When is immunotherapy used?
Cancer immunotherapy may be an effective option for patients with certain types of cancer including melanoma, Hodgkin’s lymphoma, kidney, lung, bladder, and head and neck cancers.
Depending on the type and extent of the cancer, cancer immunotherapy treatments may be paired with other forms of treatment such as radiation therapy, chemotherapy, and targeted therapies.
Your medical oncologist will work together with the other experts on your cancer care team to determine the best possible treatment for you.
Types of Immunotherapy
Checkpoint Inhibitors
The immune system needs to be able to tell the difference between normal and foreign cells, and know which to attack. To do this, checkpoints—certain proteins on the surface of T-cells (a type of white blood cells)—activate or inactivate these T-cells to start an immune response. Checkpoint inhibitor treatments disrupt “inactivate” signals from the proteins, exposing the cancer cells as invaders and allowing the T-cells to attack.
- Checkpoint inhibitors are the most widely used form of immunotherapy for cancer. Generally, 20 to 30 percent of patients are helped by this form of cancer therapy. Some patients with advanced disease have experienced remissions lasting for years.
Side effects of this treatment are minimal for many patients. Checkpoint inhibitors can create autoimmune issues, meaning the immune system attacks healthy tissue along with the cancer. These side effects can vary; however, most side effects can be well managed with steroid medications.
Cancer Treatment Vaccines
Because cancer cells develop from a person’s own healthy cells, the immune system may not read the cancer cells as harmful. Some cancer treatment vaccines work by prompting the immune system to attack the cancer by presenting it with some piece of the cancer. These vaccines are harvested from the individual patient’s tumor. Tumor cells are killed, altered, multiplied, and injected back into the patient to activate the immune response.
Other cancer treatment vaccines contain substances designed to attach themselves to cancer cells to signal an immune system response. Vaccines that are vector-based, meaning the substances are delivered with certain weakened or killed viruses, bacteria, or yeast cells, may further stimulate an immune response.
Patients who have more advanced tumors or weakened immune systems may not be able to produce a strong immune response after vaccination. This could limit the immune system’s ability to respond to a vaccine. For this reason, some researchers think cancer treatment vaccines may work better for smaller tumors, early-stage cancers, or in combination with other treatments such as checkpoint inhibitors.
Oncolytic Viruses
Oncolytic virus therapy uses a genetically modified form of the herpes simplex virus type-1 (cold sores) so that it can’t replicate in healthy cells. The modified virus is injected into melanoma lesions. Inside these tumors, the virus replicates and causes the cells to rupture and die.
Side effects from oncolytic viruses tend to be milder than those from chemotherapy or other therapies, and can include fever, chills, fatigue, back and joint pain, nausea, and headache.
Cell Therapy
Another form of cancer immunotherapy, called cell therapy or adoptive cell transfer (ACT), involves removing immune cells from the patient, altering them genetically to help them fight cancer, multiplying them in the laboratory, and then infusing them back into the patient. This type of treatment is manufactured individually for each patient and is still experimental.
One method of cell therapy involves collecting a sample of T-cells that have permeated a patient’s tumor, called tumor-infiltrating lymphocytes (TILs). These cells are used because they can target tumor cells. However, the body may not make enough of them on its own to destroy the tumor or overpower the immune suppressive signals. So, in the laboratory, TIL counts are increased and the cells are activated. TILs are then infused back into the bloodstream.
Another method of cell therapy that is being actively studied is chimeric antigen receptor (CAR) T-cell therapy. This approach involves collecting a patient’s T-cells and genetically modifying them to express a protein, CAR. The modified cells are grown in the laboratory and infused back into the patient. These receptors allow the modified T-cells to attach to specific proteins on the surface of cancer cells and therefore to attack the cancer cells.
Other Therapeutic Antibodies
Bispecific monoclonal antibody (BsMAb) derivatives do not require individualizing treatment for each patient. In this form of treatment, the antibodies attach to both the cancer cell and a T-cell to kill the cancer cell.
Another class of therapeutic antibodies involves chemically linking antibodies to a toxic substance (like a poison or a radioactive compound), then using the antibody portion to bind to a target molecule on the surface of the cancer cells. Once the antibody is bound to a cancer cell, the antibody is taken up by the cancer cell, which is killed by the toxic substance.
If side effects do occur in therapeutic antibody treatment, they most often happen while the drug is first delivered. Possible side effects can include fever, chills, weakness, headache, nausea, vomiting, diarrhea, low blood pressure, and rashes.
Your Team at Intermountain Cancer Center
Every patient and every cancer is different. Every treatment plan is also different, based on national guidelines and your specific pathology.
Whatever your plan is, you can be confident with your care team at Intermountain Cancer Center locations. Our highly trained team of medical oncologists is experienced in providing cancer immunotherapy. The Cancer Immunotherapy Program at Intermountain Cancer Center is also actively researching and offering clinical trials to increase opportunities for effective cancer treatments.
What to expect during immunotherapy
Immunotherapy Side Effects
The side effects that you may experience will depend on the cancer immunotherapy treatment you are taking and how your immune system reacts to that treatment. Though cancer immunotherapy treatments are fairly well tolerated (there’s no hair loss), a different set of side effects are possible during or after treatment.
Certain types of cancer immunotherapy treatments may come with side effects such as fatigue, fever, chills, nausea, and reactions at the site of the infusion. Your care team will have a better idea of the side effects you may experience. Ask your care team for a list so that you can recognize and manage them as soon as they begin, and keep track of your side effects to update your care team.
Progress
Tumors can respond differently to cancer immunotherapy treatment based on how well your immune system can target the cancer cells. For some patients, treatment can help shrink or eradicate the tumor and for others, it can stop or slow the tumor’s growth. Your care team will use scans to monitor your treatment progress and always let you know the you next steps.
What’s the difference between chemotherapy and immunotherapy?
Chemotherapy uses chemical substances to kill cancerous cells. Chemo drugs work by attacking all rapidly dividing cells in the body, which can include cells other than the cancer (like hair follicles).
Immunotherapy empowers your own immune system to fight cancerous cells. There are different types of immunotherapy but they all work to allow the immune system to recognize cancer cells as an invader and destroy it.
Either treatment may be given alone or in combination with other treatments like surgery or radiation therapy.
Frequently Asked Questions
How effective is immunotherapy for cancer?
Every individual’s treatment and success looks different, because cancer presents itself differently in every body. Immunotherapy may be an effective option for patients with certain types of cancer including melanoma, Hodgkin’s lymphoma, kidney, lung, bladder, head and neck cancers.