Last updated on Dec. 9, 2022

Immunotherapy is a treatment option for a growing number of cancers. Unlike traditional treatments like chemotherapy and radiation therapy, immunotherapies do not target the cancer itself.

“At times, our immune system can become tolerant to cancer for various reasons,” says Aung Naing, M.D., who leads an immunotherapy working group in MD Anderson’s Phase I clinical trials program. “With immunotherapy, we are trying to harness or reinvigorate the immune system so that it recognizes and attacks the cancer instead of being tolerant.”

What are the different types of immunotherapy?

There are several types of immunotherapy. Immune checkpoint inhibitors work by blocking checkpoint proteins – including CTLA-4, PD-L1 and PD-1 – on the surface of T cells. These proteins normally prevent T cells from attacking healthy cells. Approved checkpoint inhibitors include:

• anti-CTLA-4 therapies ipilimumab and tremelimumab
• anti-PD-1 therapies pembrolizumab, nivolumab, cemiplimab and dostarlimab
• anti-PD-L1 therapies atezolizumab, avelumab and durvalumab
• anti-LAG-3 therapy relatlimab

Adoptive cellular therapies are another form of immunotherapy. The only Food and Drug Administration (FDA)-approved options are CAR T cell therapies, which are created from T cells taken from the patient. The cells are engineered to better recognize the cancer, expanded to large numbers and given back to the patient. FDA-approved CAR T cell therapies include brexucabtagene autoleucel, tisagenlecleucel, axicabtagene ciloleucel and lisocabtagene maraleucel.

Cancer vaccines train the body to recognize specific features of the cancer and stimulate the immune system to attack. The only approved cancer vaccine is sipuleucel-T.

Finally, cytokine therapies rely on immune proteins called interferons and interleukins to stimulate immune activity. The main cytokines that have been approved for cancer treatment are interleukin-2 and interferon alpha.

Immunotherapy treats many types of cancer

Currently, the FDA has approved immunotherapies to treat certain patients with the cancer types listed below. The list is expanding frequently as more immunotherapy drugs complete testing through clinical trials. So, if immunotherapy isn’t an option for you right now, that could change in the future.

“We are constantly evaluating therapies in new cancer types and testing new therapies that have not been used before,” says Naing.

In most cases, patients must have had previous treatment with certain treatments or have specific tumor markers in order to be eligible for these therapies. Keep in mind that the information shared here should not be considered medical advice. “It’s important to talk to your doctor to determine whether you may be eligible for immunotherapy or to address specific medical questions or concerns,” Naing says.

Advanced solid tumors

Certain children and adults with advanced solid tumors and specific tumor characteristics may be eligible for treatment with the immune checkpoint inhibitors pembrolizumab or dostarlimab, regardless of cancer type.

B-cell lymphoma

For some children and adults with B-cell lymphoma, the following immunotherapy treatments may be an option:

• Certain adults with advanced large B-cell lymphoma may be eligible for CAR T cell therapy with tisagenlecleucel, axicabtagene ciloleucel or lisocabtagene maraleucel.
• Certain adults with mantle cell lymphoma may be eligible for brexucabtagene autoleucel CAR T cell therapy.
• Certain adults with advanced follicular lymphoma may be eligible for axicabtagene ciloleucel CAR T cell therapy.
• Certain adults and children with primary mediastinal B-cell lymphoma may be treated with pembrolizumab.

Bile duct cancer

The FDA has approved durvalumab in combination with the chemotherapies gemcitabine and cisplatin for certain adult patients with locally advanced or metastatic bile duct cancer, also known as cholangiocarcinoma.

Bladder cancer

Several checkpoint inhibitors have been approved to treat certain patients with locally advanced or metastatic bladder cancer. Approved drugs include pembrolizumab, atezolizumab, nivolumab, durvalumab and avelumab in certain indications. Nivolumab in combination with the targeted therapy cabozantinib is approved as a first-line treatment in some patients.

Breast cancer

For some adults with triple-negative breast cancer, immune checkpoint inhibitors may be an option. The FDA has approved treatment with atezolizumab in combination with the chemotherapy paclitaxel (protein-bound) and pembrolizumab in combination with chemotherapy. 

Cervical cancer

Certain patients with recurrent or metastatic cervical cancers may be eligible for treatment with the immune checkpoint inhibitor pembrolizumab, either alone or in combination with chemotherapy and the targeted thearpy bevacizumab.

Colorectal cancer

Immune checkpoint inhibitors may be an option for certain patients with advanced colorectal cancer with specific tumor markers, including pembrolizumab and nivolumab (either alone or in combination with ipilimumab).

