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Last updated on March 21, 2022
Immunotherapy is a treatment option for a growing number of cancers. Unlike traditional treatments like chemotherapy and radiation therapy, immunotherapies do not target the cancer itself.
“At times, our immune system can become tolerant to cancer for various reasons,” says Aung Naing, M.D., who leads an immunotherapy working group in MD Anderson’s Phase I clinical trials program. “With immunotherapy, we are trying to harness or reinvigorate the immune system so that it recognizes and attacks the cancer instead of being tolerant.”
What are the different types of immunotherapy?
There are several types of immunotherapy. Immune checkpoint inhibitors work by blocking checkpoint proteins – including CTLA-4, PD-L1 and PD-1 – on the surface of T cells. These proteins normally prevent T cells from attacking healthy cells. Approved checkpoint inhibitors include:
- anti-CTLA-4 therapy ipilimumab
- anti-PD-1 therapies pembrolizumab, nivolumab, cemiplimab and dostarlimab
- anti-PD-L1 therapies atezolizumab, avelumab and durvalumab
- anti-LAG-3 therapy relatlimab
Adoptive cellular therapies are another form of immunotherapy. The only Food and Drug Administration (FDA)-approved options are CAR T cell therapies, which are created from T cells taken from the patient. The cells are engineered to better recognize the cancer, expanded to large numbers and given back to the patient. FDA-approved CAR T cell therapies include brexucabtagene autoleucel, tisagenlecleucel, axicabtagene ciloleucel and lisocabtagene maraleucel.
Cancer vaccines train the body to recognize specific features of the cancer and stimulate the immune system to attack. The only approved cancer vaccine is sipuleucel-T.
Finally, cytokine therapies rely on immune proteins called interferons and interleukins to stimulate immune activity. The main cytokines that have been approved for cancer treatment are interleukin-2 and interferon alpha.
Immunotherapy treats many types of cancer
Currently, the FDA has approved immunotherapies to treat certain patients with the cancer types listed below. The list is expanding frequently as more immunotherapy drugs complete testing through clinical trials. So, if immunotherapy isn’t an option for you right now, that could change in the future.
“We are constantly evaluating therapies in new cancer types and testing new therapies that have not been used before,” says Naing.
In most cases, patients must have had previous treatment with certain treatments or have specific tumor markers in order to be eligible for these therapies. Keep in mind that the information shared here should not be considered medical advice. “It’s important to talk to your doctor to determine whether you may be eligible for immunotherapy or to address specific medical questions or concerns,” Naing says.
Advanced solid tumors
Certain children and adults with advanced solid tumors and specific tumor characteristics may be eligible for treatment with the immune checkpoint inhibitors pembrolizumab or dostarlimab, regardless of cancer type.
B-cell lymphoma
For some children and adults with B-cell lymphoma, the following immunotherapy treatments may be an option:
- Certain adults with advanced large B-cell lymphoma may be eligible for CAR T cell therapy with tisagenlecleucel, axicabtagene ciloleucel or lisocabtagene maraleucel.
- Certain adults with mantle cell lymphoma may be eligible for brexucabtagene autoleucel CAR T cell therapy.
- Certain adults with advanced follicular lymphoma may be eligible for axicabtagene ciloleucel CAR T cell therapy.
- Certain adults and children with primary mediastinal B-cell lymphoma may be treated with pembrolizumab.
Bladder cancer
Several checkpoint inhibitors have been approved to treat certain patients with locally advanced or metastatic bladder cancer. Approved drugs include pembrolizumab, atezolizumab, nivolumab, durvalumab and avelumab in certain indications. Nivolumab in combination with the targeted therapy cabozantinib is approved as a first-line treatment in some patients.
Breast cancer
For some adults with triple-negative breast cancer, immune checkpoint inhibitors may be an option. The FDA has approved treatment with atezolizumab in combination with the chemotherapy paclitaxel (protein-bound) and pembrolizumab in combination with chemotherapy.
Cervical cancer
Certain patients with recurrent or metastatic cervical cancers may be eligible for treatment with the immune checkpoint inhibitor pembrolizumab, either alone or in combination with chemotherapy and the targeted thearpy bevacizumab.
Colorectal cancer
Immune checkpoint inhibitors may be an option for certain patients with advanced colorectal cancer with specific tumor markers, including pembrolizumab and nivolumab (either alone or in combination with ipilimumab).
Esophageal cancer
For some patients with squamous cell esophageal cancer, the immune checkpoint inhibitors pembrolizumab and nivolumab may be an option.
Certain patients with esophageal cancer or gastroesophageal junction cancer may be treated with immune checkpoint inhibitors:
- For some patients with resectable cancer, the FDA has approved treatment with nivolumab.
- Certain patients with advanced cancers may be treated with pembrolizumab or nivolumab combined with certain chemotherapies.
