What is cancer immunotherapy?

Immunotherapy, sometimes called biological therapy, is a type of cancer treatment. It works by using your immune system to help treat the cancer.

Usually, your immune system fights germs, bacteria and viruses that may cause disease. Cancer cells can sometimes weaken your immune system and stop it from working properly.

Immunotherapy works by:

• improving your immune system to help attack cancer cells
• removing barriers that stop your immune system from finding and attacking cancer cells

There are several different types of immunotherapies used in cancer treatment. They target different parts of your immune system.

Certain immunotherapies are currently approved for use in Australia for some cancers and are being trialled for other cancers.

Talk with your doctor about whether immunotherapy could benefit you.

What are the types of cancer immunotherapy?

There are several different types of immunotherapies that can be used in the treatment of cancer.

Monoclonal antibodies (mAbs)

These medicines can:

• attach to cancer cells and signal your immune system to destroy them
• block parts of the cancer cell to slow its growth
• deliver radiotherapy or chemotherapy directly to the cancer cell to attack it

Checkpoint inhibitors

Immune checkpoint inhibitors help your immune system find and attack cancer cells. Normally, your body has “checkpoints” that stop your immune system from working too hard. Checkpoint inhibitors block these checkpoints so your T-cells (the fighter cells in your body) can better recognise and destroy cancer cells.

Other types of immunotherapy

• Immune stimulants — help your immune system become more active so it can attack cancer cells.
• Adoptive cell transfer — an experimental treatment that strengthens your T-cells, helping them find and destroy cancer cells.
• Oncolytic virus therapy — uses viruses to infect the tumour cells and cause an immune response against the infected cells.
• CAR T-cell therapy — helps your T-cells attack cancer more effectively. Some of your T-cells are taken from your blood and changed in a lab so they can better recognise and destroy cancer cells. These improved T-cells are then returned to your blood. This process can take several weeks.
• Cancer vaccines — use biological material to help your immune system prevent, find and treat cancer cells.

What are the benefits of cancer immunotherapy?

There are many types of cancer immunotherapy that can be used to target cancer. Immunotherapy can be used by itself or with other cancer treatments.

Immunotherapy may be used to treat:

• head and neck cancers
• lung cancer
• kidney cancer
• liver cancer
• bladder cancer
• melanoma and Merkel cell carcinoma (a rare type of skin cancer)
• breast cancer

It's also used in the treatment of blood cancers including lymphoma and leukaemia.

Immunotherapy is most often used for cancer that is already advanced at the time of diagnosis, or that has come back and spread after treatment. Sometimes it is used if other treatments haven't worked to get rid of your cancer.

When thinking about your treatment and if immunotherapy is right for you, your doctor will consider:

• your age
• your general health
• what type of cancer you have
• how much the cancer has grown or spread
• what kind of treatment you've already had

What does cancer immunotherapy involve?

What your immunotherapy treatment involves depends on the type of immunotherapy. It can be given:

• orally — by swallowing a pill or liquid
• intravenously — through a drip into a vein
• topically — by rubbing a cream onto your skin
• intravesically — by putting it into your bladder

How often and how long you have immunotherapy depends on:

• the type and stage of your cancer
• the type of immunotherapy and how you respond to it
• what side effects you have

How can I prepare myself for cancer immunotherapy?

Speak to your doctor or oncologist before treatment to understand how best to prepare. You might need to have blood tests or scans before starting treatment.

How soon will I recover?

Cancer immunotherapy works with your immune system, so your recovery depends on the dose and schedule of your treatment. Side effects may stop once treatment ends or will gradually improve over time.

What complications can happen?

Cancer immunotherapy stimulates your immune system. This can cause complications known as autoimmune toxicity — when your immune system attacks healthy cells as well as cancer cells.

Common complications and side effects of cancer immunotherapy include autoimmune effects such as:

• joint pain
• fever or chills
• dermatitis, causing skin rashes and itching
• tiredness (fatigue)
• weight loss or weight gain
• diarrhoea, abdominal pain and bloating

Less common side effects include:

• headache and changes in eyesight
• chest pain
• liver inflammation
• pulmonary oedema (fluid in the lungs)
• confusion
• seizures

You may also experience flu-like symptoms such as:

• coughing
• shortness of breath
• muscle pain

Side effects can appear during or after treatment. Sometimes side effects start months or even years after immunotherapy treatment. This is because your immune system retains a memory of the immunotherapy.

Tell your doctor about any new symptoms or side effects that you notice during or after your treatment. Also let them know about any side effects that are getting worse.

Your doctor will recommend treatment for the side effects. While there is a risk of severe side effects, most people have only mild side effects.

Are there alternatives to cancer immunotherapy?

Different cancers and different people respond differently to treatment. Other treatment options that your doctor may recommend include:

• surgery
• radiation therapy
• chemotherapy

Different approaches to treating a cancer can be used at the same time. If one treatment does not work, your oncologist may recommend a different approach.

What will happen if I decide not to have the procedure or it is delayed?

Diagnosing and starting cancer treatment early gives you a better chance of a successful outcome and recovery. The decision to delay or not have immunotherapy is up to you. Your doctor will talk to you about your options, and may make a recommendation.

Resources and support

Dealing with cancer and cancer treatment can feel overwhelming, but there are many organisations that can help with information and support.

The Cancer Council has information on cancer and support services — call them on 13 11 20.

The Peter MacCallum Cancer Centre has videos on what to expect from immunotherapy.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.

Languages other than English

• Cancer Council NSW has cancer information in different languages.
• Cancer Australia also has cancer resources in languages other than English.

Information for Aboriginal and/or Torres Strait Islander peoples

• Cancer Council has information for Aboriginal and/or Torres Strait Islander peoples.
• Cancer Australia has support and resources for Aboriginal and/or Torres Strait Islander peoples with cancer, their families and communities.
• Our Mob and Cancer has information on cancer treatments and living with cancer.