Esophageal cancer

For some patients with squamous cell esophageal cancer, immune checkpoint inhibitors may be an option.

• Nivolumab is approved in combination with either ipilimumab or chemotherapy as a first-line treatment for certain patients with advanced cancers. 
• Nivolumab is approved for certain patients with advanced cancers following prior chemotherapy.

Certain patients with esophageal and gastroesophageal junction cancers may be treated with:

• The FDA has approved treatment with nivolumab for certain patients with resectable cancer.
• Certain patients with advanced cancers may be treated with either pembrolizumab or nivolumab combined with certain chemotherapies. 

Head and neck cancers

Certain patients with advanced squamous cell cancer of the head and neck, such as oral cancer or throat cancer, may be eligible for treatment with the immune checkpoint inhibitors nivolumab or pembrolizumab. In some cases, pembrolizumab may be used alone or in combination with certain chemotherapies.

Hodgkin lymphoma

For certain patients with refractory classical Hodgkin lymphoma, the FDA has approved treatment with pembrolizumab and nivolumab.

Kidney cancer

Immune checkpoint inhibitors may be an option for certain patients with advanced kidney cancer. Either avelumab or pembrolizumab may be used in combination with the chemotherapy axitinib for some patients. Nivolumab may be used alone or in combination with ipilimumab for some patients. Pembrolizumab alone has been approved following surgery for certain patients with increased risks of recurrence.

The cytokine therapies interferon alpha, in combination with the targeted therapy bevacizumab, or interleukin-2 may also be options for some patients.

Leukemia

Tisagenlecleucel CAR T cell therapy is an option for some children and young adults with refractory B-cell acute lymphoblastic leukemia (ALL). For adults with relapsed or refractory B-cell ALL, brexucabtagene
autoleucel CAR T cell therapy may be an option.

The cytokine therapy interferon alpha may also be an option for some patients with certain leukemias.

Liver cancer

Certain patients with liver cancer may be treated with the immune checkpoint inhibitors pembrolizumab, nivolumab (alone or in combination with ipilimumab), tremelimumab in combination with durvalumab, or atezolizumab in combination with the targeted therapy bevacizumab.

Lung cancer

Certain patients with advanced non-small cell lung cancer may be eligible for treatment with immune checkpoint inhibitors, including nivolumab (alone or with ipilimumab), pembrolizumab, atezolizumab, durvalumab, cemiplimab, and trememlimumab (with durvalumab). In some circumstances, these therapies are only approved for treatment in combination with certain chemotherapies or targeted therapies.

Some patients with advanced small cell lung cancer also may be eligible for treatment with pembrolizumab, nivolumab, atezolizumab or durvalumab. Atezolizumab and durvalumab are used in combination with specific chemotherapies.

Melanoma

Immune checkpoint inhibitors have been approved for certain patients with advanced melanoma. These include pembrolizumab, atezolizumab, ipilimumab,  nivolumab and relatilimab. Nivolumab may be offered along or as part of a combination with ipilimumab or relatlimab. Relatlimab is approved in combination with nivolumab. Atezolizumab is approved in combination with certain targeted therapies.

The cytokine therapies interferon alpha or interleukin-2 may also be options for some patients.

Mesothelioma

For some patients with unresectable malignant pleural mesothelioma, the FDA has approved treatment with ipilimumab in combination with nivolumab.

Multiple myeloma

Certain patients with advanced multiple myeloma may be treated with the CAR T cell therapy idecabtagene vicleucel.

Non-Hodgkin lymphoma

Some patients with relapsed or refractory B-cell non-Hodgkin lymphoma may be eligible for treatment with the immunotherapy:

• Certain adults with advanced large B-cell lymphoma may be eligible for CAR T cell therapy with tisagenlecleucel, axicabtagene ciloleucel or lisocabtagene maraleucel.
• Certain adults with mantle cell lymphoma may be eligible for brexucabtagene autoleucel CAR T cell therapy.
• Certain adults with advanced follicular lymphoma may be eligible for axicabtagene ciloleucel CAR T cell therapy.
• Certain adults and children with primary mediastinal B-cell lymphoma may be treated with pembrolizumab.

The cytokine therapy interferon alpha may also be an option for some patients with certain non-Hodgkin lymphomas.

Prostate cancer

Some patients with metastatic castration-resistance prostate cancer may be treated with the therapeutic vaccine sipuleucel-T.

Skin cancer

Treatment with immune checkpoint inhibitors is approved for some patients with skin cancer:

• Pembrolizumab and avelumab has been approved for adults and children with Merkel cell cancer. 
• Pembrolizumab and cemiplimab has been approved for some patients with cutaneous squamous cell cancer.
• Cemiplimab has been approved for certain patients with basal cell carincoma.

