What Is Immunotherapy?
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Medically reviewed by Gagandeep Brar, MD
Immunotherapy is a type of cancer treatment that uses the body’s immune system to detect and attack cancer cells. An oncologist (or, a medical doctor who specializes in the diagnosis and treatment of cancer) may recommend immunotherapy to boost or change the body’s immune response to certain types of cancer.
You can receive immunotherapy through several routes: through a needle into a vein (intravenously), by mouth (orally), on the skin (topically), or directly into the bladder (intravesical). If immunotherapy is right for you, you'll likely receive treatment in an outpatient clinic or a hospital. The treatment schedule usually depends on the type of cancer you have, how advanced your condition is, the type of immunotherapy you're getting, and how your body reacts to the treatment.
Purpose
The purpose of immunotherapy is to treat cancer by stimulating or boosting the immune system response. Your body’s immune system is made up of blood cells, organs, and substances like lymph fluid. When the immune system detects a foreign substance, such as an infection or cancer cell, it works to find the harmful cells and destroy them quickly.
Cancer cells develop from normal cells, so it can be difficult for the immune system to recognize them as foreign invaders. These cancer cells can evade the immune system response by either producing genetic changes that make them less visible or using proteins on the surface of the cell to turn off immune cells. Cancer cells are also able to change normal cells around a cancerous tumor to prevent immune cells from reaching it. That's why cancer cells can often go undetected and spread quickly.
As a result, immunotherapy helps the immune system recognize and attack cancer cells that may be hard to detect. This is an effective type of treatment for many cancers.
Types of Immunotherapy
Immunotherapy is a type of biological therapy. Biological therapies are any treatment that uses substances from living organisms. There are several types of immunotherapy. Your oncologist will recommend which immunotherapy you need based on the type of cancer you have and your overall health.
Immune Checkpoint Inhibitors
Immune checkpoint inhibitors are drugs that block the immune system's checkpoints. Checkpoints are a normal part of the immune system that keeps immune responses from getting too strong. Checkpoints stop or slow an immune response so that it does not cause damage to your body. By blocking the checkpoints, these drugs can allow the immune cells to respond more strongly to cancer cells.
Chimeric Antigen Receptor (CAR) T-cell Therapy
CAR T-cell therapy is a treatment that boosts the response of a type of immune cell called T-cells (a type of white blood cell that helps your body fight infections, germs, and other foreign invaders). During this procedure, your healthcare team will take a sample of your blood and mix it with a virus that makes the T-cells able to recognize and attach to tumor cells. Then, they give this mixture to you via an IV.
Monoclonal Antibodies
Monoclonal antibodies are proteins that are grown in a lab. They are designed to target and attach to specific proteins on cancer cells. These antibodies trigger the immune system to attack cancer cells.
Treatment Vaccines
For some types of cancer, there are vaccines available to boost the immune system’s response. These vaccines help your body recognize cancer cells and send immune cells to that area of the body to help destroy cancer cells.
Immunomodulators
Immunomodulators are drugs that can increase or decrease the immune response by targeting certain proteins on the cells.
Oncolytic Viruses
Oncolytic viruses are viruses that have been modified in a lab. They are designed to infect and kill cancer cells.
How Does It Work?
Each type of immunotherapy has a unique process and schedule. Your treatment plan will depend on your type of cancer, how advanced it is, the type of immunotherapy being used, and whether your body reacts well to the treatment. In most cases, your healthcare team will give you immunotherapy in cycles, which include periods of treatment followed by periods of rest.
Before Immunotherapy
Your immunotherapy appointment may take place in an outpatient facility or hospital. When you arrive for your appointment, you will be asked to fill out screening questionnaires and a treatment waiver. Your healthcare team may recommend a blood draw to check your lab values and blood cell levels before the procedure.
For most types of immunotherapy, there is no anesthesia required—meaning, you will be awake and alert during the procedure. Immunotherapy can take several hours, so plan to bring reading materials or something to do. To prepare for immunotherapy, your healthcare provider will likely place an intravenous line (IV) with a needle into the vein. It's worth noting that certain types of immunotherapy can take several weeks to prepare.
Preparing for CAR T-cell Therapy
To prepare for CAR T-cell therapy, your healthcare provider will perform a procedure called leukapheresis to remove white blood cells (including T cells) from your blood. During leukapheresis, you will lie down in a bed or reclined chair. Your healthcare provider will place two IV lines. One line will remove the blood and separate the white blood cells. The second line will administer the rest of the blood. Expect to stay seated or lying down for about two to three hours during this procedure.
After leukapheresis, your healthcare provider will send the separated T-cells to a lab to be altered. The modified T-cells will be grown and multiplied in the lab for several weeks. When they are ready to be administered back into your body for treatment, your oncologist will discuss the next steps with you.
During Immunotherapy
During immunotherapy, your healthcare provider will administer the treatment while staying with you to monitor your vital signs and overall health. Vital signs include heart rate, blood pressure, respiratory rate, and temperature.
