Immunotherapy

What is immunotherapy?  

Immunotherapy or biological therapy is a type of treatment that relies on your immune system to destroy cancer cells. 

Immunotherapy assists our immune system to identify cancer cells and attack them. It also boosts your immune system.  

Your doctor may recommend immunotherapy as the standard treatment for your cancer. 

He or she may also recommend immunotherapy alongside other treatments such as chemotherapy.  

How does immunotherapy work?

Our immune system is an intricate assembly of proteins, organs, and cells that help our bodies fight illness, infection, and diseases.

The immune system can also identify and destroy cancerous cells or damaged cells. That means cancerous cells cannot spread or grow. However, cancerous cells are very smart.

Cancer cells can fool your immune systems into thinking they are normal cells and hence escape destruction.

Cancer could develop under the following conditions:

• In case of a weak immune system that cannot destroy the identified cancer cells

• When cancer cells give signals that avoid attack by the immune system

• In the case of cancer cells evade the immune system

• Immunotherapy arrests or limits the growth of cancer

• Immunotherapy boosts your immune system to become more efficient in fighting cancer cells

• It ensures cancer does not spread to other parts of your body

• Immunotherapy promotes direct delivery of chemotherapy or radiation to cancer cells

Why do you need immunotherapy?

Not every cancer can be treated using immunotherapy. However, immunotherapy is the standard treatment for certain metastatic cancers.

Immunotherapy may be used as the main treatment or it could be used alongside other procedures like chemotherapy, surgery, or radiotherapy.

In deciding whether you need immunotherapy, your doctor will be guided by:

• The type of cancer you have been diagnosed with

• If you have received other forms of cancer treatment

• The stage of the cancer- Immunotherapy is useful in treating advanced cancer

Immunotherapy aims to:

• Shrink the tumour before surgery

• Ease symptoms brought about by cancer

• Cure cancer

• Minimize the likelihood of your cancer returning

• Boost the potency of radiation therapy or chemotherapy

• Let you live longer

Types of immunotherapy

The main immunotherapies in use today include:

Checkpoint inhibitors

Our bodies have checkpoints that ensure the immune system remains in control even when faced with damaged healthy cells or intruders.

T lymphocytes (T-cells) defend our bodies from cancer cells and infection.

Immune checkpoints act as a barrier against cancer cells so that they do not activate the push button on your immune cells. They evade attacks from the immune system.

Immune checkpoints do so by cutting off the link between protein cells.

Checkpoint inhibitors treat the following cancers:

• Esophageal cancer

• Bladder cancer

• Melanoma

• Cervical cancer

• Kidney cancer

• High-risk triple-negative breast cancer

Monoclonal antibody therapy

In case of intruders in the body, your immune system turns to antibodies as the first line of defense. These are protein-based antibodies that mark intruders for targeting by the immune system.

Monoclonal antibodies are lab-manufactured antibodies. They reinforce other antibodies in fighting off intruders.

Monoclonal antibodies target cancerous cells to block abnormal proteins in such cells. They may also target cancerous cells by delivering radioactive agents or drugs to eliminate cancerous cells.

Monoclonal antibody therapy treats the following cancer:

• Colorectal cancer

• Multiple myeloma

• Cancer of the bladder

• Lymphoma

• Non-small cell lung cancer

• Breast cancer 

Cytokines

Cytokines are a type of proteins that boost your immune system in fighting intruders such as cancerous cells.

Cytokines control blood cell and immune cell activity and growth. These proteins help your immune system to indicate a coordinated attack on particular cancerous targets.

They may also relay signals that aid in the faster death of cancerous cells while promoting the longevity of healthy cells.

There are two forms of cytokines that your healthcare provider might use in treating cancer.

Interleukins – These aid in the communication of immune system cells. They also initiate an immune response. Interleukins increase B-cells and T-cells in your immune system to fight cancer.

Your healthcare provider can opt for lab-made interleukins in treating kidney cancer, melanoma, and other types of cancer.

Interferons – They limit cancer cell growth while boosting your immune system to fight the disease. Lab-made interferons are widely used in treating specific forms of cancer.

Cancer vaccines

Vaccines like the human papillomavirus (HPV) vaccine protect your body against certain types of infections associated with throat and anal cancer.

Cancer vaccines safeguard you from an infection that might cause cancer in the future. Cancer vaccines assist your body to fight cancer but do not prevent the disease.

Immunomodulatory drugs

Also known as biological response modifiers, immunomodulatory drugs hinder the development of new blood cells in cancerous tumours.

This stops the growth of cancerous tumours. Some cancers treated using immunomodulatory drugs include lymphoma.

Benefits of immunotherapy 

Immunotherapy can be the ideal treatment for you for various reasons.  

If other treatments such as chemotherapy or radiation have not worked for you, it is worthwhile to consider immunotherapy. For example, skin cancer responds better to immunotherapy than other treatments. 

Some cancer treatments like chemotherapy can work better when combined with immunotherapy. 