Head and neck cancers
Certain patients with advanced squamous cell cancer of the head and neck, such as oral cancer or throat cancer, may be eligible for treatment with the immune checkpoint inhibitors nivolumab or pembrolizumab. In some cases, pembrolizumab may be used alone or in combination with certain chemotherapies.
Hodgkin lymphoma
For certain patients with refractory classical Hodgkin lymphoma, the FDA has approved treatment with pembrolizumab and nivolumab.
Kidney cancer
Immune checkpoint inhibitors may be an option for certain patients with advanced kidney cancer. Either avelumab or pembrolizumab may be used in combination with the chemotherapy axitinib for some patients. Nivolumab may be used alone or in combination with ipilimumab for some patients. Pembrolizumab alone has been approved following surgery for certain patients with increased risks of recurrence.
The cytokine therapies interferon alpha, in combination with the targeted therapy bevacizumab, or interleukin-2 may also be options for some patients.
Leukemia
Tisagenlecleucel CAR T cell therapy is an option for some children
and young adults with refractory B-cell acute lymphoblastic leukemia (ALL). For adults with relapsed or
refractory B-cell ALL, brexucabtagene
autoleucel CAR T cell
therapy may be an option.
The cytokine therapy interferon alpha may also be an option for some patients with certain leukemias.
Liver cancer
Certain patients with liver cancer may be treated with the immune checkpoint inhibitors pembrolizumab, nivolumab (alone or in combination with ipilimumab), or atezolizumab in combination with the targeted therapy bevacizumab.
Lung cancer
Certain patients with advanced non-small cell lung cancer may be eligible for treatment with immune checkpoint inhibitors, including nivolumab (alone or with ipilimumab), pembrolizumab, atezolizumab, durvalumab and cemiplimab. In some circumstances, these therapies are only approved for treatment in combination with certain chemotherapies or targeted therapies.
Some patients with advanced small cell lung cancer also may be eligible for treatment with pembrolizumab, nivolumab, atezolizumab or durvalumab. Atezolizumab and durvalumab are used in combination with specific chemotherapies.
Melanoma
Immune checkpoint inhibitors have been approved for certain patients with advanced melanoma. These include pembrolizumab, atezolizumab, ipilimumab, nivolumab and relatilimab. Nivolumab may be offered along or as part of a combination with ipilimumab or relatlimab. Relatlimab is approved in combination with nivolumab. Atezolizumab is approved in combination with certain targeted therapies.
The cytokine therapies interferon alpha or interleukin-2 may also be options for some patients.
Mesothelioma
For some patients with unresectable malignant pleural mesothelioma, the FDA has approved treatment with ipilimumab in combination with nivolumab.
Multiple myeloma
Certain patients with advanced multiple myeloma may be treated with the CAR T cell therapy idecabtagene vicleucel.
Non-Hodgkin lymphoma
Some patients with relapsed or refractory B-cell non-Hodgkin lymphoma may be eligible for treatment with the immunotherapy:
- Certain adults with advanced large B-cell lymphoma may be eligible for CAR T cell therapy with tisagenlecleucel, axicabtagene ciloleucel or lisocabtagene maraleucel.
- Certain adults with mantle cell lymphoma may be eligible for brexucabtagene autoleucel CAR T cell therapy.
- Certain adults with advanced follicular lymphoma may be eligible for axicabtagene ciloleucel CAR T cell therapy.
- Certain adults and children with primary mediastinal B-cell lymphoma may be treated with pembrolizumab.
The cytokine therapy interferon alpha may also be an option for some
patients with certain non-Hodgkin lymphomas.
Prostate cancer
Some patients with metastatic castration-resistance prostate cancer may be treated with the therapeutic vaccine sipuleucel-T.
Skin cancer
Treatment with immune checkpoint inhibitors is approved for some patients with skin cancer:
- Pembrolizumab and avelumab has been approved for adults and children with Merkel cell cancer.
- Pembrolizumab and cemiplimab has been approved for some patients with cutaneous squamous cell cancer.
- Cemiplimab has been approved for certain patients with basal cell carincoma.
Stomach cancer
Certain patients with recurrent locally advanced or metastatic stomach cancer or gastroesophageal junction cancer may be eligible for treatment with the immune checkpoint inhibitors pembrolizumab or nivolumab plus certain chemotherapies.
Endometrial cancer For some patients with advanced uterine cancer, treatment with checkpoint inhibitors may be an option:
- Pembrolizumab has been approved in combination with the targeted therapy lenvatinib for certain patients with advanced endometrial cancer.
- Dostarlimab has been approved for certain adults with recurrent or avanced endometrial cancer.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
For some patients with non-small
lung cancer, chemotherapy
isn’t the most effective treatment option. But based on a tumor’s
molecular profile or biomarker testing results, lung
cancer treatment can be customized to target the tumor’s unique
cellular characteristics.
