inhibitors and other types of immunotherapy, targeted therapy, and radiation therapy to overcome resistance to immunotherapy.
- Finding ways to predict responses to immunotherapy. Only a small portion of people who receive immunotherapy will respond to the treatment. Finding ways to predict which people will respond to treatment is a major area of research.
- Learning more about how cancer cells evade or suppress immune responses against them. A better understanding of how cancer cells get around the immune system could lead to the development of new drugs that block those processes.
- How to reduce the side effects of treatment with immunotherapy.
To find clinical research studies that involve immunotherapy visit Find NCI-Supported Clinical Trials or call the Cancer Information Service, NCI’s contact center, at 1-800-4-CANCER (1-800-422-6237).
NCI’s list of cancer clinical trials includes all NCI-supported clinical trials that are taking place across the United States and Canada, including the NIH Clinical Center in Bethesda, MD.
If you would to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions.
In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g.
, “Immunotherapy to Treat Cancer was originally published by the National Cancer Institute.”
The immune system finds and defends the body from infection and disease. Cancer is a complex disease that can evade and outsmart the immune system. It’s often not recognized until it has already become too difficult to handle.
Cancer immunotherapy improves the immune system’s ability to eliminate cancer. There are several types of immunotherapies, and each helps the immune system in a different way.
Types of immunotherapies
Immune checkpoint therapy helps cancer-fighting immune cells, called T cells, mount a longer-lasting response against the cancer.
Adoptive cellular therapy increases the number and/or effectiveness of immune cells, usually T cells, which improves the power of the immune response against the cancer. There are three main types of adoptive cellular therapy:
- Chimeric Antigen Receptor (CAR) T cell therapy gives patients large amounts of T cells that are all genetically engineered to find and fight the cancer.
- Chimeric Antigen Receptor (CAR) natural killer (NK) cell therapy is a promising new cellular immunotherapy that is still in clinical trials. NK cells are immune system cells that identify and then kill abnormal cells, including some cancer cells. Many cancers are good at avoiding detection, though. This limits the ability of NK cells to fight the disease naturally. In CAR NK cell therapy, NK cells are engineered to better recognize cancer, boosting their ability to find and kill cancer cells. Researchers do this by collecting NK cells from donated umbilical cord blood. They then add a molecule known as a chimeric antigen receptor, or CAR, to the NK cells. This CAR recognizes a molecule on the surface of cancer cells, enabling the CAR NK cells to better find and fight cancer.
- Tumor infiltrating lymphocyte (TIL) therapy uses a patient’s T cells that are collected from a piece of surgically-removed tumor. While these cells may recognize the cancer, there are too few of them to succeed. The number of these cells is increased substantially in the lab and then given back to the patient.
- Endogenous T-cell (ETC) therapy uses T cells from a patient’s blood. From this diverse pool of T cells, doctors select only those that may recognize signatures specific to the cancer. The number of these specific T cells is increased substantially and then given back to the patient.
Cancer vaccines help the body recognize cancer cells and stimulate the immune system to destroy them. Cancer vaccines usually contain one of the following:
- cancer cells taken from the patient’s tumor
- proteins designed to attach themselves to cancer cells
- proteins specific to a patient’s tumor
Monoclonal antibodies attach to specific proteins on the surface of cancer cells or immune cells. They either:
- mark the cancer as a target for the immune system, or
- boost the ability of immune cells to fight the cancer
Cytokine therapy relies on proteins called interferons and interleukins to trigger an immune response. Interleukin-2 (IL-2) is used to treat kidney cancers and melanomas that have spread to other regions of the body.
Interferon alpha (IFN-alpha) is currently being used to treat melanoma, kidney cancer and certain leukemias and lymphomas.
These cytokine treatments are also being combined with other types of immunotherapies to increase their effectiveness.
Each type of immunotherapy has distinct side effects. Moreover, certain immunotherapies are more effective for some types of cancer than others. A patient’s overall health and type of cancer determines which immunotherapies are available to them.
