Immunotherapy for Cancer: What Are My Options?

Immunotherapy is a relatively new approach to cancer treatment. It improves the body's immune system's ability to find and fight cancer. Since 2010, immunotherapy drugs have been developed, tested, and deployed as treatments for some cancer types and stages.

They're not a silver bullet, but for some people and types of cancer, immunotherapy drugs have transformed the treatment landscape. Immunotherapy approved for cancer that has come back or has spread may not help with early-stage cancers.

This article will review what cancer types and stages may benefit from immunotherapy, as well as information about immunotherapy's successes and the side effects of treatment. It will review how immunotherapy works, how much immunotherapy costs, and when immunotherapy for cancer would and wouldn't be used. 

How Immunotherapy Treats Cancer 

Immunotherapy drugs work by helping the body’s immune system fight back against cancer. They may remove blockers that cancers hide behind to escape detection, or they may train immune systems to detect the cancer and attack it. In many cases, immunotherapy ramps up the immune system.

Each immunotherapy treatment is tested and approved for different cancers one at a time. They’re approved for specific stages and types of cancer, so they’re not used across the board. Their use depends on your cancer stage and your healthcare provider's determination of the best treatment plan based on your health and goals.

New treatment combinations are being tested all the time. Immunotherapies may be used alone or combined with other immunotherapies, with chemotherapy, radiation, surgery, targeted treatments, and other therapies and medications. 

Certain cancers have immunotherapies approved by the Food and Drug Administration (FDA). Immunotherapies have been FDA-approved to treat these types of cancer:

• Bladder cancer
• Brain cancer
• Breast cancer
• Cervical cancer
• Colorectal cancer 
• Esophageal cancer 
• Head and neck cancer
• Kidney or renal cell cancer
• Leukemia
• Liver cancer
• Lung cancer
• Lymphoma (Hodgkin's and non-Hodgkin's)
• Melanoma
• Multiple myeloma
• Ovarian cancer 
• Pancreatic cancer
• Prostate cancer
• Sarcoma
• Skin cancer 
• Stomach cancer 
• Uterine (endometrial) cancer

Immunotherapy is also in clinical trials for many other types and stages of cancer. The appropriate stage for cancer treatment with immunotherapy depends on the cancer and which drugs have been approved for that type of cancer. 

Success of Treatment: Does Immunotherapy Work?

Immunotherapies are typically approved first for more advanced cancers, especially those that cannot be removed with surgery. In these cases, they can extend someone’s life or keep their cancer from worsening. 

More recently, immunotherapies are being used to treat early cancers, even as a first-line treatment, alone or with other therapies, including chemotherapy, radiation, and surgery. Sometimes, people can skip other treatments like chemotherapy if immune therapies work well. 

In some cases, immunotherapy alone or immunotherapy or plus surgery may be the only treatment needed to cure early-stage and locally advanced cancers. Treatment with immunotherapy before surgery can shrink the tumors and make surgery easier.

Some people on immunotherapy who previously would have had only months to live with standard treatments have experienced no progression in their cancer for many years with immunotherapy.

Not all cancers react to immunotherapy. Even someone with the “right” type and stage of cancer may not respond as well as the next person for various reasons. These may have to do with the genetics of their immune system or the genetics and characteristics of their cancer. Scientists are still studying ways of finding out who is most likely to respond to immunotherapy and who isn’t.

Types of Immunotherapy

Immunotherapy drugs treat cancer by increasing the immune system’s ability to find and fight cancer cells. Several types of immunotherapy are used to treat cancer with different approaches.

These include:

• Immune checkpoint inhibitors turn down the body’s natural inhibitory mechanisms, called checkpoints, that stop the immune cells from attacking healthy cells. Some cancer cells use these checkpoints to hide from the immune system. Taking the brakes off these checkpoints with inhibitors can let the immune system find and fight cancer cells.
• Cancer vaccines activate the immune system. Many vaccines prevent disease by priming the immune system against viruses or bacteria. These are preventive vaccines, some of which fight cancer-causing viruses. Other vaccines are treatment vaccines used to activate the immune system against cancer.
• Immune cell therapies remove immune cells from the person with cancer and train them to fight cancer. The cells are modified in the lab to boost their ability to fight cancer and are then reinfused into the person. It uses a special virus that helps the T cells (a type of immune cell) attach to the tumor cells and kill them.
• Immunomodulators are drugs that generally boost the immune system. They can help fight certain types of cancer. Cytokines are one type of immunomodulator. These small proteins carry messages between cells, stimulating the immune cells to attack cancer.

