Immunotherapy

There are several types of immunotherapies used to treat cancer, and many more are currently being studied.

The main types of immunotherapies include:

1. Checkpoint inhibitors – these block proteins that prevent immune cells from attacking cancer cells. These "checkpoints" normally prevent the immune system from being too aggressive, but cancer cells can exploit them to hide from immune detection. 
2. Chimeric antigen receptor (CAR) T-cell therapy – this involves harvesting a patient's T cells (a type of immune cell), genetically modifying them in the laboratory to better recognise cancer cells, then infusing them back into the patient so that these cells can fight cancer. 
3. Tumour infiltrating lymphocytes (TILs) – these are special white blood cells taken from a tumour, multiplied in a lab, and returned to the body to target and destroy the cancer. 
4. Monoclonal antibodies - these are laboratory-made antibodies designed to bind to specific targets on cancer cells, either marking them for destruction by the immune system or blocking signals that help the cancer grow. 
5. Cancer vaccines – these help the immune system recognise and attack specific cancer-associated proteins. 
6. Cytokine therapy – this therapy uses proteins that naturally regulate immune system activity to boost the body's anti-cancer response.

NCCS is actively involved in cancer research and conducts both investigator-initiated trials and industry sponsored trials that provide patients access to new cutting-edge therapies. To participate in a clinical trial, you can consult your treating oncologist to find out if there are any suitable trials that you are eligible to participate in.

Currently, immunotherapy can be used to treat a wide range of cancers including but not limited to bladder, breast, cervical, colorectal, endometrial, gastric, hepatobiliary, kidney, lung cancer and melanoma. Immunotherapy works better to treat some cancers compared to others. Depending on the cancer type and staging, immunotherapy can be used on its own or may be combined with other treatments such as chemo, surgery, or radiation therapy for the best treatment outcome.

Immunotherapy may be used:

• Before surgery or radiation to shrink a tumour (neoadjuvant therapy) 
• After surgery or radiation to help kill any remaining cancer cells (adjuvant therapy) 
• Alongside other drugs that act directly on cancer cells, such as chemotherapy
• If the cancer comes back or doesn't fully respond to other treatments

The timing and sequencing of these combinations are important. Sometimes treatments are given simultaneously, other times sequentially. Researchers continue to study optimal combinations, dosing, and timing to maximise treatment effectiveness whilst managing side effects. As ongoing research is being conducted, more indications for immunotherapy are emerging.

Immunotherapy can be administered in different ways, depending on the type of treatment and the condition being treated:

1. Intravenous (IV) infusion is the most common method for many immunotherapies, particularly checkpoint inhibitors and monoclonal antibodies. The drug is delivered directly into the bloodstream through a vein, usually over 30 minutes to several hours. This is typically administered in a clinic setting. 
2. Subcutaneous injections involve injecting the treatment under the skin, similar to how insulin is given to diabetics. Some newer immunotherapies and certain cytokine treatments can be administered this way. 
3. Oral medications taken as tablets or capsules, are available for some immunotherapy drugs. This is becoming more common as pharmaceutical companies develop more oral formulations of treatments. 
4. Intratumoral injections involve injecting the immunotherapy directly into a tumour. This approach can concentrate the treatment at the cancer site while potentially reducing systemic side effects. 
5. CAR-T cell therapy requires a more complex process: T cells are first collected from the patient through a procedure called leukapheresis (similar to blood donation), then modified in a laboratory over several weeks, and finally infused back into the patient intravenously. 
6. TIL therapy involves surgically removing tumour tissue, expanding the immune cells from that tissue in a laboratory for several weeks, then infusing the expanded cells back into the patient intravenously after preparatory chemotherapy.

The frequency of immunotherapy treatments varies – some treatments are given weekly, some are administered every few weeks

As immunotherapy uses the body’s immune system to destroy cancer, it can cause different side effects from traditional cancer treatments. Side effects may be different for each person, depending on the type and dose of immunotherapy you receive, as well as your type of cancer, location, and overall health.

General side effects include:

• Skin changes, such as rash 
• Fatigue 
• Nausea, vomiting, or diarrhoea 
• Flu-like symptoms, such as fever, chills, and muscle aches 
• Infusion reactions

Immunotherapy may also cause the immune system to attack healthy cells. This can cause immune-related adverse effects. These may happen at any time during treatment or sometimes even after treatment stops. A wide range of organs can potentially be affected by immune-related adverse events such as the lungs, bowel, liver, kidney and skin to name a few. It is important to be aware of possible side effects so that you know what to watch for and can raise it with your care team so the side effects can be detected early and managed appropriately.

Preparing for immunotherapy involves several important steps to optimise treatment success and manage potential side effects.

• Medication review is crucial as certain medications can interfere with immunotherapy. Your healthcare team will review all current medications, supplements, and herbal remedies that you are taking. 
• Vaccination updates should be completed before starting treatment, as live vaccines should generally be avoided during immunotherapy. Your doctor may recommend updating routine vaccinations like flu shots. 
• Good nutrition and eating a balanced diet to support your immune system is important. Some patients benefit from consulting a nutritionist, especially if they have digestive issues. 
• Lifestyle modifications include getting adequate sleep, managing stress, and not smoking or consuming excessive alcohol helps healthy immune function. 
• A good support system such as family or friends is essential since treatment schedules can be demanding and you may need assistance with daily activities. 
• Education about side effects helps you recognise early warning signs. Your team will tell you about specific symptoms to watch for and emergency contact information. 
• Mental health support through counselling or support groups can help manage the emotional aspects of cancer treatment.

Your healthcare team will provide a personalised preparation plan based on your specific treatment and medical history.

The cost of immunotherapy depends on various factors including:

• The type and number of doses of immunotherapy used 
• How long and how often immunotherapy is given

Based on your recommended treatment plan, your healthcare team will provide an estimated breakdown of the treatment cost and the subsidies available before you start treatment.