Receiving a cancer diagnosis usually comes with many doubts, especially when you hear about new or different treatments to the most well-known ones. One of the most common questions is what immunotherapy can provide in certain cancer patients and when it is considered, as it is not always indicated for all people or for all tumours. Understanding how it works and in which situations it is recommended helps to have a better conversation with the oncologist and to have realistic expectations.
What is immunotherapy and how does it work against cancer?
Immunotherapy is a type of cancer treatment that seeks to strengthen or reactivate the body’s own defenses so that they identify and attack malignant cells. Unlike approaches such as chemotherapy or radiation therapy, their primary goal is not to destroy the tumor directly, but to push the immune system to do that job more effectively.
The Immune System’s Role in Fighting Cancer Cells
The immune system is designed to recognize abnormal cells and eliminate them.
Under normal conditions, it detects threats and coordinates a response that involves different types of lymphocytes.
The problem is that many tumors learn to “hide” or slow down that surveillance.
When they manage to evade defenses, cancer cells can grow and spread more easily.
Immunotherapy intervenes at just this point: it helps the immune system to recognize the tumor again or to respond more strongly to it.
Immunotherapy Mechanisms of Action
Among the most important cells in this response are T lymphocytes.
Some immunotherapies stimulate them to attack more intensely. Others block signals that the tumor uses to turn off or confuse the immune system.
The desired result is a more effective and, in some cases, longer-lasting immune response. The National Cancer Institute of the United States describes different types of immunotherapy and their use in oncology.
When immunotherapy is considered as a treatment option
Immunotherapy is not a “one-size-fits-all recipe.” It is considered when there are clinical reasons to think that it may work well or when the usual options have not given the expected result. The decision depends on the type of cancer, its stage, the patient’s general condition, and tumor-specific tests.
Cancers that respond best to immunotherapy
Although research is progressing rapidly, there are cancers where immunotherapy already plays an important role, such as:
- Advanced melanoma.
- Non-small cell lung cancer.
- Kidney cancer.
- Certain lymphomas.
It may also be an alternative in some leukemias that have not responded well to conventional treatments, depending on the subtype and the available regimen.
Factors that determine whether a patient is a candidate
The oncologist usually assesses several elements, because the benefit can vary greatly from person to person.
Among the points that are most frequently reviewed are:
- Type of tumor and extent (if localized or metastasized).
- General health and coexisting medical conditions.
- Previous treatments and the response of the cancer to these therapies.
- Risk of side effects related to excessive activation of the immune system.
In practice, details of the tumor tissue, the clinical history, and the comprehensive management plan, which often combines more than one therapy, are also considered.
Importance of biomarkers in patient selection
Biomarkers are biological measurements that help estimate whether a tumor might respond to certain treatments. In immunotherapy, there is a lot of talk about PD-L1 expression, because it can guide the use of immune checkpoint inhibitors in some cancers.
Other markers that may influence are microsatellite instability and tumor mutational load. The American Society of Clinical Oncology offers informational resources on cancer and treatment decisions.
What benefits immunotherapy can bring to certain cancer patients
When well indicated, immunotherapy can provide relevant benefits, but they are not always present in all cases. There are patients who respond markedly and others who do not obtain the same effect. That is why constant monitoring and reevaluation are part of the process.
Efficacy in cases of melanoma and lung cancer
In advanced melanoma, sustained responses have been observed in a portion of patients, including metastatic disease.
In lung cancer, especially when the tumor has certain characteristics (such as high PD-L1 expression), immune checkpoint inhibitors have shown improvements in survival in selected groups.
Advantages over conventional treatments such as chemotherapy
Immunotherapy doesn’t feel the same as chemotherapy, and its side effects are often of a different nature.
Chemotherapy can affect healthy, fast-growing cells (which is why it is associated with hair loss, nausea, and decreased defenses in many cases).
Immunotherapy, due to its mechanism, tends to cause problems linked to inflammation due to immune activation. In some patients, tumor control is achieved with acceptable tolerance and with a duration of response that is maintained even after the regimen is completed, although this does not always occur.
Durable immune response and immunological memory
A valuable aspect of immunotherapy is so-called immunological memory.
If the immune system “learns” to identify the tumor, it can maintain surveillance for a long time.
In certain patients, this results in long remissions or sustained control of the disease. Even so, each case is different and requires periodic clinical and imaging controls.
Main types of immunotherapy available
There are several modalities. Some have been used for years and others have been gaining space with clinical research. The type indicated depends on the cancer, the goal of treatment, and the findings of the tumor.
Monoclonal antibodies
They are proteins developed in the laboratory that bind to specific targets of the tumor.
They can block growth signals, mark cells for the immune system to eliminate, or interfere with pathways that promote tumor progression.
They are used in different tumours, such as some breast cancers, colorectal cancer and lymphomas, depending on the type of antibody and the tumour profile.
Immune checkpoint therapies
Immune checkpoints are mechanisms that regulate T cell activity to prevent excessive responses. Some tumors take advantage of these brakes to deactivate the immune attack.
Drugs that block those brakes, called checkpoint inhibitors, have changed the management of several cancers. Some of the scientific evidence and related publications can be consulted.
Cancer vaccines and oncolytic viruses
Cancer vaccines seek to train the immune system to recognize tumor antigens.
Oncolytic viruses are modified viruses that selectively infect and destroy tumor cells, while stimulating an immune response against cancer.
