FAQs about immunotherapy

It is crucial that those who are diagnosed with cancer get treated properly. Luckily, there are ways of boosting the body’s natural defences to overcome the disease.
 

The renowned medical oncologist, Professor Hendrik-Tobias (Tobi) Arkenau, spoke with us recently to discuss immunotherapy and how it can help beat cancer. In this article, he answers some of your frequently asked questions regarding this treatment. Read on to find out just how effective immunotherapy can be.
 

How does immunotherapy work?

Immunotherapy in general works in a way where we manipulate the immune system to recognise cancer cells and therefore fight the cancer cells.
 

It is different to the classical chemotherapy you may have heard about where effectively a drug is administered systemically and often in a non-targeted way destroys most fast-growing tissue including the cancer, but also vital systems, for example your gastrointestinal system and bone marrow. As a result you may develop side effects including mouth ulcers, diarrhoea, nausea and vomiting, and it may also affect the bone marrow lowering your white blood cells resulting in a higher risk of infection.
 

Immunotherapy works differently. As I said, the current approved drugs mostly stimulate your T-cells by blocking specific receptors on either the T- or cancer cell so that your immune system is able to recognise cancer proteins and fight the cancer.
 

What are the side-effects of immunotherapy?

So as opposed to the more common and sometimes troublesome side effects of chemotherapy, for example, prolonged risk of infection (neutropenia), sepsis, mouth ulcers, nausea, vomiting and diarrhoea, immunotherapies are generally better tolerated by our patients.

However there are a few important principles I want to share: The side effects of immunotherapy can be broad and is often related to an ‘overshooting’ T-cell response, essentially mimicking an autoimmune disease, i.e. the activated T-cells attack not only cancer cells, but also healthy tissue. These immune-related side effects can affects can often be subtle, and it is therefore important that you let us know early when you experience changes for example skin rashes, diarrhoea, and shortness of breath.

It's also very important to come in and see your medical team so the ‘overshooting’ immune response can be controlled timely. This is often very easily done, for example, with steroids which effectively suppress the immune response.
 

It is important to have an experienced clinical team but also a wider support team with other specialities including endocrinologist, cardiologists and chest physicians amongst others. Seeing a doctor who understands and knows how to manage the potential side effects from immunotherapy is extremely important.

What is reassuring is that serious side effects are generally rare.
 

How successful is immunotherapy?

Over the last 10 years, we have learned the basics in how immunotherapy works by giving single-agent drugs, and they have been successful in a variety of different cancers including lung, breast, lung, colorectal cancer, melanoma amongst many others.
 

Now we have further knowledge and starting to use combinations of other drugs to even increase and prolong tumour responses. With two or even three immunotherapy drugs combined, targeting different aspects of the immune response cascade, we're getting better responses and long-lasting survivals. Ideally, in the very near future we can 'personalise' the immunotherapy treatment by incorporating the knowledge of the immune status of each individual patient and the unique ‘gene-signature‘ of the cancer.
 

Early studies show promising results whereby ‘good’ immune cells are extracted from tumours and subsequently enriched in laboratories and then in a much higher concentration reinfused into patients.
 

At my clinic at Sarah Cannon, we've been doing this through our TIL therapy or cellular therapy programme including CAR T-cells. Currently, it is being done through clinical trials. However, I believe this method is likely to become more commonplace, and we may expect to gain even better outcomes in future.
 

If you require immunotherapy, we recommend getting in contact with an expert medical oncologist such as Dr Hendrik Tobias Arkenau . Visit his Top Doctors profile today for information on appointment availability.