Immunotherapy

Procedures for cancer immunotherapy

Immunotherapy is usually just one part of a cancer treatment plan. It's typically given in addition to other cancer therapies, such as chemotherapy, radiation and surgery. Not every patient requires all of these, but a tailored combination is often part of an individual's cancer treatment journey.

Immunotherapy is provided on an outpatient basis (meaning that no hospital stay is required). Depending on the drug, it may be given in the following ways:

• Intravenously (IV). Infused directly into a vein
• Topically. Applied to skin as a lotion or cream
• Orally. Taken by mouth as a pill or capsule
• Intravesical administration. Delivered directly into the bladder using a catheter (a thin, flexible tube) for early-stage bladder cancer 

How long and how often you'll have immunotherapy treatments depends on the type of therapy, type and stage of the cancer, and how your body responds. Treatments may occur daily, weekly or monthly, or may be administered in cycles. Cycle-based therapy includes a rest period after each treatment session, giving the body a chance to rest, respond to the therapy and generate new, healthy cells.

Throughout immunotherapy treatment, you'll have regular checkups so your doctor can monitor your progress and address any problems.

Types of immunotherapy for cancer

Immunotherapy is an expanding field of cancer treatment, with many new types under investigation. The following are the most common immunotherapies used today.

Monoclonal antibodies

One way the immune system protects the body from germs and other foreign substances is by making antibodies. These are proteins that circulate in the blood, looking for viruses, bacteria and other organisms that cause disease. When an antibody finds a target cell, it attaches to a specific molecule on the surface called an antigen. That binding marks the cell for destruction by other immune system cells or processes.

Monoclonal antibodies are antibody-like proteins created in the lab to recognize specific cancer cells. They are engineered to function in different ways, including by flagging cancer cells, by triggering an immune response that destroys the outer wall of a cancer cell, by blocking the growth of cancer cells, by directly attacking cancer cells, and by delivering radiation therapy or chemotherapy. Monoclonal antibodies are used to treat a wide variety of cancers.

Immune checkpoint inhibitors

Some immune cells have a built-in system, using proteins known as immune checkpoints, that stops them from attacking healthy cells. Certain cancer cells protect themselves from destruction by activating these checkpoints in immune cells. Immune checkpoint inhibitors, which are a type of monoclonal antibody, block that activation, allowing the immune cells to recognize and destroy cancer cells.

Immune checkpoint inhibitors may be used to treat:

• Bladder cancer
• Breast cancer
• Cervical cancer
• Colon cancer
• Head and neck cancers, such as mouth or throat cancer
• Hodgkin's lymphoma
• Liver cancer
• Lung cancer
• Rectal cancer
• Renal cell cancer, a type of kidney cancer
• Skin cancers, including melanoma
• Stomach cancer
  
  

Adoptive T-cell therapy

T cells are a powerful type of white blood cell that fights germs to fend off disease. In this type of immunotherapy, T cells are collected from your own blood or tumor tissue, then grown in large numbers in the laboratory and returned to your body to help your immune system combat the cancer. Sometimes the T cells are modified in the lab to make them better cancer fighters. For one type of adoptive cell therapy, called CAR (chimeric antigen receptor) T-cell therapy, specific proteins are added to the patient's T-cells that enable them to recognize and destroy cancer cells.

Adoptive T-cell therapy may be used in the treatment of blood cancers, including:

• Leukemia
• Lymphoma
• Multiple myeloma

Vaccines

Cancer cells contain molecules called tumor-associated antigens. These antigens aren't found in normal cells. Cancer vaccines help the immune system learn to recognize these antigens and destroy cancer cells containing them. The vaccine may be made from your own tumor cells or from immune cells collected from your body. These cells are modified in the lab and infused back into your body, where they stimulate a targeted immune response against your cancer.

A vaccine for prostate cancer is currently the only cancer vaccine approved for treatment. However, clinical trials (studies using human volunteers) are evaluating vaccines to treat melanoma and glioblastoma (an aggressive type of brain tumor).

Oncolytic viruses

This therapy uses viruses known to infect cancer cells. The viruses are modified in the lab to produce an immune-boosting substance, then injected directly into the tumor. After invading a tumor cell, the virus rapidly replicates, causing the cell to burst. This releases the substance that stimulates the immune system to seek out and destroy remaining cancer cells.

To date, this technique has been approved only as a treatment for metastatic melanoma.

Side effects of immunotherapy for cancer

Because immunotherapy ramps up your immune system, healthy tissues and organs can also be attacked. This may result in various side effects – though they're usually mild.

Side effects can show up at any point during treatment, so it's important to talk to your doctor about what to look out for. Different types of immunotherapy have different side effects. The most common ones include:

• Abnormal blood pressure (low or high)
• Chills
• Dizziness
• Fatigue
• Fever
• Digestive issues, such as nausea, vomiting, diarrhea or constipation
• Headache
• Heart palpitations
• Itchiness
• Muscle or joint pain
• Pain, swelling or soreness at the infusion or injection site
• Rash
• Respiratory issues, such as coughing, congestion or shortness of breath
• Weakness
• Weight loss or gain

Possible adverse effects

Most patients won’t have major complications, but in some people, the stimulated immune system goes beyond targeting cancer cells and attacks healthy tissues. This can cause serious damage to the skin, lungs, heart, brain or other body parts. Some patients have developed severe inflammatory conditions, including inflammation of the lungs, pancreas, liver, kidneys, colon, nerves, eyes and heart muscle.

The extent of these adverse effects will depend on several factors, including:

• The patient's condition prior to treatment
• The type of cancer
• How advanced the cancer is
• The type of immunotherapy and dosage used

UCSF has specialists who focus specifically on managing the toxicities associated with immunotherapy. Our Cancer Immunotherapy Toxicity Evaluation Program provides resources for patients and doctors navigating these side effects.