Immunotherapy drugs can be more effective against cancer when combined with other therapies, such as radiation therapy, targeted drugs, immunotherapy agents, and with chemotherapy.
What is chemotherapy?
Chemotherapy drugs have been used for decades to treat cancer, either alone or in combination therapies. These drugs kill rapidly dividing cells, including tumor cells, using a variety of mechanisms.
What is immunotherapy?
Immunotherapy is a more recent advancement in cancer treatment. These therapies are designed to help the body’s own defenses – the immune system – be more effective at fighting cancer. There are many different forms of immunotherapy that work using a range of mechanisms to treat cancer.
Immunotherapy has been very effective for some patients and cancer types, with some achieving remarkable outcomes. However, it does not work for all patients or for all types of cancer.
“Combining immunotherapies with other treatments, including chemotherapy, has been a promising strategy for improving outcomes for patients with a range of types of cancer that are difficult to treat,” says Stephen Hodi, MD, Director of the Melanoma Treatment Center and the Center for Immuno-Oncology at Dana-Farber Cancer Institute.
Can chemotherapy and immunotherapy be combined to treat cancer?
Yes. Research has shown that chemotherapy plus immunotherapy – known as chemoimmunotherapy – can sometimes be more effective than either treatment alone. There are several possible explanations for this synergy.
When chemotherapy begins to kill cancer cells, two things can happen.
- The tumor begins to get smaller, potentially exposing its interior to the immune system or disrupting the tumor microenvironment, which could be shielding the tumor from the immune system. These changes can increase the ability of immunotherapies and immune cells to target and kill remaining cancer cells.
- When the tumor cells die, they release antigens, which are flags that stimulate an immune response against the cancer, potentially enhancing the effects of the immunotherapy.
In addition, the combination of these therapies can sometimes work well together because they can help prevent drug resistance. For example, a tumor cell that resists being killed by chemotherapy might not be able to resist the immunotherapy. Without immunotherapy, that cell could live on and cause the tumor to grow again, but with immunotherapy, that cell will be more likely to die.
Research has also shown that chemotherapy drugs can act directly on immune cells in a variety of ways that can stimulate or clear the way for the immune system to fight cancer.
When are chemotherapy and immunotherapy combined to treat cancer?
The U.S. Food and Drug Administration (FDA) has approved several chemotherapy and immunotherapy combinations.
These therapy combinations are highly personalized, and may only apply to cancers with certain features, such as the presence of specific immune biomarkers, or may only be appropriate for specific stages of the cancer. A doctor with expertise in the specific type of cancer should provide personalized guidance for individual cases.
Examples of cancers with approved immunotherapy and chemotherapy combinations include:
- Lung cancers like non-small cell lung cancer, small cell lung cancer
- Gastrointestinal cancers like esophageal cancer, gastric cancer, biliary tract cancer, and bladder cancer
A recent clinical trial led by Dana-Farber researchers also suggests that chemotherapy and immunotherapy could benefit certain patients with colon cancer.
What are the side effects of combining chemotherapy and immunotherapy?
Patients are likely to experience side effects with combined chemotherapy and immunotherapy. Those can include the side effects typically seen with each therapy individually.
- Chemotherapy related side effects: Fatigue, nausea, hair loss, and low blood counts.
- Immunotherapy side effects: Gastrointestinal issues, skin reactions, flu-like symptoms, and other immune-related side effects.
Your care team will work closely with you to manage your symptoms and help you make decisions about your treatment.
Hello- is immunotherapy recommended for breast cancer patients? My original diagnosis was in 2014 Stage IIIA and spread to the lymph nodes. I was recently told that my breast cancer metastasized and the ct scan shows that it is in my bones, liver and lungs. I am PR positive (5%) and Her2 negative. Thank you!
Hi Winona,
Thank you for reading and apologies for the delay in response. Unfortunately, we cannot provide personalized medical advice through this blog. Breast cancer investigators are tackling cancer on multiple fronts, including immunotherapy. You can find more information about breast cancer research and treatment on our website: https://www.dana-farber.org/breast-oncology-program/clinical-research-and-trials/
Wishing you the best,
DFCI
Where I will get the details of the clinical trials? May be the answer lies in the clinical trial protocols!
Hi Satish,
Thank you for reading. You can find current clinical trials offered through Dana-Farber here: http://www.dana-farber.org/Research/Clinical-Trials.aspx You can also search for clinical trials here: https://clinicaltrials.gov/
However, the website isn’t constantly updated, and data is constantly changing. You can always make an appointment to discuss treatment options with a doctor, who will have a better understanding of clinical trials that are being offered. Here is where you can find information on making an appointment: https://www.dana-farber.org/request-an-appointment/
Wishing you all the best,
DFCI
What about Immunotherapy combined with Alecensa?
I am still alive , years after they gave me a 25 percent chance of living 4 months … With a combination of Radiation and Keytruda
Are there currently trials for this combination with multiple myeloma
Hi Debra,
Thank you for reading and reaching out to us. You can find current clinical trials offered through Dana-Farber here: http://www.dana-farber.org/Research/Clinical-Trials.aspx You can also search for clinical trials here: https://clinicaltrials.gov/
However, the website isn’t constantly updated, and data is constantly changing. You can always make an appointment to discuss treatment options with a doctor, who will have a better understanding of clinical trials that are being offered. Here is where you can learn more about making an appointment at Dana-Farber: https://www.dana-farber.org/request-an-appointment/
We are wishing you all the best,
DFCI
Have cancer and rececent scan showed it in the liver. Was told I only have months to live. Are there any clinical trials I could take part in.
978-618-4601
Hi Barb,
Thank you for reading and reaching out to us. You can find current clinical trials offered through Dana-Farber here: http://www.dana-farber.org/Research/Clinical-Trials.aspx You can also search for clinical trials here: https://clinicaltrials.gov/
However, the website isn’t constantly updated, and data is constantly changing. You can always make an appointment to discuss treatment options with a doctor, who will have a better understanding of clinical trials that are being offered. Here is where you can learn more about making an appointment at Dana-Farber: https://www.dana-farber.org/request-an-appointment/
We are wishing you all the best,
DFCI
Thanks to Dana Farber’s Dr. Hamisha Beltran, who suggested immunotherapy in combination with chemotherapy for neuroendocrine prostate cancer with a mutation suggesting it was vulnerable to pembrolizumab. Genomic analysis of the biopsy by Foundation Health was crucial. Also critical was support of some experienced friends John F. and Karen T. who perused the literature to identify Dr. Beltran as the expert for a second opinion. Natural intelligence worked. Maybe AI can match them for patients without such access.