Treatment that stimulates the immune system to attack cancer cells

Immunotherapy refers to treatments that use the body's own immune system to combat diseases; immuno-oncology specifically involves immunotherapy directed at cancer.
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Immunotherapy includes a variety of treatments that work in different ways: some are intended to boost the immune system defenses in a general way; others help train the immune system to recognize and attack cancer cells specifically. So far it appears that this type of treatment works better for some types of cancer than others. The immune system, which is a collection of organs, specialized cells and substances that protect against infectious organisms, can help protect against cancer. Often, however, cancer cells make themselves "invisible" to the immune system by masquerading as harmless body cells.
How is Immunotherapy Used to Fight Cancer?
If you take the brakes off the immune system, you can unleash an attack on cancer cells. That's the theory behind PD-1/PD-L1, a vitally important immunotherapy discovery illustrated in this video.
Types of immunotherapy
Cancer vaccines are substances given to people to prevent cancer from developing, or to treat existing cancers by strengthening and optimizing the body's immune response against the tumors. Examples of preventive cancer vaccines are those that protect against infection with the human papilloma virus (HPV), which causes cervical cancer and some other cancers, including cancers of the mouth and throat.
The first cancer treatment vaccine was approved by the Food and Drug Administration in 2010. Called Provenge, it is designed to stimulate an immune response against metastatic prostate cancer. Provenge is customized to each individual patient.
Researchers are testing experimental treatment vaccines in a variety of cancers, including melanoma, brain tumors, breast cancer, kidney cancer, leukemia, and others.
Cancer vaccines can be combined with other types of therapies.
Monoclonal antibodies are synthetic copies of antibody proteins that exist in the immune system and whose job is to identify foreign invaders by binding to specific proteins called antigens on the surface of cells. After they bind, antibodies recruit other cells and substances of the immune system to attack the foreign cells.
Researchers can make large numbers of identical (monoclonal) synthetic antibodies in the laboratory and give them to cancer patients. Monoclonal antibodies can be used to block so-called "checkpoint molecules," such as CTLA-4, PD-1, and PD-L1 and thereby "release the brake" from immune cells in order for these cells to kill tumor cells more effectively. Other monoclonal antibodies attach to and block antigens that cancer cells use to grow and spread. Still other monoclonal antibodies carry a radioactive substance, drug, or toxin that kills cancer cells that are recognized by the antibody.
Read our Insight blog for information and inspiration about Dana-Farber and immunotherapy.

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Reviewed by: Ezra Cohen, M.D.

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UC San Diego Health

What is immunotherapy? Cancer immunotherapy, also known as immuno-oncology, is a form of cancer treatment that uses the power of the body’s own immune system to prevent, control, and eliminate cancer.

Immunotherapy can:

Educate the immune system to recognize and attack specific cancer cells
Boost immune cells to help them eliminate cancer
Provide the body with additional components to enhance the immune response

Cancer immunotherapy comes in a variety of forms, including targeted antibodies, cancer vaccines, adoptive cell transfer, tumor-infecting viruses, checkpoint inhibitors, cytokines, and adjuvants. Immunotherapies are a form of biotherapy (also called biologic therapy or biological response modifier (BRM) therapy) because they use materials from living organisms to fight disease. Some immunotherapy treatments use genetic engineering to enhance immune cells’ cancer-fighting capabilities and may be referred to as gene therapies. Many immunotherapy treatments for preventing, managing, or treating different cancers can also be used in combination with surgery, chemotherapy, radiation, or targeted therapies to improve their effectiveness.

Unleashing the power of the immune system is a smart way to fight cancer:

The immune system is precise, so it is possible for it to target cancer cells exclusively while sparing healthy cells.
The immune system can adapt continuously and dynamically, just like cancer does, so if a tumor manages to escape detection, the immune system can re-evaluate and launch a new attack.
The immune system’s “memory” allows it to remember what cancer cells look like, so it can target and eliminate the cancer if it returns.

