Immunotherapy is a cancer treatment that boosts the immune system’s ability to detect and destroy cancer cells. NewYork-Presbyterian’s cancer specialists are leaders in developing and using immunotherapy to treat people with many types of cancer, including blood cancers and solid tumors. In addition to surgery, chemotherapy, radiation therapy, and targeted therapies, immunotherapy is now considered the “fifth pillar” of cancer treatment.
What is Immunotherapy?What is Immunotherapy?
Cancer immunotherapy activates (turns on) the immune system’s ability to attack cancer cells wherever they may be in the body. It is one of the most significant medical advances in over a century. By discovering how to turn on the immune system with specific drugs, we are now curing cancers that were not curable just 10 years ago and expanding our approaches for treating cancer in previously unheard-of ways.
Immunotherapy vs. chemotherapy
Most forms of immunotherapy and chemotherapy are given intravenously (by vein), but they work differently. Chemotherapy drugs (some of which are taken by mouth) work by killing cancer cells directly. However, immunotherapy drugs teach your immune system cells how to recognize cancer cells and mount an attack against them.
How does immunotherapy work?
We have wondered why the immune system does not fight cancer for years. Several recent discoveries have shown us why. Your immune system responds to foreign invaders, like bacteria and viruses, with a targeted response to keep you healthy.
While your immune system identifies these substances as foreign, your cancer cells are your own cells that have developed abnormally. As a result, the immune system may not see them as foreign —enabling the cancer cells to evade detection and destruction by your immune system. Immunotherapies are designed to help your immune system “see” cancer cells so they can be destroyed.
What types of cancer can be treated with immunotherapy?
Immunotherapy medications are most often used to treat advanced cancers, especially those that have continued growing or returning after other treatments. Over the last 10 to 15 years, the U.S. Food and Drug Administration (FDA) has approved several new immunotherapy drugs for advanced solid tumors as well as blood cancers. Other immunotherapies are being evaluated in clinical trials, some in combination with chemotherapy.
Immunotherapies are currently FDA-approved to treat:
- Acute lymphoblastic leukemia
- Cervical cancer
- Colorectal cancer
- Cutaneous squamous cell carcinoma (a type of skin cancer)
- Endometrial cancer
- Esophageal cancer
- Follicular lymphoma
- Head and neck cancer
- Hodgkin lymphoma
- Large B-cell lymphoma
- Liver cancer
- Lung cancer
- Mantle cell lymphoma
- Merkel cell cancer
- Multiple myeloma
- Pleural mesothelioma
- Prostate cancer
- Renal cell carcinoma (kidney cancer)
- Stomach (gastric) cancer
- Triple-negative breast cancer
- Urothelial (bladder) cancer
Types of Immunotherapy We OfferTypes
NewYork-Presbyterian offers immunotherapies for many types of cancer, including melanoma, lung cancer, kidney cancer, breast cancer, Hodgkin lymphoma, non-Hodgkin lymphoma, bladder cancer, and prostate cancer. If you have cancer that can be treated with immunotherapy, your care team will match you with the most appropriate option.
- Checkpoint inhibitors - Immune checkpoint proteins regulate the strength and duration of an immune response. Cancer cells can commandeer these proteins (such as CTLA4, PD-1, and PD-L1) and use them to avoid detection by the immune system. Checkpoint modulators inhibit these proteins, taking this power away from cancer cells and allowing the immune response against cancer to occur. Examples include pembrolizumab, nivolumab, relatlimab, atezolizumab, cemiplimab, avelumab, durvalumab, and ipilimumab.
- CAR T-cell therapy - Made from a patient’s own white blood cells called T cells, CAR stands for “chimeric antigen receptor.” The T cells are collected from the patient, modified in a lab to express these receptors so they can recognize certain proteins on the surfaces of cancer cells, multiplied, and returned to the patient to detect, attach to, and destroy cancer cells throughout the body. Examples include tisagenlecleucel, axicabtagene ciloleucel, brexucabtagene autoleucel, lisocabtagene maraleucel, idecabtagene vicleucel, and ciltacabtegene autoleucel.
- Therapeutic antibodies – Therapeutic antibodies are designed to target proteins in cancer cells, causing the cells to commit suicide or mark them for destruction by immune cells. “Antibody-drug conjugates” are antibodies attached to a toxic payload that kills cancer cells, such as an anticancer drug or radioactive substance. The antibody ferries the payload to cancer cells. Once the antibody attaches to its target on cancer cells, it releases its payload to kill the cancer. There are many types of therapeutic antibodies, such as trastuzumab, alemtuzumab, brentuximab, and blinatumomab.