Immunotherapy is associated with fewer side effects compared to other treatments. Immunotherapy primarily targets the immune system as opposed to all cells. 

Having immunotherapy could mean staying cancer-free for longer. The immuno-memory properties enable your immune system to target returning cancer cells.  

Side effects

Like any other treatment, immunotherapy also comes with certain side effects. The majority of the side effects are mild. They will clear as soon as your body gets used to the medication.

In case of severe side effects, your doctor may consider reducing the dose. Alternatively, he or she may decide to stop the therapy for some time until the severity subsides.

The following factors will determine the type and severity of immunotherapy side effects:

• Dose

• The type of drug given

• Mode of administering the drug (that is, intravenously or orally)

• The patient’s overall health

The side effects of immunotherapy are different for different people but include:

Skin reaction – Certain immunotherapy drugs cause itchy skin or the development of skin rashes. The skin reaction may occur during treatment and persist during the procedure.

In case of any skin change after treatment, let your doctor know of this. Your doctor can prescribe medication to manage the itchiness. He or she may also recommend certain creams or moisturizers to ease the itchiness.

Flu-like symptoms – You may experience nausea, pain or chases in muscles and joints, chills, and loss of appetite.

Some people experience flu-like symptoms immediately after immunotherapy. Your doctor can prescribe acetaminophen or other related drugs to minimize these side effects.

Birth defects – Certain immunomodulating drugs like lenalidomide and thalidomide may lead to severe birth defects when taken by a pregnant woman.

Fatigue – You are likely to feel exhausted after immunotherapy. This is a temporary feeling. Fatigue is associated with the dose of immunotherapy drug being administered.

Preparing for immunotherapy 

Confirm your booking with your healthcare provider a day or two before immunotherapy.

The healthcare team will conduct a blood test to check if your blood levels are within acceptable levels. Otherwise, your doctor may delay or cancel the treatment.  

You may also undergo additional treatment such as IV fluids or blood transfusion. The treatment is meant to correct any abnormalities. 

Take a light meal on the eve of the treatment. If you are on any medication, let your healthcare provider know about it. 

You will be asked to wear loose-fitting clothes and comfortable shoes.  

It would be a good idea for your spouse, a friend, or a relative to accompany you to the hospital on the day of treatment.  

Ask your doctor if it is okay to carry with you books or a music player to keep you busy as the treatment can take several hours. 

Make sure you carry all the medical records that you have with you. 

The healthcare team will check your weight before the treatment. This is to enable them to compute the immunotherapy dose. 

Before treatment, you have to sign a consent form. Make sure you have carefully read through this form before signing it. If you have any queries, your treating doctor will be happy to answer them.   

How do you receive immunotherapy?

There are various ways of receiving immunotherapy:

• Orally – This can be in the form of capsules or pills
• Intravenously – via a needle into a vein
• Topically – Through skin application

Immunotherapy drugs can be administered at a clinic, hospital, or even at home.

The healthcare team will design a treatment protocol that best suits your healthcare condition.

An individual course of treatment starts with a treatment phase and then you rest during the recovery period. Such a break is important because it allows your body ample time to generate healthy cells.

The treatment cycle could be daily, once per week, or after every month.

The treatment period is determined by:

• The type of cancer and stage

• The specific immunotherapy drug being administered

• How your immune system responds to the immunotherapy drug

Cost of immunotherapy in India

India has become the preferred destination for immunotherapy treatment because of the following reasons:

• Experienced and highly skilled doctors

• State-of-the-art medical infrastructure

• Highly affordable treatment

• Innovative technologies

The cost of immunotherapy treatment in India starts from Rs. 80,000 all the way to Rs. 2,00,000. Below, I summarize the cost of immunotherapy across selected cities in India:

Some factors that affect this wide discrepancy in the cost of immunotherapy across healthcare facilities in India include:

Type of cancer – immunotherapy treatment cost differs based on the type of cancer being treated. The type of cancer will dictate the diagnostic tests, medication, and type of immunotherapy. 

Cancer metastasis – The cost of immunotherapy in treating cancer in India depends on the type of organs affected and the extent to which such cancer has spread. 

If the cancer has only affected one organ, the cost of immunotherapy is cheaper than when multiple organs have been affected. 

Treatment plan – Sometimes, your doctor will recommend immunotherapy alongside other treatments like surgery or chemotherapy. That would mean the overall cost of your treatment will increase. 

Duration of treatment – The time of treatment will affect the cost of immunotherapy. The stage and type of cancer will determine the number of immunotherapy sessions. 

Patient’s health – your overall health will influence the cost of immunotherapy. This is because if your health is not very good, you would need more sessions spread across a longer duration to allow for healthy cell recovery.

Drugs used – There are various types of drugs that are prescribed for immunotherapy. These are priced differently. Your doctor will decide which medication to prescribe. This will have implications for the cost of immunotherapy.

India offers the lowest cost of immunotherapy compared to other countries providing similar treatment.

The table below provides the average cost of immunotherapy in various countries compared to India.

References

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