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Common questions about immunotherapy

Immunotherapy is a type of drug treatment that uses the body’s own immune system to fight cancer. It is different to chemotherapy, which works by killing cancer cells.

Different types of immunotherapy work in different ways. Some stimulate the immune system so it works better against cancer. Others remove barriers that stop the immune system attacking the cancer.

Checkpoint immunotherapy is currently available in Australia for some types of cancer. It has worked well for some people, but it does not help everyone.

Answers to some common questions about immunotherapy are below.

Surgery, chemotherapy and radiation therapy are still the main treatments for many cancers. However, some people with particular types of cancer  may benefit from checkpoint immunotherapy.

To work out if checkpoint immunotherapy is suitable for you, your cancer specialist will consider the type and stage of cancer, your treatment history, your future treatment options and your overall health. Even if immunotherapy is recommended as a treatment, it is difficult to predict whether it will work. The rate of success varies depending on the type of cancer.

So far, most people who have been treated with checkpoint immunotherapy have had advanced cancer. This means either the cancer has come back and spread after the initial treatment, or it was at an advanced stage when they were first diagnosed. For particular cancer types, such as melanoma, immunotherapy is starting to become available for earlier-stage cancers.

The main type of immunotherapy uses drugs known as checkpoint inhibitors. Checkpoint immunotherapy has different rates of success with different types of cancer:

Advanced melanoma – about 5 in 10 people (50%) benefit from checkpoint immunotherapy

Advanced kidney cancer, bladder cancer, lung cancer, head and neck cancer or Hodgkin lymphoma – 2–3 in 10 people (20–30%) benefit from checkpoint immunotherapy

Most other types of advanced cancer – less than 1 in 10 people (1–10%) benefit from checkpoint immunotherapy

Immunotherapy works in a different way to other cancer treatments and has different side effects. Other treatments for cancer include:

Surgery – removes cancer from a specific area of the body. This can be effective if the cancer is found before it has spread to other parts of the body. However, surgery on its own is rarely able to treat cancer that has spread. The main side effects of surgery are pain and risk of infection.

Radiation therapy – uses targeted radiation (usually x-ray beams) to kill or damage cancer cells so they cannot grow, multiply or spread. The treatment focuses on a specific area at a time and is most effective when the cancer has not spread to other parts of the body. It can also be used to treat symptoms such as pain. Radiation therapy can cause fatigue, as well as side effects at or near the treatment site (e.g. skin problems, nausea, bowel problems).

Chemotherapy – uses drugs to kill or damage rapidly dividing cells anywhere in the body. It can work for many types of cancer because cancer cells divide rapidly. Chemotherapy also damages healthy cells that divide rapidly, such as hair follicles, blood cells and cells inside the mouth and bowel.  This can cause a range of side effects, such as nausea, fatigue, hair loss, and low white blood cell counts (making you more prone to infections). Unlike cancer cells, normal cells can recover, so most side effects are temporary.

Targeted therapy – uses drugs to attack specific features of cancer cells, known as molecular targets, that are causing the tumour to grow uncontrollably. While targeted therapy is designed to affect only the cancer cells, it can still cause side effects in some people.

As researchers learn more about cancer, treatments change. Immunotherapy is not a new idea, but older types were less effective. Checkpoint immunotherapy is having better results in some cancers. Like all treatments, checkpoint immunotherapy sometimes causes side effects. The extra activity of the immune system can cause inflammation anywhere in the body, leading to a variety of possible side effects, such as skin rash,
diarrhoea and breathing problems.

You may have several questions and concerns about having immunotherapy. There have been media reports of how immunotherapy is a “miracle drug” and how it can cure cancer. This means that people’s expectations can be very high when starting treatment, or they may be confused and upset if they aren’t offered immunotherapy as part of their treatment.

Will it work? – The most challenging issue is that checkpoint immunotherapy doesn’t work for everyone. If you are thinking about trying immunotherapy, ask your cancer specialist how likely you are to respond to the treatment and what other treatments are available. To make
immunotherapy available to more people in the future, researchers are trying to understand why some people respond better than others.

How long will it take to work? – Like most other cancer treatments, checkpoint immunotherapy usually takes a while to work, so you and your family may experience anxiety waiting to see whether you’ll respond to the treatment. If it does work, you may worry about how long immunotherapy will control the cancer or whether the cancer will come back. These uncertainties can make it challenging to make plans about work, relationships and travel. Many people find comfort in everyday activities; others focus on doing things they’ve always wanted to do. Let your cancer nurse or specialist know how you’re feeling. They may recommend seeing a psychologist to help you work through your thoughts.

If immunotherapy doesn’t work or stops working, ask your cancer specialist about your other treatment options. You may be able to try another type of immunotherapy drug or join a clinical trial.

The cost of checkpoint immunotherapy drugs is high (often several thousand dollars per dose).

As at June 2019, the Australian Government covers most of this cost for some types of advanced cancer through the Pharmaceutical Benefits Scheme (PBS). Reimbursement for some other types of cancer may be added in the future. Your specialist can give you the latest information.

What if it’s not on the PBS? – You may be able to access checkpoint immunotherapy through clinical trials or, sometimes, through a compassionate access program or cost-share program offered by the pharmaceutical company.

Some people choose to make significant financial decisions to cover the costs of immunotherapy for cancers that are not on the PBS. Before deciding to pay for these drugs, it is important to fully understand the financial costs, as well as the possible risks and benefits for your type of cancer. Take the time to discuss these questions with your cancer specialist and your family.

Ask your cancer specialist if immunotherapy is a suitable treatment for you and whether it is reimbursed through the PBS for your type of cancer. It may be possible to access immunotherapy treatments through clinical trials. Speak with your treatment team for more information.

Download our booklet ‘Understanding Clinical Trials and Research’

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This information is reviewed by

This information was last reviewed July 2019 by the following expert content reviewers: A/Prof Brett Hughes, Senior Staff Specialist, Medical Oncology, Royal Brisbane and Women’s Hospital and The Prince Charles Hospital, and Associate Professor, The University of Queensland, QLD; Dawn Bedwell, 13 11 20 Consultant, Cancer Council Queensland, QLD; Tamara Dawson, Consumer; A/Prof Craig Gedye, Senior Staff Specialist, Medical Oncology, Calvary Mater Newcastle, and Conjoint Associate Professor, School of Medicine and Public Health, University of Newcastle, NSW; A/Prof Alexander Menzies, Medical Oncologist, Associate Professor of Melanoma Medical Oncology, and Faculty Member, Melanoma Institute Australia, The University of Sydney, Royal North Shore Hospital and Mater Hospital, NSW; Dr Donna Milne, Nurse Consultant Melanoma and Skin Service, Peter MacCallum Cancer Centre, VIC; Dr Geoffrey Peters, Staff Specialist, Medical Oncology, Canberra Hospital and Health Services, and Clinical Lecturer, Australian National University, ACT.