We talked with Anne Tsao, M.D.,
to understand what non-small cell lung cancer patients should know
about molecular profiling, including what tests they may need and when
they should receive them.
Here’s what she shared.
How does genetic testing
help guide lung cancer treatment?
The molecular abnormalities of a cancer – such as changes in its
DNA, RNA and proteins – are what drive its growth. New treatments like
targeted
therapy and immunotherapy
can attack these abnormalities to slow or stop a cancer’s growth. By
knowing a tumor’s genetic makeup, we’re better able to predict which
treatment is going to be most effective for each patient.
Common genetic mutations seen in lung cancer are EGFR, RET, MET, BRAF
and ALK. If we find one of these, we may offer a patient a targeted therapy.
If a patient has high expression of PD-L1 protein on the surface of
their cancer cells, a type of immunotherapy called immune
checkpoint inhibitors may be an option.
Because
they’re more precise, these treatments are usually more effective and
have less risk to normal tissue when compared with chemotherapy.
Patients tend to experience fewer side
effects than with chemotherapy.
What genetic tests
should lung cancer patients receive?
At MD Anderson, we look at a patient’s genetic sequencing, and the
results from a fluorescence in situ hybridization test, commonly
called FISH. We also look at proteins on the tumor cells and stroma
with immunohistochemistry. These tests help us understand the order of
a patient’s DNA, chromosome rearrangements and the proteins on the
tumors’ cells. Together, these can help up identify the most effective
treatment.
Which lung cancer patients should receive
molecular profiling?
It’s especially important that lung cancer patients who’ve never
smoked undergo molecular profiling, but I would advocate that all lung
cancer patients should have biomarker testing. 30% of lung cancer
cases can be more effectively treated with targeted therapies versus
standard chemotherapy, and if you’re in that 30%, it can make a
dramatic difference in survival times and quality of life.
When should a lung cancer patient receive molecular profiling?
It can be done at initial biopsy or at the time of surgery. Also,
any time there’s a shift or a progression of the disease, patients
should undergo biomarker testing again because there may be new
targets we can go after.
How is molecular profiling
done, and how long does it take?
Testing can be done in two ways. First, we can do a biopsy where we
remove tissue from your lungs to be tested. Another approach is called
a liquid biopsy. Through a blood draw, we’re able to detect the
cancer’s abnormalities. It takes about three to four weeks to get the
results of a tissue biopsy, and liquid biopsy results take about two
to three weeks.
Sometimes a tissue biopsy approach called
fine needle aspiration doesn’t collect not enough tissue to
successfully profile a tumor’s genetic make-up. Be sure to tell your
doctor that you’d like to receive molecular profiling so that they
know the best approach to take with your biopsy.
Why
is it important to get molecular profiling at specialized cancer
center like MD Anderson?
There are many benefits to seeking care at a specialized cancer center. To start, you’ll receive care from experts with extensive experience in treating your specific type of cancer. At MD Anderson, we have a team of surgeons, medical oncologists, radiation oncologists, radiologists, pathologists and interventional pulmonologists that focus just on lung cancer. It’s all we treat -- all day, every day.
It will also grant you access to the most cutting-edge technology and treatments. For example, we conduct molecular profiling in-house, so there are no delays in sending your tumor specimen out for biomarker testing. These results take less time, and they’re reliable.
Also, a cancer center that performs research will give you access to clinical trials, which can sometimes offer the best treatment approach for your diagnosis, especially if you carry a known genetic mutation or biomarker.
Even your earliest decisions, such as whether to receive a biopsy or start chemotherapy, can influence which treatment options are available to you. So, trusting your care to a specialized cancer center from the start can help ensure the best results.
What’s your advice for someone newly diagnosed with lung cancer?
Don’t feel rushed or pressured to start treatment. A single
chemotherapy infusion can alter your targeted treatment options – and
sometimes make you ineligible for certain clinical trials. So, know
that it’s OK to wait to have molecular profiling done.
You’ll have the best chance for successful treatment if you take the
time to undergo molecular profiling before starting treatment. I
encourage you to seek out a specialized cancer center like MD Anderson
that has the resources to conduct the tests – and do so quickly. That
way, you and your doctors can get the insights needed to make the best
treatment decisions for your specific diagnosis.
Request an
appointment at MD Anderson online or by calling 1-877-632-6789.
When I was diagnosed with multiple myeloma in October 2009, I knew exactly where I wanted to go for my cancer treatment.
Because with MD Anderson’s help, my late mother astonished everyone by living an additional 15 years with a very rare form of cancer called liposarcoma. And by 2009, I’d been working at MD Anderson for more than a decade — first as a nurse in the operating room unit, later as a nurse in the business office of the Stem Cell Transplantation & Cellular Therapy Center, and finally, as a Physician Relations liaison.
