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Immunotherapy for cancer

Biological therapy; Biotherapy

Immunotherapy is a type of cancer treatment that relies on the body's infection-fighting system (immune system). It uses substances made by the body or in a lab to help the immune system work harder or in a more targeted way to fight cancer. This helps your body get rid of cancer cells.

Immunotherapy works by:

  • Stopping or slowing the growth of cancer cells
  • Preventing cancer from spreading to other parts of the body
  • Boosting the immune system's ability to get rid of cancer cells

There are several types of immunotherapy for cancer.

Monoclonal Antibodies

The immune system protects the body from infection. It does this by detecting germs such as bacteria or viruses and making proteins that fight infection. These proteins are called antibodies.

Scientists can make special antibodies in a lab that seek out cancer cells instead of bacteria. Called monoclonal antibodies, they are also a type of targeted therapy.

Some monoclonal antibodies work by sticking to cancer cells. This makes it easier for other cells made by the immune system to find, attack, and kill the cells.

Other monoclonal antibodies work by blocking signals on the surface of the cancer cell that tell it to divide.

Another type of monoclonal antibody carries radiation or a chemotherapy drug to cancer cells. These cancer-killing substances are attached to the monoclonal antibodies, which then deliver the toxins to the cancer cells.

Monoclonal antibodies treat several different types of cancer:

  • Non-Hodgkin lymphoma
  • Hodgkin lymphoma
  • Chronic lymphocytic leukemia
  • Anaplastic large cell lymphoma
  • Advanced melanoma
  • Stomach cancer
  • Breast cancer
  • Advanced colon or rectal cancer
  • Kidney cancer
  • Certain types of brain cancer
  • Cancers of the head and neck

Immune Checkpoint Inhibitors

"Checkpoints" are specific molecules on certain immune cells that the immune system either turns on or turns off to create an immune response. Cancer cells can use these checkpoints to avoid being attacked by the immune system.

Immune checkpoint inhibitors are a newer type of monoclonal antibody that act on these checkpoints to boost the immune system so it can attack cancer cells.

PD-1 inhibitors are used to treat:

  • Melanoma of the skin
  • Non-small cell lung cancer
  • Kidney cancer
  • Hodgkin lymphoma
  • Stomach cancer
  • Liver cancer
  • Head and neck cancer 

PD-L1 inhibitors treat bladder cancer, lung cancer, and Merkel cell carcinoma, and are being tested against other types of cancer.

Drugs that target CTLA-4 treat melanoma of the skin.

Non-specific Immunotherapies

These therapies boost the immune system in more general way than monoclonal antibodies. There are two main types:

Interleukin-2 (IL-2) helps immune cells grow and divide more quickly. A lab-made version of IL-2 is used for advanced forms of kidney cancer and melanoma.

Interferon alpha (INF-alfa) makes certain immune cells better able to attack cancer cells. It is rarely used to treat:

  • Hairy cell leukemia
  • Chronic myelogenous leukemia
  • Follicular non-Hodgkin lymphoma
  • Cutaneous (skin) T-cell lymphoma
  • Kidney cancer
  • Melanoma
  • Kaposi sarcoma

Vaccine-Based Immuno therapy

This type of therapy uses viruses that have been altered in a lab to infect and kill cancer cells. When these cells die, they release substances called antigens. These antigens tell the immune system to target and kill other cancer cells in the body.

This type of immunotherapy is still in the very early stages of development.

Currently this type of therapy is used to treat advanced prostate cancer. It is being tested on other types of cancer.

Side Effects of Immunotherapy

The side effects for different types of immunotherapy for cancer differ by the type of treatment. Some side effects occur where the injection or IV enters the body, causing the area to be:

  • Sore or painful
  • Swollen
  • Red
  • Itchy

Other possible side effects include:

  • Flu-like symptoms (fever, chills, weakness, headache)
  • Nausea and vomiting
  • Diarrhea
  • Muscle or joint aches
  • Feeling very tired
  • Headache
  • Low or high blood pressure
  • Inflammation of the liver, lungs, endocrine organs, gastrointestinal tract, or skin

These therapies can also cause a severe, sometimes fatal, allergic reaction in people sensitive to certain ingredients in the treatment. However, this is very rare.

References

Cancer.Net website. Understanding immunotherapy. www.cancer.net/navigating-cancer-care/how-cancer-treated/immunotherapy-and-vaccines/understanding-immunotherapy. Updated April 2017. February 15, 2018.

National Cancer Institute website. CAR T cells: engineering patients' immune cells to treat their cancers. www.cancer.gov/about-cancer/treatment/research/car-t-cells. Updated December 14, 2017. Accessed February 15, 2018.

National Cancer Institute website. Immunotherapy to treat cancer. www.cancer.gov/about-cancer/treatment/types/immunotherapy. Updated May 4, 2017. Accessed February 15, 2018.

Pardoll D. Cancer immunology. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 6.

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          Review Date: 1/31/2018

          Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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