Potential Side Effects of Immunotherapy

Side effects vary by the type of immunotherapy used.

Immune checkpoint inhibitors, for example, may cause side effects, including rash or other skin problems, digestive issues like nausea and diarrhea, and fatigue or fever. More dangerous reactions to checkpoint inhibitors include infusion reactions, autoimmune reactions, and widespread inflammation.

Immune system-modulating drugs can cause flu-like symptoms, including fever and chills, weakness and dizziness, nausea or vomiting, muscle or joint aches, fatigue, and headache.

Cytokines, specifically, can lead to serious side effects. These include: 

• Breathing problems.
• Blood pressure issues (low or high)
• Allergic reactions
• Decreased blood counts, leading to infections and bleeding
• Blood clots
• Mood, behavioral, thinking, and memory issues
• Rash, burning, or ulcers on the skin
• Organ damage

Cell therapies are complex procedures that can cause severe reactions.

One side effect of T-cell therapy is cytokine release syndrome, in which the procedure triggers the release of high levels of cytokines into the blood. It can cause flu-like symptoms, a rapid heartbeat, low blood pressure, and trouble breathing. It can be mild or severe and life-threatening. 

Manipulated T cells can also attack normal cells. It can cause a range of issues, including organ damage.

Another cell therapy–related issue is capillary leak syndrome, when fluid and proteins leak out of blood vessels and into surrounding tissues. It causes low blood pressure and can lead to organ failure and shock.

Most preventative vaccines have very mild side effects. Cancer treatment vaccines can cause flu-like symptoms. Some vaccine components can cause a severe allergic reaction. Specific cancer treatment vaccines have their risks, including stroke, tumor lysis syndrome, and herpesvirus infection.

List of Immunotherapy Drugs for Cancer 

Numerous immunotherapies have been approved to treat various cancers. Many more are in clinical trials. The lists below include immunotherapies approved by the FDA and the type of cancer they’re authorized to treat.

Immune Checkpoint Inhibitors

Immune checkpoint inhibitors include:

• Bavencio (avelumab) for Merkel cell carcinoma, bladder and urinary tract (urothelial cell) cancer, and kidney cancer
• Imfinzi (durvalumab) for non-small cell lung cancer, small cell lung cancer, biliary tract cancer, bladder cancer, and liver cancer
• Imjudo (tremelimumab-actl) for non-small cell lung cancer and liver cancer
• Jemperli (dostarlimab-gxly) for endometrial cancer
• Keytruda (pembrolizumab) for melanoma, non-small cell lung cancer, Hodgkin lymphoma, Merkel cell carcinoma, B-cell lymphoma, stomach cancer, cervical cancer, head and neck squamous cell cancer, bladder and urinary tract cancer, esophageal cancer, liver cancer, kidney cancer, endometrial cancer, squamous cell skin cancer, breast cancer
• Libtayo (cemiplimab-rwlc) for squamous cell and basal cell skin cancer and non-small cell lung cancer
• Opdivo (nivolumab) for melanoma, lung cancer, mesothelioma, kidney cancer, Hodgkin's lymphoma, head and neck squamous cell cancer, bladder and urinary tract cancer, colorectal cancer, liver cancer, esophageal cancer, and stomach cancer
• Opdualag (nivolumab and relatlimab-rmbw) for melanoma
• Sylvant (siltuximab) for Castleman's disease
• Tecentriq (atezolizumab) for bladder cancer, non-small cell lung cancer, small cell lung cancer, liver cancer, melanoma, and sarcomas
  
• Yervoy (ipilimumab) for melanoma, kidney cancer, colorectal cancer, liver cancer, non-small cell lung cancer, mesothelioma, and esophageal cancer
  