The procedure itself will vary depending on which type of immunotherapy you’re receiving:
Immune checkpoint inhibitors: Your healthcare team will administer immune checkpoint inhibitors through an IV. Tell your provider if you feel like you are having an infusion reaction during the procedure. Possible symptoms may include fever, chills, flushed face, rash, itching, dizziness, and trouble breathing.
CAR T-cell therapy: Your healthcare team may sometimes administer chemotherapy a few days before this procedure to lower the number of immune cells in your blood. This will allow the modified T-cells to work more effectively. During the procedure, your healthcare provider will administer the T-cells via an IV. It is important to have this procedure in a specialized medical facility because it may cause serious side effects.
Monoclonal antibodies: Your healthcare provider will administer the antibodies through an IV. Some people experience an infusion reaction during the procedure. Symptoms may include fever, chills, headache, nausea, vomiting, diarrhea, low blood pressure, weakness, and a rash. Tell your provider right away if you begin to feel ill during the infusion.
Treatment vaccines: Treatment vaccines are made up of parts of cancer cells to help the body learn how to recognize them. Your provider will inject the vaccines into your body through an IV. Common vaccines include Provenge (sipuleucel-T) for prostate cancer and T-VEC (talimogene laherparepvec) for melanoma.
Immunomodulators: There are different types of immunomodulators. One type of immunomodulatory is Bacillus Calmette-Guerin (BCG), which is a germ that your provider can inject directly into the bladder to treat early-stage bladder cancer. BCG can be given through a catheter and side effects may include fever, chills, and a burning sensation in the bladder. Another type is imiquimod, which is a topical cream that your provider can apply directly to the skin to treat early-stage skin cancers.
After Immunotherapy
Your immunotherapy appointment may take up to several hours. In most cases, you will be able to drive yourself home after your appointment. If you do not feel well, it's a good idea to ask a friend or family member to accompany you to your appointment and drive you home. If you experienced an infusion reaction during the procedure, you may need to stay in the hospital overnight for treatment and observation from your healthcare team.
CAR T-cell therapy may lead to serious complications in the weeks after therapy. After this type of immunotherapy, you will not be able to drive, operate heavy machinery, or participate in any potentially dangerous or strenuous activities for several weeks after the infusion.
After your immunotherapy appointment, your healthcare provider will talk with you about follow-up appointments and tests. You may need to schedule a physical exam, blood test, or imaging test shortly after treatment.
Risks and Precautions
Immunotherapy may cause side effects and serious complications. It is important to talk with your oncologist about the risks and benefits of each type of procedure. In general, biological therapies like immunotherapy tend to cause fewer side effects than chemotherapy.
It's possible to experience the following side effects after immunotherapy:
Allergic reaction
Higher risk of infection
Low levels of blood cells
Abnormal levels of minerals in the blood
Certain types of immunotherapy like CAR T-cell therapy may cause a serious complication called cytokine release syndrome (CRS). Cytokines are proteins that are found in immune cells. As the immune system response increases, the body produces more cytokines. This can lead to an overload of cytokines that causes the following symptoms:
High fever and chills
Nausea and vomiting
Headaches
Dizziness
Fast heart rate
Muscle and joint pain
Fatigue
Trouble breathing
How to Prepare for Immunotherapy
Immunotherapy is an effective cancer treatment, but it's common to have mixed emotions going into your first appointment. To feel a bit more at ease, it may help to know what to expect. Consider the following:
Location: Your immunotherapy appointment may take place at an outpatient facility or hospital. Because this type of therapy may cause a reaction, it is important to go to a facility that specializes in cancer treatment and immunotherapy.
Attire: Plan to wear loose, comfortable clothing to your appointment. You may be given a hospital gown to change into before your appointment. Plan to bring layers in case the procedure causes you to feel hot or cold.
Food and drink: Ask your oncologist if it is safe to eat and drink before your procedure. Because some types of immunotherapy may cause nausea and vomiting, you may want to avoid a large meal before your appointment.
Medications: It is common to take several different prescription medications every day when you are being treated for cancer. Ask your oncologist if you need to stop any of your medications or supplements before immunotherapy. For some types of immunotherapy, you may need to have chemotherapy before the appointment.
Items to bring: Plan to bring a photo identification card and insurance card to your appointment. The appointment may take up to several hours, so plan to bring a book or something to listen to such as a good podcast or your favorite music playlist.
Emotional support: Ask your healthcare team if a loved one can sit with you during your appointment. You may want to ask a friend or family member to drive you home in case you feel ill after your appointment.
Cost and insurance: Call your insurance company and hospital billing department before your immunotherapy appointment to determine if the procedure is covered and what your copay will be.
At-home immunotherapy: If your oncologist prescribes immunotherapy pills, you may be able to take them at home. Use caution when handling the medication. Wear gloves and dispose of the wrapper safely.
A Quick Review
Immunotherapy is a type of cancer treatment that uses your body’s immune system to find and attack cancer cells. The purpose of immunotherapy is to boost your body’s immune response to certain types of cancer. There are several types of immunotherapy—all of which come with their own set of risks and benefits. You can receive this treat through an IV, by mouth, or on the skin. Your exact treatment plan will depend on your type of cancer and the severity of your condition.
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