Sometimes two different types of immunotherapies are combined during treatment. Other times, a single immunotherapy is used with another type of therapy, such as chemotherapy. These combination approaches are used to improve treatment.
Several immunotherapies are standard treatments for certain cancers, while others are only offered through clinical trials. Some types of cancer aren’t treatable by current immunotherapies. To extend the benefits of immunotherapy, MD Anderson is leading research to identify new and more effective ways to improve the immune response to cancer.
How Immunotherapy Is Used to Treat Cancer
Immunotherapy is treatment that uses certain parts of a person’s immune system to fight diseases such as cancer. This can be done in a couple of ways:
- Stimulating, or boosting, the natural defenses of your immune system so it works harder or smarter to find and attack cancer cells
- Making substances in a lab that are just immune system components and using them to help restore or improve how your immune system works to find and attack cancer cells
In the last few decades immunotherapy has become an important part of treating some types of cancer. New immunotherapy treatments are being tested and approved, and new ways of working with the immune system are being discovered at a very fast pace.
Immunotherapy works better for some types of cancer than for others. It’s used by itself for some of these cancers, but for others it seems to work better when used with other types of treatment.
What the immune system does
Your immune system is a collection of organs, special cells, and substances that help protect you from infections and some other diseases. Immune cells and the substances they make travel through your body to protect it from germs that cause infections. They also help protect you from cancer in some ways.
The immune system keeps track of all of the substances normally found in the body. Any new substance that the immune system doesn’t recognize raises an alarm, causing the immune system to attack it.
For example, germs contain substances such as certain proteins that are not normally found in the human body. The immune system sees these as “foreign” and attacks them.
The immune response can destroy anything containing the foreign substance, such as germs or cancer cells.
The immune system has a tougher time targeting cancer cells, though. This is because cancer starts when normal, healthy cells become changed or altered and start to grow control. Because cancer cells actually start in normal cells, the immune system doesn’t always recognize them as foreign.
Clearly there are limits on the immune system’s ability to fight cancer on its own, because many people with healthy immune systems still develop cancer:
- Sometimes the immune system doesn’t see the cancer cells as foreign because the cells aren’t different enough from normal cells.
- Sometimes the immune system recognizes the cancer cells, but the response might not be strong enough to destroy the cancer.
- Cancer cells themselves can also give off substances that keep the immune system from finding and attacking them.
To overcome this, researchers have found ways to help the immune system recognize cancer cells and strengthen its response so that it will destroy them. In this way, your own body is actually getting rid of the cancer, with some help from science.
Types of cancer immunotherapy
There are several main types of immunotherapy used to treat cancer, and many are being studied. For more information about immunotherapy as a treatment for a specific cancer, please see Cancer A-Z and choose a cancer type.
- Checkpoint inhibitors: These drugs basically take the ‘brakes’ off the immune system, which helps it recognize and attack cancer cells.
- Chimeric antigen receptor (CAR) T-cell therapy: This therapy takes some T-cells from a patient's blood, mixes them with a special virus that makes the T-cells learn how to attach to tumor cells, and then gives the cells back to the patient so they can find, attach to, and kill the cancer.
- Cytokines: This treatment uses cytokines (small proteins that carry messages between cells) to stimulate the immune cells to attack cancer.
- Immunomodulators: This group of drugs generally boosts parts of the immune system to treat certain types of cancer.
- Cancer vaccines: Vaccines are substances put into the body to start an immune response against certain diseases. We usually think of them as being given to healthy people to help prevent infections. But some vaccines can help prevent or treat cancer.
- Monoclonal antibodies (mAbs or MoAbs): These are man-made versions of immune system proteins. mAbs can be very useful in treating cancer because they can be designed to attack a very specific part of a cancer cell.
- Oncolytic viruses: This treatment uses viruses that have been modified in a lab to infect and kill certain tumor cells..