Soft tissue sarcoma

The immune checkpoint inhibitor atezolizumab is approved for certain adult and pediatric patients with alveolar soft part sarcoma, a type of soft tissue sarcoma. 

Stomach cancer

Certain patients with recurrent locally advanced or metastatic stomach cancer or gastroesophageal junction cancer may be eligible for treatment with the immune checkpoint inhibitors pembrolizumab or nivolumab plus certain chemotherapies.

Endometrial cancer 

For some patients with advanced uterine cancer, treatment with checkpoint inhibitors may be an option:

• Pembrolizumab has been approved in combination with the targeted therapy lenvatinib for certain patients with advanced endometrial cancer.
• Dostarlimab has been approved for certain adults with recurrent or avanced endometrial cancer.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

MD Anderson’s Moon Shots Program™ increases the speed at which our experts turn their research into new cancer treatment options for patients. At the core of this ambitious initiative are 10 research platforms, which provide the 13 disease-specific Moon Shots with specialized equipment, knowledge and data analysis tools.

To learn how the platform impacts our immunotherapy research and cancer treatment, we spoke with the Immunotherapy platform team, which is led by Jim Allison, Ph.D., and Padmanee Sharma, M.D., Ph.D.

What is immunotherapy?

Immunotherapy is a cancer treatment that uses the body’s own immune system to fight cancer.

One type of immunotherapy, called immune checkpoint inhibitors, provides lasting cures to a subset of patients with specific cancers, including:

• Bladder cancer
• Hodgkin’s lymphoma
• Kidney cancer
• Head and neck cancers
• Melanoma
• Merkel cell carcinoma
• Non-small cell lung cancer

Currently, not all patients benefit from immunotherapy, but through clinical trials, our experts are learning how to make this treatment more effective.

How does the platform contribute to our mission of ending cancer?

Our goal is to make immunotherapy a standard treatment option for many more types of cancers and patients. To expand the use of immunotherapy, we’re working to:

• identify the patients most likely to benefit from current immunotherapies,
• investigate why immunotherapy works for some patients and types of cancers but not others, and
• develop new immunotherapies and powerful combinations of existing therapies.

We’re testing tumor and blood samples taken from patients treated on immunotherapy clinical trials to achieve these goals.

The information we gather from analyzing these samples allows us to identify biomarkers that predict the likelihood that a patient will respond to currently available immunotherapies. This information can also guide our laboratory experiments aimed at finding new immunotherapy strategies.

What makes the Immunotherapy platform unique?

Our platform’s proximity to patients and our location within the world’s largest cancer center enables us to bring cutting-edge immunotherapy trials and treatments into the clinic at a relatively quick pace, which is extremely difficult to achieve in an academic research center.

Success in our work requires collecting a large number of tumor and blood samples from patients. In addition, some of the state-of-the art analyses we perform require very fresh samples, so it’s crucial that we have eligible patients nearby.

We also have a unique team of clinicians, physician-scientists, laboratory scientists and bioinformaticians – all of whom interact extremely closely. This collaborative effort provides real-time monitoring of patients across many immunotherapy clinical trials for several cancer types.

These advantages allow us to seamlessly move immunotherapy discoveries made in our research labs to our patients. The platform is also designed to tailor our research strategies in response to observations made in the clinic, so we can continuously improve the immunotherapies we’re bringing to patients.

We view this process as being both “from bench to bedside” as well as the reverse, from the clinic back into the laboratory. This is only possible in a limited number of cancer centers.

How is the platform advancing cancer immunotherapy?

Our platform leads path-changing studies that help uncover the complex biology of immunotherapies, in particular immune checkpoint inhibitors. Our accomplishments include:

• Discovering that the two primary immune checkpoint inhibitors used today, anti-PD-1 and anti-CTLA-4, affect the immune response in different ways.
• Conducting a clinical trial that led to the approval of anti-PD-1 therapy for the treatment of metastatic renal cell carcinoma, which is now the standard of care for these patients.
• Identifying how to predict whether a patient will respond to immunotherapy early during treatment of metastatic melanoma, which is vital to delivering the right treatment to the right patient as quickly as possible.
• Providing preclinical data that supported the initiation of a clinical trial combining anti-CTLA-4 and anti-PD-1 therapy for the treatment of castrate-resistant prostate cancer, which was previously considered a bad target for immunotherapy.

What’s next for the Immunotherapy platform?

We would like to see immunotherapy applied earlier in treatment, in combination with traditional therapies, such as radiation, chemotherapy and targeted therapies. These sorts of combinations are already showing promise of eliminating cancer throughout the body and making immunotherapy available for more types of cancers.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.