Cancer immunotherapy treatment : University College London Hospitals NHS Foundation Trust

What is immunotherapy and how does it work?

Immunotherapy uses your immune system to fight cancer. It works by helping your immune system to recognise and destroy cancer cells.

The immune system protects your body from illness and infection. For example, when bacteria enter your body, the immune system fights against it. T-lymphocytes, also called T-cells, are an important part of the immune system. They attack and kill germs, cancer cells and infected cells.

There are different types of immunotherapy. Each type helps the immune system in a different way and is used to treat different cancers. Immunotherapies have long-lasting effects and can keep working in the body for months or even years.

Immune checkpoint inhibitors are a type of immunotherapy. They work by helping the immune system to attack cancer cells. Cancer cells can sometimes push a stop button on the T-cells, switching off their immune response. This stops the immune system from attacking the cancer cells. Checkpoint inhibitors block cancer cells from pushing the stop button.

Examples of ICIs are pembrolizumab, nivolumab or ipilumumab. See the individual drug information for more details.

ICIs treatment can be given:

On its own
In combination with another type of immunotherapy
In combination with chemotherapy
In combination with both chemotherapy and another immunotherapy treatment.

Some people may also have radiotherapy during their immunotherapy treatment.

Most immunotherapy treatments last for up to two years, as long as they are working and side effects are manageable. How long you will receive the ICIs treatment depends on:

Your diagnosis
The treatment plan
Any side effects you may have.

Immunotherapy is given in cycles over a set period of time. For example, you may have treatment once a month or every two weeks for six months. It is administered as an infusion into a vein in your hand or forearm. Treatment usually takes less than two hours, but this can vary.

Before each infusion, you will need to have a blood test and to see a doctor, specialist nurse or pharmacist. This is to make sure that you are well enough to go ahead with the next cycle.

Immunotherapy can sometimes cause your immune system to attack healthy parts of your body. This may cause inflammation (swelling) in different organs or tissues. If this happens, you may need medication, like steroids, to calm your immune system. This treatment is called immunosuppressive therapy.

Side effects are more likely if you are taking a combination of immunotherapy drugs rather than just one.

Sometimes, for your safety, your cancer treatment may need to be paused to check for these side effects. They can happen at any time during your treatment and some may even last up to three years after treatment ends.

Here are some side effects you may experience. Your healthcare team will talk to you about them and answer any questions.

Common side effects include:

Fatigue
Diarrhoea
Skin rash or itching
Changes in thyroid hormone levels.

Less common side effects can include:

Headaches
Joint or muscle pain, or muscle weakness
Changes in liver function (with or without itching, yellowing of the skin or abdominal pain)
Changes in kidney function (with or without change in how much you pee or the colour of your pee)
Changes in blood sugar levels
Shortness of breath or cough
Fever caused by inflammation.

Rare symptoms may include:

Tingling or numbness in your fingers or toes
Chest pain
Fast or irregular heartbeat
Sore eyes
Hair thinning or hair loss
Abdominal pain
Feeling sick or being sick
Confusion.

Potential side effects for each drug are detailed in the individual drug information sheets.

Diarrhoea

You must contact your team or urgent advice line if you have loose, runny poo and have to go to the toilet more often than usual, especially at night. It is very important that we test your stool sample for any infections and start steroids as soon as possible.

If you have diarrhoea, keep well hydrated and avoid any caffeinated, milk-based or fizzy drinks.

Rashes and skincare

If you notice a skin rash or your skin is itchy, please contact your team or the urgent advice line. You may need steroid creams or tablets to treat the rash.

During treatment, and for a few months afterwards, your skin will be more sensitive to the sun. This means that you will be more prone to sunburn even in cooler weather. You should wear a sun cream with a high sun protection factor (SPF) when you go out and cover up with clothing and a hat. Try to keep your skin moisturised and avoid soap, soap-based or perfumed products.

Fatigue

Fatigue can be a side effect of immunotherapy, but it can also be a general symptom from your cancer. If your tiredness worsens after starting treatment, let your team know.

If you experience any symptoms listed above or notice any changes that are unusual to you after starting immunotherapy, report these to your team as soon as you can.

If you feel unwell, your symptoms have worsened or you are worried about your symptoms, contact the 24-hour oncology urgent advice line on 020 3447 3893.

Yes. If your flu or COVID booster vaccines are due when you are on treatment, you should take them one or two weeks after finishing a treatment cycle.

Generally, it is fine to take your regular medicines when you are on immunotherapy. Your doctor will be able to advise you on this so remember to take a list of your medicines to your appointment.

If you have any questions or are worried about your symptoms, contact your healthcare team or call the 24-hour oncology urgent advice line on 020 3447 3893.

If you have a paper copy of this page, you can complete your team’s details below:

My doctor/CNS is: …………..

Tel: …………..

For an overview of immunotherapy treatment and potential side effects, please watch the video developed by North East London Cancer Alliance:

nelcanceralliance.nhs.uk/resources/videos/immunotherapy-treatment-overview

The Immunobuddies podcast includes detailed information about immunotherapy. Visit the Immuno-Oncology Clinical Network to access it:

https://ioclinicalnetwork.co.uk/onewebmedia/May%202024%20Immunotherapy%20Immunobuddies%20Leaflet.pdf

Pembrolizumab

www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/pembrolizumab

Nivolumab

www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/nivolumab

Ipilimumab