• Zynyz (retifanlimab-dlwr) for Merkel cell cancer
  

Cancer Vaccines

Cancer vaccines include:

• Vaccines can prevent viral infections that can lead to cancers, like the human papillomavirus vaccines for cervical cancer and throat cancer and the hepatitis B vaccine for liver cancer.
• Bacillus Calmette-Guerin (BCG) therapy uses a type of bacteria that doesn’t typically cause disease to trigger an immune response against bladder cancer.
• Oncolytic virus therapy for melanoma with Imlygic (talimogene laherparepvec, or T-VEC) uses a modified virus that breaks apart cancer cells and triggers a local and systemic immune response, including tumor-specific T cells.

Cell Therapies

Immune cell therapies include:

• Abecma (idecabtagene vicleucel) for multiple myeloma
• Breyanzi (lisocabtagene maraleucel) for B-cell lymphoma
• Carvykti (ciltacabtagene autoleucel) for multiple myeloma
• Kymriah (tisagenlecleucel) for acute lymphoblastic leukemia, B-cell acute lymphoblastic leukemia, B-cell lymphoma, and follicular lymphoma
• Provenge (sipuleucel-T) for prostate cancer (sometimes called a cancer treatment vaccine)
• Tecartus (brexucabtagene autoleucel) for Mantle cell lymphoma and acute lymphoblastic leukemia
  
• Yescarta (axicabtagene ciloleucel) for B-cell lymphoma and follicular lymphoma
  

Immunomodulators

Immunomodulators include:

• Adstiladrin (nadofaragene firadenovec-vncg) for bladder cancer
• Aldara (imiquimod) for skin cancers
• Elzonris (tagraxofusp-erzs) for blood cancer (blastic plasmacytoid dendritic cell neoplasm)
• Multiferon (interferon alpha) for hairy cell leukemia, Kaposi's sarcoma, lymphoma, chronic myeloid leukemia, and melanoma
  
• Pomalyst (pomalidomide) for multiple myeloma and Kaposi's sarcoma
• Proleukin (interleukin-2) for melanoma and kidney cancer
• Revlimid (lenalidomide) for multiple myeloma and mantle cell lymphoma
  
• Sylatron (peginterferon alfa-2b) for melanoma
  
• Thalomid (thalidomide) for multiple myeloma
  

Where to Get Immunotherapy Treatment 

Talk to your oncologist (cancer specialist) about immunotherapy options and clinical trials for your type and stage of cancer. Where you get immunotherapy depends on the kind of treatment and your cancer.

FDA-approved immunotherapies should be available through your oncologist at the hospital or cancer center. Immunotherapies in clinical trials would only be available if you’re enrolled and at participating hospitals.

Many immunotherapies are given as infusions. These require visiting a medical setting, like a hospital, doctor’s office, or infusion clinic. They’re usually given every two to six weeks, sometimes in cycles or as a maintenance therapy, for as long as they’re effective.

Other immunotherapies are more complex procedures that would be done at the hospital, typically as an outpatient.

Summary

Immunotherapy is a relatively new approach to cancer treatment. It uses the body's immune system to fight cancer. FDA-approved immunotherapies treat a variety of cancers, including brain, colorectal, skin, and lung cancers, among many others. 

How oncologists use immunotherapy depends on the type and stage of cancer. They may use immunotherapy alone or in combination with other cancer treatments. Other treatments include chemotherapy, radiation therapy, targeted therapy, and surgery.

Types of immunotherapy include immune checkpoint inhibitors, cancer vaccines, cell therapies, and immunomodulators. They work in different ways. The success of immunotherapy depends on the type of cancer and the stage of the cancer. 

Immunotherapies can have side effects. These include rash, diarrhea, fatigue, and fever. More severe side effects include infusion reactions, immune overreactions, and autoimmune reactions. These can cause organ damage.

Immunotherapy is a promising new treatment for cancer, but it is still under development. It is not always effective, and it is not suitable for everyone with cancer.

The cost of immunotherapy can be high. Medicare, Medicaid, or commercial health insurance may cover some or all of the cost. There are also financial assistance programs available.