Why immunotherapy

Immunotherapies have been approved in the United States and elsewhere to treat a variety of cancers and are prescribed to patients by oncologists. These approvals are the result of years of research and testing designed to demonstrate the effectiveness of these treatments. Immunotherapies are also available through clinical trials, which are carefully controlled and monitored studies involving patient volunteers.

Immunotherapy doesn’t always work for every patient, and certain types of immunotherapy are associated with potentially severe but manageable side effects. Scientists are developing ways to determine which patients are likely to respond to treatment and which aren’t. This research is leading to new strategies to expand the number of patients who may potentially benefit from treatment with immunotherapy.

Although scientists haven’t yet mastered all the immune system’s cancer-fighting capabilities, immunotherapy is already helping to extend and save the lives of many cancer patients. Immunotherapy holds the potential to become more precise, more personalized, and more effective than current cancer treatments—and potentially with fewer side effects. Learn more about how you can support new breakthroughs in cancer immunotherapy research.

Frequently Asked Immunotherapy Questions

What types of cancers can immunotherapy treat?

Immunotherapy has potential to treat all cancers.

Immunotherapy enhances the immune system’s ability to recognize, target, and eliminate cancer cells, wherever they are in the body, making it a potential universal answer to cancer.

Immunotherapy has been approved in the U.S. and elsewhere as a first-line of treatment for several cancers, and may also be an effective treatment for patients with certain cancers that are resistant to prior treatment. Immunotherapy may be given alone or in combination with other cancer treatments. As of December 2019, the FDA has approved immunotherapies as treatments for nearly 20 cancers as well as cancers with a specific genetic mutation

Learn more about immunotherapies for different types of cancer

Does immunotherapy have any side effects?

Immunotherapy may be accompanied by side effects that differ from those associated with conventional cancer treatments, and side effects may vary depending on the specific immunotherapy used. In most cases, potential immunotherapy-related side effects can be managed safely as long as the potential side effects are recognized and addressed early.

Cancer immunotherapy treats the patient—by empowering their immune system—rather than the disease itself like chemotherapy and radiation. Patients may be tested for biomarkers that may indicate whether cancer immunotherapy would be an effective treatment.
Side effects of immunotherapy may results from stimulation of the immune system and may range from minor inflammation and flu-like symptoms, to major, potentially life-threatening conditions similar to autoimmune disorders.
Common side effects may include but are not limited to skin reactions, mouth sores, fatigue, nausea, body aches, headaches, and changes in blood pressure.

Conventional cancer treatments also have a range of side effects with a wide range of severity.

Chemotherapy is intended to target fast-growing cancer cells, so it may damage other fast-growing normal cells in your body. Common side effects may include but are not limited to hair loss, nausea, diarrhea, skin rash, and fatigue.
Radiation uses radioactive particles to destroy cancer cells in a localized area, so it may damage other healthy cells in that area. Side effects may be associated with the area of treatment, such as difficulty breathing when aimed at the chest, or nausea when aimed at the stomach. Skin problems and fatigue are common.
The goal of surgery is to remove the cancerous tumor or tissue and varies according to the type of surgery performed. Common side effects may include but are not limited to pain, fatigue, swelling, numbness, and risk of infection.

Learn more about immunotherapy side effects

How long does immunotherapy last?

Cancer immunotherapy offers the possibility for long-term control of cancer.

Immunotherapy can “train” the immune system to remember cancer cells. This “immunomemory” may result in longer-lasting and potentially permanent protection against cancer recurrence.

Clinical studies on long-term overall survival have shown that the beneficial responses to cancer immunotherapy treatment can be durable—that is, they continue even after treatment is completed.

How long has immunotherapy been used as a cancer treatment?

Cancer immunotherapy originated in the late 1890s with a cancer surgeon named Dr. William B. Coley (1862–1936). He discovered that infecting cancer patients with certain bacteria sometimes resulted in tumor regression and even some complete remissions. Advances in cancer immunology since Coley’s time have revealed that, in patients that responded to his treatment, his bacterial toxin therapy stimulated their immune systems to attack the tumors.

