What types of cancer can be treated with immunotherapy?

Since its introduction in 1891, immunotherapy has evolved to include many different types of therapies which help the body’s immune system to fight cancer, such as cancer vaccines, monoclonal antibodies, checkpoint inhibitors and Chimeric antigen receptor (CAR) T-cell therapies. However, as little as five years ago, immunotherapy wasn’t a commonly available treatment option for many types of cancer in Australia.

Following several landmark clinical trials both in Australia and globally, immunotherapy has expanded to treat a much broader range of cancer types. Immunotherapy is most commonly used to treat advanced cancers that have spread beyond the area where the cancer first developed, known as secondary or metastatic cancers, and recurrent cancer (when cancer returns after treatment).

Immunotherapy is also reimbursed under the Pharmaceutical Benefits Scheme (PBS) for many of these cancers in Australia.

As we better understand how cancers grow and multiply, new discoveries are being made and more immunotherapy treatments are becoming available every day.

Immunotherapy can work more effectively when used in combination with other anti-cancer treatments such as chemotherapy and radiation therapy, and many commonly used treatment plans combine these cancer therapies.

In Australia, immunotherapy is currently TGA approved for use for the following cancer types:

• Acute lymphoblastic leukaemia (ALL)
• Bladder cancer
• Bowel cancer (deficient in mismatch repair proteins)
• Cervical cancer
• Chronic lymphocytic leukaemia (CLL)
• Head and neck cancer
• Hepatocellular cancer (liver cancer)
• Kidney cancer
• Lung cancer
• Lymphoma
• Melanoma skin cancer
• Myeloma
• Non-melanoma skin cancer (cutaneous squamous cell carcinoma and merkel cell carcinomas)
• Oesophageal cancer
• Triple negative breast cancer

While immunotherapy can offer successful treatment for many people, it’s important to remember that it isn’t always a cure-all and doesn’t work for everyone. Immunotherapy isn’t effective for all types of cancers and, in some people, immunotherapy may not work or may stop working after a period of time.

Scientists are still trying to understand why some patients do not respond to immunotherapy, and why some cancers are more responsive to it than others. This is a significant focus of cancer research.

For example, immunotherapy has dramatically improved survival rates for people with advanced melanoma skin cancer. When a combination of two immunotherapies is used, ipilimumab and nivolumab, up to 50% of patients achieve long term remission and others are even cured, but unfortunately 50% of patients either do not respond or develop resistance to these treatments. It is results such as these that show the importance of developing and trialling new treatments.

If your immunotherapy treatment stops working, there may be different immunotherapies, different combinations of treatment, or other anti-cancer therapies that are suitable for your cancer.

Sometimes, adding a new immunotherapy drug can make the first drug work better, so your doctor may recommend starting on a new immunotherapy drug to achieve the best possible results. In other cases, a combination of different therapies, such as immunotherapy with chemotherapy or radiation therapy, can have better results than immunotherapy alone. Many of these treatment combinations are commonly used and widely available, while others are so new that they can only be accessed through participating in a clinical trial.

If you are already participating in a clinical trial for immunotherapy and it stops working, there will be procedures and actions that are part of the clinical trial protocol which your doctor and research team will support you through. Even if you choose to stop taking part in a clinical trial, there may be other treatment options for you to consider. Talk to your doctor about treatments that may be suitable for you and your cancer, such as moving to other forms of standard treatment or joining a different clinical trial.

When immunotherapy and other cancer treatments stop working for people with advanced cancer, the focus may shift to improving quality of life and managing the symptoms of your cancer. Your doctors will talk to you about a management plan and continue to support you and your family every step of the way.