Patient Basics: Immunotherapy

Originally published by Harvard Health.

What Is It?

Immunotherapy refers to treatments that stimulate, enhance or suppress the body’s own immune system.

Immunotherapy is also called:

• Biological therapy
• Biotherapy
• Biological response modifier therapy

Immunotherapy is used to treat certain types of cancer. It is also used to treat inflammatory diseases. These include:

• Rheumatoid arthritis
• Crohn’s disease
• Multiple sclerosis

Our body’s immune system recognizes cancer cells as foreign or abnormal. Unlike normal cells, cancer cells have unique proteins (antigens) on their outer surface. Antibodies are proteins produced by the immune system. They latch onto the cancer cells’ antigens. In this way, they label or tag the abnormal cells.

Ideally, special cells in the immune system would be recruited to destroy the tagged cancer cells. Sometimes, however, the immune system needs some help.

Biological therapy helps to stimulate the immune system to fight cancer. The chemicals used in immunotherapy often are called biological response modifiers. They enhance the body’s normal immune-system reaction to a cancer threat.

Some biological response modifiers are chemicals that occur naturally in the body. But they are produced in larger amounts in a laboratory to help boost a person’s immune response.

Biological response modifiers can play many different roles in fighting cancer. For example, they can:

• Recruit more immune system cells to attack a tumor
• Make cancer cells more vulnerable to an attack by the immune system
• Change the way cancer cells grow
• Coax cancer cells into behaving more like normal cells

Immunotherapy also can be used to suppress the immune system. This is particularly helpful in autoimmune disorders. In these disorders, the immune system “misfires.” It wrongly attacks normal tissues.

Inflammation is useful for fighting infection. But in autoimmune diseases, it damages normal tissues. Biological therapies can cool off this harmful inflammation.

Examples of biological therapies currently in use include:

• Interferons. Boost the body’s immune response. They also can act directly on cancer cells to control their rapid growth.
• Interleukins. Stimulate growth of the body’s immune cells, especially lymphocytes. Lymphocytes are a type of white blood cell.
• Colony stimulating factors (CSFs). Encourage the growth of bone marrow stem cells. Bone-marrow stem cells, especially white blood cells, are needed to fight infections. But they often are destroyed by cancer treatments such as chemotherapy or radiation.

CSFs are used after other cancer therapies. They help to grow a new population of cells in the blood.

• Monoclonal antibodies. These are made in a laboratory. They recognize the antigens on the surface of cancer cells.

Monoclonal antibodies can be used alone. Or they can be linked to anti-cancer drugs or to radioactive substances. They can carry these linked poisons directly to tumor cells inside the body.

Some antibodies acting alone can significantly interfere with cancer cells. They can stop them from growing. Or they can cause them to be destroyed by the body’s immune system. Monoclonal antibodies spare the body’s normal cells.

Monoclonal antibodies also may help people with autoimmune diseases. They target immune cells or chemical messengers involved in inflammation. Monoclonal antibodies may reduce pain and improve joint function in people with rheumatoid arthritis.

What It’s Used For

Different biological response modifiers are currently being used against many different types of cancer.

Interferons have been used to treat:

• Kidney cancer
• Kaposi’s sarcoma
• Melanoma
• Certain types of leukemia and lymphoma
• Chronic hepatitis B and C

Interleukin-2 (IL-2) may be effective for kidney cancer and advanced melanoma.

Rituximab (Rituxan) is a monoclonal antibody. It is used to treat a type of lymphoma. This treatment is also used for rheumatoid arthritis that is not responding to other agents.

Other monoclonal antibody treatments include:

• Abatacept (Orencia) for rheumatoid arthritis
• Trastuzumab (Herceptin) for breast cancer

Anti-TNF therapy inhibits the production of tumor necrosis factor. It is one of the most effective treatments for rheumatoid arthritis, inflammatory bowel disease and other inflammatory diseases when conventional drugs fail.

Anti-TNF medications include:

• Adalimumab (Humira)
• Infliximab (Remicade)
• Etanercept (Enbrel)

Preparation

Before treatment with interferon, your doctor will;

• Ask if you have a history of heart disease
• Ask about medication allergies

• Order blood tests, including tests of liver function and levels of various blood cells.

Your doctor also will ask about any history of depression or other psychiatric problems. Interferon has been associated with an increased risk of depression and possibly suicide.

Screening for exposure to tuberculosis (TB) is done before treatment with many biological therapies. The screening can be done with a skin test, a blood test and/or a chest X-ray. Your doctor also will ask whether you have had any:

• Recent infections
• Heart disease
• Lung disease
• Cancer
• Nervous system diseases

How It’s Done

Interferons, adalimumab and etanercept are given by injection. A medical professional will show you how to prepare the needle and syringe. You will be taught how to inject yourself.

A family member or other caregiver can learn the injection technique as well. He or she can give you the injection if you feel too weak or ill to give it to yourself.

Usually, the IL-2 and monoclonal antibodies are given intravenously.

Follow-Up

Your doctor may use many different tests to monitor the effects of your treatment. These include:

• Physical examinations
• Blood tests
• X-rays
• Scans

Risks

Risks and side effects of biotherapy include:

• Swelling
• Redness or infection at the injection site
• Rashes
• Allergic reactions
• Flulike symptoms, such as:
  • Fever
  • Muscle aches
  • Chills
  • Fatigue
• Digestive problems
• Changes in blood pressure
• Heart inflammation
• Kidney failure
• Low levels of white (infection-fighting) blood cells
• Thinning hair
• Infection, including TB, especially in people with prior exposure

Interferons may be associated with depression and suicidal thoughts.

Trastuzumab (Herceptin) can cause the heart to pump less vigorously leading to heart failure. Usually heart function will improve when the drug is stopped.

When To Call a Professional

Call your doctor immediately if you develop:

• Pain
• Redness or swelling at the injection site
• A rash or hives
• Light-headedness
• Difficulty breathing
• A tight feeling in your throat
• Fever, cough or flulike symptoms
• Any other problems that your doctor may warn you about

Also, call your doctor at the first sign of depression. Call even if you think it might just be a passing case of the blues.

Additional Info

Clinicaltrials.gov
National Library of Medicine (NLM)
Toll-Free: 1-888-346-3656
http://www.clinicaltrials.gov/

American Cancer Society (ACS)  
Toll-Free: 1-800-227-2345
http://www.cancer.org/