Immunotherapy
Immunotherapy helps your immune system recognize cancer cells better and fight them. Its side effects are different from those of chemotherapy and should be reported early.
What is immunotherapy?
Our immune system fights germs and abnormal cells. Cancer cells sometimes find a way to hide from this system or switch it off.
Immunotherapy helps the immune system recognize cancer better and act against it. There are several types. One of the most common is immune checkpoint inhibitors. Immune checkpoints are brakes in the immune system that stop it from overreacting. These medicines release those brakes so that immune cells can attack the cancer more strongly.
Other types include monoclonal antibodies, treatment vaccines, and immune cell transfer. Your doctor chooses the type of treatment for you.
Who is it for?
Immunotherapy is used for some cancers, such as some skin, lung, kidney, and bladder cancers, among others. Whether it is right for you depends on:
- The type and stage of the cancer
- The results of tests on a sample of the tumor
- Any history of autoimmune disease and the medicines you take
- Your general health
Sometimes immunotherapy is used alone, and sometimes together with chemotherapy, radiation therapy, or targeted therapy.
Every patient’s treatment plan is different; ask your doctor about your own situation.
How is immunotherapy given?
Most immunotherapy medicines are given as an IV (intravenous) infusion. Some are taken as pills or capsules, as a cream applied to the skin (for very early skin cancers), or through the bladder (for bladder cancer).
Infusions are given at a doctor’s office, a clinic, or a hospital outpatient unit. Sessions may be several weeks apart. Sometimes treatment is given in cycles, with rest periods. Your doctor decides how long treatment lasts.
During treatment, your doctor follows your progress with exams, blood tests, and imaging. Ask your doctor what your test and imaging results mean. Before you start, tests on a sample of the tumor or blood tests are sometimes done to find out whether this treatment is right for you.
What is each session like?
A blood test is usually done before each session. Then a nurse places an IV in your vein and the medicine drips in over about half an hour to an hour or more. The exact time depends on the medicine.
If you have chills, itching, trouble breathing, dizziness, or chest pain during the infusion, tell the nurse right away.
Before you leave the clinic, ask for a list of symptoms you should report and the phone number of your care team. Keep this card with you at all times.
Common side effects and how to care for yourself
An activated immune system can sometimes react against healthy tissue too. These are called “immune-related side effects,” and they can affect any organ. These are the ones usually seen:
- Fatigue
- Skin: rash and itching
- Bowel: diarrhea, belly pain, or bloody or black stool
- Lungs: a new cough, trouble breathing
- Hormone glands (such as the thyroid): racing heart, weight changes, feeling cold, severe tiredness
- Liver: yellow skin or eyes, dark urine
- Eyes or nerves: blurry vision, weakness or numbness, severe headache
Care tips:
- Do not brush off any side effect. Tell your care team about every new symptom, even if it seems mild.
- Do not take medicine of your choice for fever or diarrhea without your doctor’s instructions.
- Keep your skin moisturized and protect it from the sun.
- Keep a notebook and write down your symptoms with the dates.
- Tell every other doctor or dentist you see that you are on immunotherapy.
Most side effects can be managed when found early, sometimes with medicine. For severe side effects, your doctor may pause or change the treatment.
When to call right away
Call your care team the same day if you:
- Have diarrhea or a change in bowel habits, or bloody or black stool
- Have a widespread rash, blisters, or peeling skin, especially if your mouth or eyes are affected
- Have a new or worsening cough or trouble breathing
- Have yellow eyes or skin, or dark urine
- Have a severe headache, confusion, changes in behavior, blurry vision, or muscle weakness
- Have a fever of 38 degrees Celsius (100.4 degrees Fahrenheit) or higher
- Have an irregular heartbeat, chest pain, or swelling in your legs
If your trouble breathing is severe or getting worse, go to the emergency room right away or call 115 (Iran’s emergency number). Keep in mind that these side effects can also appear months after treatment ends.
Every patient’s treatment plan is different; ask your doctor about your own situation.
Frequently asked questions
How is immunotherapy different from chemotherapy?
Chemotherapy directly damages cancer cells and other fast-dividing cells. Immunotherapy strengthens or guides your own immune system so it responds to the cancer. The side effects are different too.
Is immunotherapy used for every cancer?
No. Whether it is used depends on the type and stage of the cancer and the features of the tumor. Your doctor decides whether it is right for you.
When do immunotherapy side effects show up?
They may appear during treatment or even months after it ends. Even after treatment is finished, take warning signs seriously and tell your care team.
If I get diarrhea or a skin rash, can I wait for it to get better?
No. During immunotherapy, tell your care team the same day about diarrhea, a rash, or a new cough or trouble breathing, and do not treat it on your own.
Should I tell my doctor about my other health conditions before starting?
Yes. Be sure to tell your doctor if you have a history of autoimmune disease, an organ transplant, or thyroid disease, or if you take medicines that suppress the immune system.