I already knew MD Anderson was great — both because of the positions I’d held and my mom’s experience. But my own experience as a patient at MD Anderson is what gave me a whole new respect for the place. We really are the best. Because what we say we do, we do.
My multiple myeloma symptoms
I had only one symptom of multiple myeloma, though I didn’t make that connection at the time. I felt a burning sensation in my feet for about 2 or 3 years. But I had no other symptoms or complaints. My physician prescribed a drug for nerve pain called gabapentin. It seemed to help.
I only found out I had multiple myeloma after my annual physical in the summer of 2009. My bloodwork showed an elevation in my total protein that my doctor found concerning. She had me come back three months later to recheck it.
Before the results of the second test came back, my doctor told me the protein issue could be caused by one of two things: either multiple myeloma, or a condition called MGUS, which stands for “monoclonal gammopathy of undetermined significance.” The second round of bloodwork showed I had multiple myeloma. I wasted no time in making an appointment at MD Anderson.
How I knew it was time to stop ‘watching and waiting’
At MD Anderson, I met first with myeloma specialist Dr. Robert Orlowski. He told me that at this early stage, the best thing to do was watch and wait. He explained that multiple myeloma has several defining “events,” any of which can signal that the time has come to begin treatment. One of those is a bone fracture, which occurs when cancerous cells form lesions that weaken them until they snap.
That’s exactly what happened to me. I bent down to pick up a pen I’d dropped during a meeting one day and felt a hard “popping” sensation. Severe chest pain followed. I called Dr. Orlowski immediately. He said to come in for an X-ray. Sure enough, I had broken a rib. It was time to start treatment.
My multiple myeloma treatment
At that stage, Dr. Orlowski recommended several rounds of induction chemotherapy to reduce the amount of cancer in my body. Then, I’d have a stem cell transplant using my own cells and begin taking a maintenance dose of a chemotherapy drug called lenalidomide. The goal was to keep me in remission for as long as possible.
I started the induction chemotherapy regimen in July 2010. Dr. Muzzafar Qazilbash performed the stem cell transplant on Dec. 11, 2010. I began taking lenalidomide shortly afterward.
Why we changed my multiple myeloma treatment plan
Overall, my recovery has gone fairly well. I did have a lot of issues with infections the first year after the transplant, but after that, things calmed down. It was smooth sailing for about 10 years.
Unfortunately, myeloma patients never really get off of treatment. So, when my protein levels started creeping up again very slowly a few summers ago, I wasn’t that surprised. We could have waited a little longer before trying something new, but Dr. Orlowski and I decided to go ahead and change my medications in February 2021.
Now, I get injections of a monoclonal antibody called daratumumab once a month at MD Anderson West Houston. I also take a chemotherapy drug called pomalidomide for 21 consecutive days out of each month, then take a week-long break.
How I’ve dealt with multiple myeloma treatment side effects
Today, I can still do almost anything I want, though I remain on three drugs — amitriptyline, tramadol and gabapentin — for neuropathy.
I developed that side effect pretty bad in my feet during induction chemotherapy, and even now, they aren’t back to normal. I still feel a constant sense of tingling and numbness, and occasionally freezing, burning and electrical sensations. As a result, I can’t always walk long distances, and I get a bit off-balance sometimes. But with medication to control it, I feel like the neuropathy is manageable.
My life today, on myeloma treatment
A small amount of protein still shows up in my bloodwork. But Dr. Orlowski says that’s OK, because sometimes you can’t get it down to zero. He noted that myeloma is becoming more like diabetes, in that it’s treated like a chronic disease and managed long-term. Theoretically, I could stay just like this for years. So long as that one protein level doesn’t go up, I’m good. We’ll just keep monitoring it.
Aside from those two things, I’m doing really well. I started traveling again in 2011. And before the pandemic made many so places inaccessible, I was able to take trips to India, Mexico, and 11 other countries. Because I’m immunocompromised, I’ll have to wait for the world to open back up again — and be a little safer — before I can resume my travels. Until then, I’ll continue to see Dr. Qazilbash for my annual checkups, Dr. Orlowski and the myeloma team monthly, and just take each day as it comes.
I’ll also continue to use my experiences at MD Anderson to help me on the job. Because in my role as a physician liaison, I explain to outside doctors how their patients can benefit when they refer them here. I’ve always been able to showcase our multidisciplinary approach — in which medical oncologists, surgical oncologists, radiation oncologists and many other specialists — come together to formulate individualized treatment plans. And with everyone’s high degree of specialization, it’s also easy to highlight our faculty and staff’s expertise.
But now, I can personally vouch for the high-quality of care patients receive at MD Anderson. Because I experienced it myself. And I am beyond grateful.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.