While Coley’s approach was largely dismissed during his lifetime, his daughter, Helen Coley Nauts, discovered his old notebooks and founded the Cancer Research Institute in 1953 to support research into his theory. In 1990, the FDA approved the first cancer immunotherapy, a bacteria-based tuberculosis vaccine called Bacillus Calmette-Guérin (BCG), which was shown to be effective for patients with bladder cancer.

Visit the Timeline of Immunotherapy

What is the relationship between cancer and the immune system?

While many of our cells grow and divide naturally, this behavior is tightly controlled by a variety of factors, including the genes within cells. When no more growth is needed, cells are told to stop growing.

Unfortunately, cancer cells acquire defects that cause them to ignore these stop signals, and they grow out of control. Because cancer cells grow and behave in abnormal ways, this can make them stand out to the immune system, which can recognize and eliminate cancer cells through a process called immunosurveillance.

However, this process isn't always successful. Sometimes cancer cells develop ways to evade and escape the immune system, which allows them to continue to grow and metastasize, or spread to other organs. Therefore, immunotherapies are designed to boost or enhance the cancer-fighting capabilities of immune cells and tip the scales in the immune system's favor.

Learn more about how the immune system functions below

What types of immunotherapy treatments are there?

Immunotherapy treatments can be broken down into five types:

Targeted antibodies are proteins produced by the immune system that can be customized to target specific markers (known as antigens) on cancer cells, in order to disrupt cancerous activity, especially unrestrained growth. Some targeted antibody-based immunotherapies, known as antibody-drug conjugates (ADCs), are equipped with anti-cancer drugs that they can deliver to tumors. Others, called bi-specific T cell-engaging antibodies (BiTEs), bind both cancer cells and T cells in order to help the immune system respond more quickly and effectively. All targeted antibody therapies are currently based on monoclonal antibodies (clones of a parent bonding to the same marker(s)).
Adoptive cell therapy takes a patient’s own immune cells, expands or otherwise modifies them, and then reintroduces them to the patient, where they can seek out and eliminate cancer cells. In CAR T cell therapy, cancer-fighting T cells are modified and equipped with specialized cancer-targeting receptors known as CARs (chimeric antigen receptors) that enable superior anti-cancer activity. Natural killer cells (NKs) and tumor infiltrating lymphocytes (TILs) can also be enhanced and reinfused in patients.
Oncolytic virus therapy uses viruses that are often, but not always, modified in order to infect tumor cells and cause them to self-destruct. This can attract the attention of immune cells to eliminate the main tumor and potentially other tumors throughout the body.
Cancer vaccines are designed to elicit an immune response against tumor-specific or tumor-associated antigens, encouraging the immune system to attack cancer cells bearing these antigens. Cancer vaccines can be made from a variety of components, including cells, proteins, DNA, viruses, bacteria, and small molecules. Some versions are engineered to produce immune-stimulating molecules. Preventive cancer vaccines inoculate individuals against cancer-causing viruses and bacteria, such as HPV or hepatitis B.
Immunomodulators govern the activity of other elements of the immune system to unleash new or enhance existing immune responses against cancer. Some, known as antagonists, work by blocking pathways that suppress immune cells. Others, known as agonists, work by stimulating pathways that activate immune cells. Checkpoint inhibitors target the molecules on either immune or cancer cells that tell them when to start or stop attacking a cancer cell. Cytokines are messenger molecules that regulate maturation, growth, and responsiveness. Interferons (IFN) are a type of cytokine that disrupts the division of cancer cells and slows tumor growth. Interleukins (IL) are cytokines that help immune cells grow and divide more quickly. Adjuvants are immune system agents that can stimulate pathways to provide longer protection or produce more antibodies (they are often used in vaccines, but may also be used alone).

Learn more about how different facets of the immune system fight cancer.

What is the difference between immunotherapy and chemotherapy?

Chemotherapy is a direct form of attack on rapidly-dividing cancer cells, but this can affect other rapidly dividing cells including normal cells. When patients respond, the treatment’s effects happen immediately. These direct effects of chemotherapy, however, last only as long as treatment continues.

