What Is Immunotherapy for Cancer? How It Works, Types, & Who Qualifies

Key Takeaways

• Immunotherapy is a major advance in cancer treatment that harnesses the power of the patient’s immune system to identify and attack cancer cells.
• Immunotherapy can be used to treat kidney cancer, lung cancer, blood cancers such as leukemia and lymphoma, prostate cancer, skin cancer, and more.
• There are many types of immunotherapies, including checkpoint inhibitors, CAR-T cell therapy, vaccines, monoclonal antibodies, and cytokines.
• To qualify for immunotherapy, a patient must have a specific biomarker that the therapy can target, such as PD-L1 or human epidermal growth factor receptor 2 (HER2) status.
• At Regional Cancer Care Associates, patients throughout New Jersey, Connecticut, Massachusetts, and the Washington, D.C., area can receive immunotherapy, including checkpoint inhibitors and CAR-T cell therapy.

What Is Immunotherapy?

Immunotherapy is a treatment designed to harness the patient’s immune system to detect, target, and destroy harmful cells. The immune system works by detecting abnormal or harmful pathogens, toxins, and cells to keep a person healthy and protected from disease. However, cancer cells can prevent the immune system from working properly. They can disguise themselves to avoid detection, suppress immune cell function, and prevent T cells from attacking the cancer cells.

Immunotherapy is designed to address this. It can do this in a few ways: enhancing immune responses, blocking checkpoints that hide cancer cells, or re-engineering cells to target a specific type of cancer cell. Immunotherapy is best for certain types of cancer, which have specific tumor traits. These include:

• Kidney cancer
• Leukemia
• Lung cancer, such as non-small cell lung cancer
• Lymphoma
• Prostate cancer
• Skin cancer, including melanoma

It may also be used for certain colorectal cancers, gynecological cancers, and other solid tumors, including triple-negative breast cancer.

How Immunotherapy Differs from Chemotherapy and Radiation

Immunotherapy works differently from other cancer treatments such as chemotherapy and radiation therapy. Chemotherapy uses strong systemic drugs to kill cancer cells, while radiation therapy delivers high-energy rays directly to a certain area to damage the cancer cells’ DNA. Unlike chemo and radiation, immunotherapy does not target cancer cells directly. Instead, it trains the immune system to recognize and fight cancer cells.

Therefore, immunotherapy side effects are different from chemo side effects. Chemotherapy results in systemic issues, such as hair loss, nausea, and low white blood cell counts, due to its systemic effects. Immunotherapy works to remove the safeguards on your immune system that are preventing the cancer cells from being detected. This results in overactive immune cells that can attack healthy organs, leading to side effects such as colitis, pneumonitis, hepatitis, and endocrine disorders.

What Are the Types of Cancer Immunotherapy?

There are various types of immunotherapies to treat cancer, and the best type for a person will depend on several factors, including specific biomarkers, the cancer type and stage, and their overall health. The types of immunotherapies include:

Checkpoint Inhibitors

Checkpoint inhibitors are the most widely used type of immunotherapy. In the immune system, checkpoints are regulatory molecules that act as the “brakes,” preventing T cells from destroying healthy cells. However, they can also prevent the T cells from targeting cancerous cells, enabling their growth and spread. Checkpoint inhibitors are specialized drugs that prevent checkpoint proteins from connecting with cancer signals, effectively releasing the “brakes.” This causes the T cells to reactivate, helping them detect and destroy cancer cells.

Common checkpoint inhibitors used in cancer treatment include:

• PD-1/PD-L1: These are proteins that are frequently found on T cells (PD-1) and cancer cells (PD-L1). Some key drugs that target these proteins include pembrolizumab, nivolumab, and atezolizumab.
• CTLA-4: This protein acts as an off switch early in the activation process of T cells. One commonly used drug that targets this pathway is ipilimumab.

Cancers treated with checkpoint inhibitors include skin cancers, lung cancers, Hodgkin lymphoma, triple-negative breast cancer, and more.