- Immunomodulators - Immunotherapy drugs that “turn down” some proteins while turning up others to treat certain cancers. Examples include lenalidomide, and thalidomide, and pomalidomide for multiple myeloma, which are taken by mouth; BCG for bladder cancer, which is applied directly into the bladder; and imiquimod for certain early skin cancers, which is a cream applied to the skin.
Immunotherapy Side EffectsSide Effects
Immunotherapy can cause side effects that may differ from person to person and depend on which medication you are receiving. They usually occur because as the immune system becomes revved up against cancerous cells, it may also affect healthy cells.
Many of the side effects caused by immunotherapy treatment are similar to those of the flu, such as:
- Autoimmune diseases, such as thyroiditis, colitis, and pancreatitis
- Feeling tired and weak
- Nausea or vomiting
- Aches in the muscles or joints
- Breathing trouble
- Low or high blood pressure
You may also have pain, soreness, itchiness, redness, swelling, or a rash at the injection site. CAR T-cell therapy can sometimes cause very serious side effects such as cytokine release syndrome (CRS), which can cause a high fever, chills, labored breathing, nausea/vomiting, dizziness, weakness, rapid heart rate, and muscle and joint pain.
Because of the risk of CRS, CAR T-cell therapy must be given in a medical center, such as NewYork-Presbyterian, with an experienced team caring for patients with these side effects.
The Latest in Immunotherapy Treatment ApproachesLatest Approaches
While immunotherapy drugs are available for people with different types of cancer, not all patients respond well to these treatments. Researchers at Columbia University and Weill Cornell Medicine are continuing to develop and evaluate new immunotherapy approaches that are more effective than existing treatments to improve outcomes for people with advanced cancer. Active areas of research at Columbia include:
- Phase I and Experimental Therapeutics Unit - Columbia University has a special clinical research program focused on Phase I clinical trials—the first phase of testing a new drug in people. Patients enrolled in these studies receive their treatment in a dedicated unit, staffed by specialists with the experience and skills required to care for these patients and conduct these studies.
- Next generation cellular therapies – CAR T-cells and other cellular therapies are under investigation in multiple clinical trials assessing their use for patients with other cancers. Researchers are studying an “off-the-shelf” CAR T-cell treatment (UCART123) for patients with acute myeloid leukemia (AML), which uses modified T cells from a “universal donor” rather than altering each patient’s T cells individually. Other clinical trials are assessing new CAR T-cell therapies for people with thyroid cancer and multiple myeloma.
- Radiation and immunotherapy - Our investigators are world leaders in the study of an interesting phenomenon called the “abscopal effect,” where a tumor treated with radiation therapy releases proteins called antigens as tumor cells are dying. These antigens can provoke an immune response against cancer cells, which could be further intensified by adding immunotherapy drugs to the patient’s treatment.
What is the success rate of immunotherapy?
The success rate for immunotherapy depends on your type of cancer, its stage, and the immunotherapy medication you are receiving. Not everyone who receives immunotherapy will respond to treatment. Your doctor will explain the chance of the treatment working for you.
How is immunotherapy administered?
Many types of immunotherapy, such as checkpoint inhibitors and CAR T-cell therapy, are given intravenously at an infusion center. Others are taken orally (by mouth), applied as a cream, or given directly into the bladder.
Who qualifies for immunotherapy?
Most people who receive checkpoint inhibitors or CAR T-cell immunotherapy have advanced cancers that persist despite prior treatment. Other types of immunotherapy, such as BCG or imiquimod, may be used for earlier-stage cancers.
How long does immunotherapy stay in your system?
The length of time immunotherapy stays in your system depends on which medication you receive and how your body processes it.
How long does it take for immunotherapy to work?
Immunotherapy may work against a cancer within weeks or months of being given. Its effectiveness varies from person to person. Your doctor will help you learn what to expect.
How long does immunotherapy last?
When someone responds to immunotherapy, they may be in remission for a year or more. This remission may last, or the cancer may come back. Some people have lived many years after immunotherapy and have been cured, while others experience a return of their cancer. Speak with your doctor about what to expect in your case, depending on the type of cancer you have and the immunotherapy you will receive.
Immunotherapy Treatments at NewYork-Presbyterian
NewYork-Presbyterian is a world leader in cancer care and immunotherapy. Our experienced and compassionate care teams provide immunotherapy in our modern and comfortable infusion suites for people with all types of cancer. NewYork-Presbyterian/Columbia University Irving Medical Center and NewYork-Presbyterian/Weill Cornell Medical Center are both accredited to administer CAR T-cell therapy.
We also have a robust clinical research program featuring many clinical trials evaluating new immunotherapies and novel ways of combining immunotherapy with other cancer treatments. The only way cancer patients can access these investigational treatments is through these pivotal clinical studies, which are typically found only at academic medical centers such as NewYork-Presbyterian. You may be eligible to participate in a clinical trial. Contact us today to see if immunotherapy is an option for you.