Immunotherapy treats the patient’s immune system, activating a stronger immune response or teaching the immune system how to recognize and destroy cancer cells. Immunotherapy may take more time to have an effect, but those effects can persist long after treatment ceases.

Learn more about immunotherapy versus chemotherapy

Who can receive immunotherapy? What immunotherapies are approved for standard care?

As of March 2022, the U.S. Food and Drug Administration had approved over 60 immunotherapies that together cover almost every major cancer type:

Aldesleukin (immunomodulator) for kidney cancer and melanoma
Alemtuzumab (targeted antibody) for leukemia
Amivantamab (bispecific antibody) for lung cancer
Atezolizumab (checkpoint inhibitor) for bladder, liver, and lung cancer, and melanoma
Avelumab (checkpoint inhibitor) for bladder, kidney, and skin cancer (Merkel cell carcinoma)
Axicabtagene ciloleucel (CAR T cell therapy) for lymphoma
Bacillus Calmette-Guérin [BCG] (vaccine) for bladder cancer
Belantamab mafodotin-blmf (antibody-drug conjugate) for multiple myeloma
Bevacizumab (targeted antibody) for brain, cervical, colorectal, kidney, liver, lung, and ovarian cancer
Blinatumomab (bi-specific T cell-engaging antibody) for leukemia
Brentuximab vedotin (antibody-drug conjugate) for lymphoma
Brexucabtagene autoleucel (CAR T cell therapy) for leukemia and lymphoma
Cemiplimab (checkpoint inhibitor) for lung cancer and skin cancer (basal cell carcinoma and cutaneous squamous cell carcinoma)
Cetuximab (targeted antibody) for colorectal and head and neck cancer
Ciltacabtagene autoleucel (CAR T cell therapy) for multiple myeloma
Daratumumab (targeted antibody) for multiple myeloma
Denosumab (targeted antibody) for sarcoma
Dinutuximab (targeted antibody) for pediatric neuroblastoma
Dostarlimab (checkpoint inhibitor) for uterine (endometrial) cancer
Durvalumab (checkpoint inhibitor) for lung cancer
Elotuzumab (targeted antibody) for multiple myeloma
Enfortumab vedotin-ejfv (antibody-drug conjugate) for bladder cancer
Gemtuzumab ozogamicin (antibody-drug conjugate) for leukemia
Granulocyte-macrophage colony-stimulating factor, or GM-CSF (immunomodulator) for neuroblastoma
Hepatitis B Vaccine (Recombinant) (preventive vaccine) for liver cancer
Human Papillomavirus Quadrivalent (Types 6, 11, 16, 18) Vaccine, Recombinant (preventive vaccine) for cervical, vulvar, vaginal, and anal cancer
Human Papillomavirus 9-valent Vaccine, Recombinant (preventive vaccine) for cervical, vulvar, vaginal, anal, and throat cancer
Human Papillomavirus Bivalent (Types 16 and 18) Vaccine, Recombinant (preventive vaccine) for cervical cancer
Ibritumomab tiuxetan (antibody-drug conjugate) for lymphoma
Idecabtagene vicleucel (CAR T cell therapy) for multiple myeloma
Imiquimod (immunomodulator) for skin cancer (basal cell carcinoma)
Inotuzumab ozogamicin (antibody-drug conjugate) for leukemia
Interferon alfa-2a (immunomodulator) for leukemia and sarcoma
Interferon alfa-2b (immunomodulator) for leukemia, lymphoma, and melanoma
Ipilimumab (checkpoint inhibitor) for colorectal, liver, and lung cancer, and melanoma and mesothelioma
Isatuximab (targeted anytibody) for multiple myeloma
Lisocabtagene maraleucel (CAR T cell therapy) for lymphoma
Loncastuximab tesirine (antibody-drug conjugate) for lymphoma
Margetuximab (targeted antibody) for breast cancer
Mogamulizumab (targeted antibody) for lymphoma
Naxitamab-gqgk (targeted antibody) for neuroblastoma
Necitumumab (targeted antibody) for lung cancer
Nivolumab (checkpoint inhibitor) for bladder, colorectal, esophageal, GEJ, head and neck, kidney, liver, lung, and stomach cancer, lymphoma, melanoma, and mesothelioma
Obinutuzumab (targeted antibody) for leukemia and lymphoma
Ofatumumab (targeted antibody) for leukemia
Panitumumab (targeted antibody) for colorectal cancer
Peginterferon alfa-2b (immunomodulator) for melanoma
Pembrolizumab (checkpoint inhibitor) for bladder, breast, cervical, colorectal, esophageal, head and neck, kidney, liver, stomach, lung, and uterine cancer as well as lymphoma, melanoma, and any MSI-H or TMB-H solid cancer regardless of origin
Pertuzumab (targeted antibody) for breast cancer
Pexidartinib (immunomodulator) for tenosynovial giant cell tumor
Polatuzumab vedotin (antibody-drug conjugate) for lymphoma
Poly ICLC (immunomodulator) for skin cancer (squamous cell carcinoma)
Ramucirumab (targeted antibody) for colorectal, esophageal, liver, lung, and stomach cancer
Relatlimab (checkpoint inhibitor) for melanoma
Rituximab (targeted antibody) for leukemia and lymphoma
Sacituzumab govitecan-hziy (antibody-drug conjugate) for bladder and breast cancer
Sipuleucel-T (vaccine) for prostate cancer
Tafasitamab (targeted antibody) for lymphoma
Tebentafusp-tebn (bispecific antibody) for melanoma
Tisagenlecleucel (CAR T cell therapy) for leukemia (including pediatric) and lymphoma
Tisotumab vedotin (antibody-drug conjugate) for cervical cancer
Trastuzumab (targeted antibody) for breast, esophageal, and stomach cancer
Trastuzumab deruxtecan (antibody-drug conjugate) for breast, esophageal, and stomach cancer
Trastuzumab emtansine (antibody-drug conjugate) for breast cancer
T-VEC (oncolytic virus) for melanoma