CAR-T Cell Therapy

Chimeric antigen receptor (CAR) T-cell therapy, or simply T-cell therapy, is another type of immunotherapy. It involves a person’s T cells, which are specialized white blood cells that destroy infected or cancerous cells. The process includes:

• Collection: The patient’s T-cells are harvested via apheresis, a blood-filtering process.
• Engineering: In a lab, the cells are modified with a chimeric antigen receptor (CAR), giving them the ability to detect and hunt cancer cells.
• Infusion: The patient undergoes a short round of chemotherapy to prepare their immune system. Then, their custom cells are infused back into their body.

Once these cells are infused into the body, the patient’s immune cells are engineered to fight cancer. CAR-T cell therapy is suitable for treating blood cancers, including leukemia, lymphoma, and multiple myeloma.

Monoclonal Antibodies

Antibodies are a vital component of the immune system, recognizing and attacking foreign invaders such as viruses and bacteria. Monoclonal antibodies are man-made proteins that imitate the behaviors of natural antibodies, acting as targeted immune messengers.

In cancer treatment, monoclonal antibodies target the specific proteins that are only found on the surface of cancer cells. They may directly attack the cells, prevent cancer cell growth, or mark cancer cells for the immune system to fight. Examples of monoclonal antibody treatments include rituximab, trastuzumab, and bevacizumab. They can help treat various cancers, including melanoma, lung cancer, brain cancer, stomach cancer, and more.

Cancer Vaccines

Vaccines can also be used to prevent and treat cancer. A preventative (prophylactic) cancer vaccine triggers the immune system to prevent certain viruses and infections that may cause or contribute to the development of cancer. These are given to healthy people with no symptoms of cancer.

A cancer treatment (therapeutic) vaccine helps boost the immune system’s natural abilities to fight off cancer by training it to detect, attack, and destroy cancer cells. These are given to patients who already have cancer. There are two types available: the Bacillus Calmette-Guérin (BCG) vaccine used to treat bladder cancer, and Sipuleucel-T, used to fight advanced prostate cancer.

Cytokines

Cytokine immunotherapy involves using engineered or naturally occurring soluble proteins (cytokines) to stimulate and enhance the body’s immune system. Cytokines help certain immune cells, such as T cells and natural killer (NK) cells, identify and destroy cancer cells. The two most common types include:

• Interleukin-2 (IL-2): This causes T and NK cells to grow and activate. It is approved for treating metastatic melanoma and advanced renal cell carcinoma.
• Interferon-alpha (IFN-α): This helps boost anti-cancer immune functions. It is used to treat conditions such as hairy cell leukemia, Stage III melanoma, and certain blood cancers.

Although cytokines are effective for certain cancers, they also tend to have a narrow treatment window and can lead to severe systemic toxicity. Therefore, research is ongoing to mitigate these hurdles.

Who Is a Candidate for Immunotherapy?

Immunotherapy is a great advance in cancer research, but it’s not suitable for every patient. To determine if immunotherapy is a viable treatment option, patients must undergo biomarker testing. This involves examining blood, tissue, or bodily fluids to identify specific genes, proteins, or molecules that can be targeted with immunotherapy. Common biomarkers that are looked for include:

• Programmed death-ligand 1 (PD-L1) expression testing: This tests for PD-L1 protein expression, which can determine eligibility for checkpoint inhibitors.
• Microsatellite instability (MSI): This test checks to see how visible the tumor is to the immune system. People with colon, endometrial, and other cancers who have high instability may respond well to immunotherapy drugs like checkpoint inhibitors.
• Tumor mutational burden (TMB): This test determines how mutated the tumor is. Tumors that are highly mutated are ideal candidates for checkpoint inhibitors.
• Human epidermal growth factor receptor 2 (HER2) status: This test determines whether the tumor is HER2 positive, which enables eligibility for targeted monoclonal antibody therapies.

These biomarker tests help determine whether immunotherapy will be an option for the patient. However, patients may need to meet other requirements, such as having good organ function and performance status, so they can tolerate the demanding treatment and recovery period.

What Are the Side Effects of Immunotherapy?