Both lines are still being developed and their availability may vary depending on the country, the type of tumour and the protocols in place.
T-cell transfer and cell therapy
In cell therapy, lymphocytes can be removed from the patient, modified to better recognize cancer cells, and reintroduced. Within this group are CAR-T cells, which have shown promising results in leukemias and lymphomas that have not responded to other options.
Due to its complexity, it is usually indicated in centres with experience and strict selection and surveillance criteria.
How Immunotherapy Is Combined With Other Cancer Treatments
In practice, it’s common for immunotherapy to be part of a combined plan.
The combination is chosen for medical reasons: to improve the likelihood of response or to extend disease control.
Combination with chemotherapy and radiotherapy
In some scenarios, immunotherapy is given along with chemotherapy to potentiate the overall effect of treatment. Chemotherapy can alter the tumor in ways that favor a better immune response in certain cases.
When integrated with radiation therapy, a phenomenon known as the abscopal effect can occur: tumors outside the irradiated field may show a response by systemic activation of the immune system. It is not something guaranteed, but it is described in the medical literature and considered in selected situations.
Use in conjunction with surgery in cases of metastasis
In certain patients, surgery may be combined with immunotherapy in neoadjuvant (before surgery) or adjuvant (after) regimens. The intention may be to reduce tumor size, facilitate resection, or decrease the risk of recurrence.
For a broad overview of cancer treatment modalities, the American Cancer Society maintains general information at the American Cancer Society maintains general information.
Side effects of immunotherapy and how to manage them
Although many people tolerate these treatments well, immunotherapy can cause significant adverse effects. The key is usually to detect them early and treat them quickly to avoid complications.
Immune System Reactions
By activating defenses, some patients develop inflammation in different organs.
Among the most monitored sites are:
- Skin (rashes, itching).
- Intestine (diarrhea, colitis).
- Lungs (pneumonitis).
- Liver (hepatitis).
- Joints and endocrine glands (hormonal alterations).
In certain cases, corticosteroids or other immunosuppressants are indicated, always under medical supervision, and the schedule is adjusted according to the severity.
Differences in side effects compared to chemotherapy
Chemotherapy side effects are often associated with direct toxicity to rapidly dividing healthy cells. In immunotherapy, the pattern is more “immunological,” with inflammation and autoimmune changes.
Not all people have the same symptoms or with the same intensity.
That is why close monitoring, laboratory tests and monitoring for warning signs are an essential part of management.
Special Considerations for Certain Patient Groups
Age, type of cancer, and previous medical conditions can change the balance between benefits and risks. In some groups, the indication requires even more care.
Immunotherapy in paediatric patients with leukaemias and lymphomas
In children and adolescents with resistant leukemias or lymphomas, cell therapy with CAR-T cells has opened up options that did not exist before for certain cases. Even with promising results, it remains an active field of research and its indication is based on strict clinical criteria.
Treatment in patients with advanced kidney cancer
Advanced kidney cancer is one of the tumours where immunotherapy has had a significant impact. Immune checkpoint inhibitors, alone or in combination with other therapies, have improved survival in patients with metastatic disease in selected settings, and are now part of the standard management in many guidelines.
Frequently Asked Questions About Cancer Immunotherapy
¿Cuánto tiempo dura el tratamiento de inmunoterapia?
It depends on the type of cancer, the drug indicated, the response and tolerance.
There are schemes that last a few months and others that last longer. Sometimes it is stopped if a sustained complete response is achieved or if side effects appear that force it to stop.
¿Todos los pacientes con cáncer pueden recibir inmunoterapia?
No. There are tumors where it is not indicated or where its benefit is limited. There are also conditions that can increase the risk, such as some active autoimmune diseases or clinical situations that require very careful evaluation. That is why biomarkers and the complete context of the patient are analyzed.
¿La inmunoterapia puede curar el cáncer por completo?
In some cases, complete and long-lasting remissions have been seen, especially in certain patients with melanoma or lung cancer. Still, you can’t promise a cure for everyone or every type of tumor. The answer depends on the biology of the cancer, the stage, the biomarkers and the course during treatment.
¿Qué exámenes suelen pedir antes de decidir si conviene inmunoterapia?
Imaging studies, blood tests, and tests of tumor tissue are often ordered.
These may include PD-L1, microsatellite instability, and mutational load, depending on the type of cancer. These data help to estimate the probability of response and to plan the most appropriate scheme.
¿Qué señales de alarma deben reportarse durante la inmunoterapia?
Symptoms such as shortness of breath, persistent cough, severe diarrhea, abdominal pain, fever, yellowing of the skin or eyes, chest pain, marked weakness, unusual headache or significant skin changes warrant immediate notification to the treating team. In immunotherapy, acting early can prevent complications.
¿La inmunoterapia siempre se da sola o puede combinarse?
It can be indicated alone or in combination. In some cancers, it is combined with chemotherapy, radiation therapy, or other therapies depending on the goal of treatment and the available evidence. The plan is adjusted based on response, side effects, and tumor progression.
Talking about immunotherapy requires seeing the complete diagnosis, the pathology results and the biomarkers, because it depends on whether it really offers an advantage. Close follow-up from the oncologist helps detect side effects early and adjust the plan when necessary. With clear information and continuous monitoring, the patient and their family can go through the process with more guidance and less uncertainty.
In the end, the most important thing is to understand what immunotherapy can bring to certain cancer patients and when it is considered.