New immunotherapies are being developed and immunotherapy clinical trials are under way in nearly all forms of cancer.

Can people with autoimmune diseases and cancer be treated with immunotherapy?

People with mild autoimmune diseases are able to receive most immunotherapies. Typically, autoimmune treatment is adjusted and a checkpoint immunotherapy, such as those targeting the PD-1/PD-L1 pathway, is used. However, each patient should speak with his or her doctor regarding the options that are most appropriate.

Can people with HIV be treated with immunotherapy?

People with HIV who are receiving effective anti-viral treatment and whose immune systems are functioning normally may respond to cancer immunotherapy and are therefore eligible to receive immunotherapy, both as standard of care and as part of a clinical trial.

How can I receive immunotherapy treatment?

The administration and frequency of immunotherapy regimens vary according to the cancer, drug, and treatment plan. Clinical trials can offer many valuable treatment opportunities for patients. Discuss your clinical trial options with your doctor.

Find an immunotherapy clinical trial

How can I tell whether immunotherapy is working?

Immunotherapy treatments may take longer to produce detectable signs of tumor shrinkage compared to traditional treatments. Sometimes tumors may appear to grow on scans before getting smaller, but this apparent swelling may be caused by immune cells infiltrating and attacking the cancer. Many patients who experience this phenomenon, known as pseudoprogression, often report feeling better overall.

In certain cancer types, immune-related side effects may be linked with treatment success—specifically, melanoma patients who develop vitiligo (blotched loss of skin color)—but for the vast majority of patients, no definitive link has been established between side effects and immunotherapy’s effectiveness.

How is the Cancer Research Institute involved in the development of immunotherapy?

For more than 65 years, the Cancer Research Institute (CRI) has been the pioneer in advancing immune-based treatment strategies against cancer. It is the world's leading nonprofit organization dedicated exclusively to saving more lives by fueling the discovery and development of powerful immunotherapies for all types of cancer.