Since immunotherapy turns off the “brakes” that prevent cancer cells from being identified and attacked, it can lead to overactive immune cells. These may attack healthy organs, resulting in immune-related adverse events (irAEs) and side effects including:

• Fatigue
• Skin reactions, such as rashes and itching
• Diarrhea or colitis
• Flu-like symptoms
• Pneumonitis (lung inflammation)
• Hepatitis
• Endocrine disorders, including thyroid and adrenal conditions

If you’re experiencing these side effects after treatment, reach out to your oncologist to discuss them.

CAR-T Cell Therapy Side Effects

Certain types of immunotherapies can also have specific side effects, such as CAR-T cell therapy. This type of immunotherapy can lead to severe side effects, including cytokine release syndrome (CRS) and neurotoxicity.

CRS causes high levels of inflammatory cytokines to be released into the bloodstream, resulting in symptoms such as high fever, fatigue, low blood pressure, rapid heartbeat, and trouble breathing. Neurotoxicity occurs when the immune response affects the central nervous system, leading to symptoms like confusion, hallucinations, tremors, and seizures. Both can be life-threatening, so seek immediate medical attention if you experience these side effects after CAR-T cell therapy.

Explore Immunotherapy Options Near You in NJ, CT, MA, and the Washington, D.C., Area

If you’re curious whether immunotherapy can be an effective treatment for your cancer, reach out to Regional Cancer Care Associates (RCCA), which offers checkpoint inhibitor infusions at infusion therapy centers near you, as well as CAR-T cell therapy through its clinical trials program.

RCCA specialists provide care to more than 30,000 new patients and 265,000 established patients each year. RCCA physicians offer patients innovative therapies, including immunotherapies and targeted therapy, cutting-edge diagnostics as well as access to approximately 300 clinical trials in community-based centers close to home.

To learn more about RCCA, call 844-346-7222 or contact RCCA online.

Frequently Asked Questions About Immunotherapy for Cancer

What is immunotherapy for cancer?

Immunotherapy is a cancer treatment that uses the patient’s immune system to detect, target, and destroy harmful cells, which often go undetected otherwise.

How does immunotherapy work differently from chemotherapy?

Immunotherapy works differently from chemotherapy because it does not directly target cancer cells. Immunotherapy trains the immune system to detect and attack cancer cells, whereas chemotherapy uses strong drugs to kill cancer cells.

What cancers can be treated with immunotherapy?

Immunotherapy only works for certain types of cancer that have specific tumor traits. They include kidney cancer, leukemia, lung cancer, lymphoma, prostate cancer, and skin cancer. It can also be used for colorectal cancers, gynecological cancers, and solid tumors, such as triple-negative breast cancer.

What is CAR-T cell therapy?

Chimeric antigen receptor (CAR) T-cell therapy is a form of immunotherapy that involves T cells. The T cells are collected from the patient’s body, modified in a lab to help them detect and attack cancer cells, and infused back into the patient’s body.

Who qualifies for immunotherapy?

To qualify for immunotherapy, a patient must have a specific biomarker that the therapy can target. Some common biomarkers include PD-L1, microsatellite instability (MSI), tumor mutational burden (TMB), and human epidermal growth factor receptor 2 (HER2) status. Doctors will also consider a patient’s overall health to see if they can handle the therapy and recovery.

What are the side effects of immunotherapy?

Immunotherapy can cause immune-related adverse events (irAEs), which occur when the therapy causes the body’s immune system to attack its own healthy tissues. It can cause side effects like:

• Fatigue
• Skin reactions
• Diarrhea or colitis
• Flu-like symptoms
• Pneumonitis
• Hepatitis
• Endocrine disorders

Can immunotherapy put cancer into remission?

Although it’s not effective for every patient, immunotherapy can lead to long-term remission in some patients, helping them achieve the best possible outcomes.

Is immunotherapy available at RCCA?

Yes. At RCCA, we provide both checkpoint inhibitor infusions at our infusion therapy centers and CAR-T cell therapy via our clinical trials.