What is immunotherapy?

Not everyone is a candidate, but if you are, immunotherapy has been ‘revolutionary’ in treating certain types of cancers

Within the last seven or 10 years, there’s been a noticeable paradigm shift in cancer treatment. It used to be your options included surgery, radiation or chemotherapy, or maybe a combination of the three.

And if you are diagnosed with cancer, there’s still a good chance you will need one or more of those modalities. But in recent years a couple of other options have come about that – if you are the right candidate – can be game changers in your cancer treatment.

You have probably seen the commercials for one such newer option, immunotherapy.

Immunotherapy is a type of cancer treatment that boosts your body’s immune system to help it recognize and attack cancer cells. It’s similar to chemotherapy in the sense that it’s a drug administered through an IV, explains Dr. Gary Thomas, board-certified medical oncologist and Medical Director SC Cancer Specialists St. Joseph’s/Candler.

Immunotherapy may be used as a standalone treatment or in combination with chemotherapy and/or radiation therapy and potentially given before or after surgery. Everyone’s treatment plan is individualized to best attack their type of cancer.

Related Article: What is personalized cancer care?

An immunotherapy infusion typically takes about 30 minutes, depending on which drug is prescribed. How long you need immunotherapy varies. Dr. Thomas has had patients who had three or four doses and the cancer was gone. Yet, he has another patient who has been on a certain immunotherapy drug for about seven years.  

“Immunotherapy has been revolutionary in the treatment of cancer. I would venture to say we give almost as much immunotherapy now as we do chemotherapy here,” Dr. Thomas says, who sees patients at our St. Joseph’s/Candler Bluffton and Hilton Head offices. “But, it’s still so new, and we have a lot more to learn about it.”

Who may get immunotherapy

Immunotherapy doesn’t work for all types of cancers and is best for only certain patients. Dr. Thomas says a lot of homework goes into determining if a patient is a good candidate for immunotherapy.

For example, we know immunotherapy isn’t successful at treating pancreatic or primary brain cancer, Dr. Thomas says. However, it’s been very successful at treating melanoma. You may recall Jimmy Carter’s triumph over stage 4 melanoma in the brain. He was taking an immunotherapy drug.

Immunotherapy may also be helpful in treating certain breast cancers (especially triple negative breast cancer), some colorectal cancers and non-small cell lung cancer.

Five years ago, the survival rate for metastatic, non-small cell lung cancer was five percent, meaning 95 percent of people with that stage would be dead in five years. With immunotherapy, it’s now a 20 percent survival rate. Still not perfect, Dr. Thomas says, but that’s 15 people out of 100 that are most likely cured compared to just five.

Even if you have one of the types of cancers that has shown to benefit from immunotherapy treatment, there is still other criteria you have to meet. One example is looking at your biomarker makeup.

A biomarker is a biological molecule found in blood, tissues or other bodily fluids. Depending on your type of cancer, your physician can score your biomarker makeup, and if you reach a certain threshold, that may make you a good candidate for immunotherapy.

If you have an underlining auto immune disease that is actively being treated or if you are on an immuno-suppressant, you are not a candidate for immunotherapy. This would include if you have had a kidney transplant, or if you have multiple sclerosis, or you have rheumatoid arthritis that is actively being treated.

“I can’t over emphasize if you have the right patient, immunotherapy can be the best treatment. With the same emphasis, it’s important to remember that not everyone is a candidate,” Dr. Thomas says.  

Side effects of immunotherapy

Immunotherapy typically has different side effects than chemotherapy. It doesn’t usually cause nausea, vomiting or hair loss, Dr. Thomas says. It can cause more severe side effects, which is another main reason you need the right candidate.

Immunotherapy can put you at risk of many of the common conditions that end in -itis, as Dr. Thomas likes to tell his patients. One example is pneumonitis, which is inflammation of the lungs. You could also be put at risk of hepatitis, or liver problems. Colitis, or frequent diarrhea, is another side effect. You may also be at risk of developing skin rashes (dermatitis), a high active thyroid or even develop type 1 diabetes.

“The patients who do experience side effects, most of the time it’s a grade 1 or grade 2, so not too serious, and there are antidotes for them,” Dr. Thomas says. “There are grade 3 and grade 4 conditions, and that’s when it can get very serious. We don’t take any of this lightly.”

Dr. Thomas is hopeful that as we continue to study and research immunotherapy drugs, outcomes will be even better and side effects more minimal.