CRI provides financial support to scientists at all stages of their careers along the entire spectrum of immunotherapy research and development: from basic discoveries in the lab that shed light on the fundamental components and mechanisms of the immune system and its relationship to cancer, to efforts focused on translating those discoveries into lifesaving treatments that are then tested in clinical trials for cancer patients.

Learn about CRI's impact

Boosting the Body's Immune System to Fight Cancer

Immunotherapy treatment harnesses the body's natural strength to fight cancer—
empowering the immune system to conquer more types of cancer and save more lives.

Antibodies

bind to antigens on threats in the body (e.g., bacteria, viruses, cancer cells) and mark cells for attack and destruction by other immune cells

B Cells

release antibodies to defend against threats in the body

CD4+ Helper T Cells

send “help” signals to the other immune cells (e.g., B cells and CD8+ killer T cells) to make them more efficient at destroying harmful invaders

CD8+ Killer T Cells

destroy thousands of virus-infected cells each day, and are also able to seek out and destroy cancer cells

Cytokines

help immune cells communicate with each other to coordinate the right immune response

Dendritic Cells

digest foreign and cancerous cells and present their proteins to immune cells that can destroy them

Macrophages

engulf and destroy bacteria, virus-infected cells, and cancer as well as present antigens to other immune cells

Natural Killer Cells

recognize and destroy virus-infected and tumor cells quickly without the help of antibodies and "remember" these threats

Regulatory T Cells

provide the checks and balances to ensure that the immune system does not overreact

How the Immune System Works

Organs, tissues, and glands around your body coordinate the creation, education, and storage of key elements in your immune systems.

Appendix

Thin tube about 4 to 6 inches long in the lower right abdomen. The exact function is unknown; one theory is that it acts as a storage site for "good" digestive bacteria

Bone Marrow

Soft, sponge-like material found inside bones. Contains immature cells that divide to form more blood-forming stem cells, or mature into red blood cells, white blood cells (B cells and T cells), and platelets

Gut

Cells lining this set of organs and glands, as well as the bacteria throughout it, influence the balance of the immune system.

Lymph Nodes

Small glands located throughout the body that filter bacteria, viruses, and cancer cells, which are then destroyed by special white blood cells. Also the site where T cells are "educated" to destroy harmful invaders in your body

Nose

This organ's receptors detect bacteria and viruses. Nasal mucus catches these pathogens so the immune system can learn to defend against them.

Skin

This organ is not only a physical barrier against infection, but also contains dendritic cells for teaching the rest of the body about new threats. The skin microbiome is also an important influence the balance of the immune system.

Spleen

Organ located to the left of the stomach. Filters blood and provides storage for platelets and white blood cells. Also serves as a site where key immune cells (B cells) multiply in order to fight harmful invaders

Tonsils

A set of organs that can stop germs entering the body through the mouth or the nose. They also contain a lot of white blood cells.

Thymus Gland

Small gland situated in the upper chest beneath the breastbone. Functions as the site where key immune cells (T cells) mature into cells that can fight infection and cancer

As a science-first organization dedicated to supporting cancer immunotherapy research, we're funding a future that fights back against cancer—all with your help.

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How does the immune system attack cancer cells?

Different cells fight different types of cancer. For example, one way the immune system fights cancer is by sending out a special form of white blood cells called T cells: The T cells see cancer as “foreign” cells that don't belong in the body. The T cells attack and try to destroy the cancerous cells.

What are the three types of immunotherapy?

Types of cancer immunotherapy.

Monoclonal antibodies (MABs) Some MABs have an effect on the immune system. ... .

Checkpoint Inhibitors. Checkpoint inhibitors are a type of immunotherapy that block different checkpoint proteins. ... .

Cytokines. ... .

Vaccines to treat cancer. ... .

CAR T-cell therapy..

What are the two treatments used to fight cancer?

But most people have a combination of treatments, such as surgery with chemotherapy and radiation therapy. When you need treatment for cancer, you have a lot to learn and think about.