Archives: Treatment Types

Radiation Therapy to Treat Cancer

Radiation Therapy to Treat Cancer

Technician positions a person lying on a treatment table for radiation therapy.

Radiation therapy kills cancer cells or slows their growth by damaging their DNA.

Credit: National Cancer Institute

Radiation therapy (also called radiotherapy) is a cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors. At low doses, radiation is used in x-rays to see inside your body, as with x-rays of your teeth or broken bones.

How radiation therapy works against cancer

At high doses, radiation therapy kills cancer cells or slows their growth by damaging their DNA. Cancer cells whose DNA is damaged beyond repair stop dividing or die. When the damaged cells die, they are broken down and removed by the body.

Radiation therapy does not kill cancer cells right away. It takes days or weeks of treatment before DNA is damaged enough for cancer cells to die. Then, cancer cells keep dying for weeks or months after radiation therapy ends.

Types of radiation therapy

There are two main types of radiation therapy, external beam and internal.

The type of radiation therapy that you may have depends on many factors, including:

  • the type of cancer
  • the size of the tumor
  • the tumor’s location in the body
  • how close the tumor is to normal tissues that are sensitive to radiation
  • your general health and medical history
  • whether you will have other types of cancer treatment
  • other factors, such as your age and other medical conditions

External beam radiation therapy

External beam radiation therapy comes from a machine that aims radiation at your cancer. The machine is large and may be noisy. It does not touch you, but can move around you, sending radiation to a part of your body from many directions.

External beam radiation therapy is a local treatment, which means it treats a specific part of your body. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.

Learn more about external beam radiation therapy.

Internal radiation therapy

Internal radiation therapy is a treatment in which a source of radiation is put inside your body. The radiation source can be solid or liquid.

Internal radiation therapy with a solid source is called brachytherapy. In this type of treatment, seeds, ribbons, or capsules that contain a radiation source are placed in your body, in or near the tumor. Like external beam radiation therapy, brachytherapy is a local treatment and treats only a specific part of your body.

With brachytherapy, the radiation source in your body will give off radiation for a while.

Learn more about brachytherapy.

Internal radiation therapy with a liquid source is called systemic therapy. Systemic means that the treatment travels in the blood to tissues throughout your body, seeking out and killing cancer cells. You receive systemic radiation therapy by swallowing, through a vein via an IV line, or through an injection.

With systemic radiation, your body fluids, such as urine, sweat, and saliva, will give off radiation for a while.

Why people with cancer receive radiation therapy

Radiation therapy is used to treat cancer and ease cancer symptoms.

When used to treat cancer, radiation therapy can cure cancer, prevent it from returning, or stop or slow its growth.

When treatments are used to ease symptoms, they are known as palliative treatments. External beam radiation may shrink tumors to treat pain and other problems caused by the tumor, such as trouble breathing or loss of bowel and bladder control.

Pain from cancer that has spread to the bone can be treated with systemic radiation therapy drugs called radiopharmaceuticals.

Types of cancer that are treated with radiation therapy

External beam radiation therapy is used to treat many types of cancer.

Brachytherapy is most often used to treat cancers of the head and neck, breast, cervix, prostate, and eye.

A systemic radiation therapy called radioactive iodine, or I-131, is most often used to treat certain types of thyroid cancer.

Another type of systemic radiation therapy, called targeted radionuclide therapy, is used to treat some patients who have advanced prostate cancer or gastroenteropancreatic neuroendocrine tumor (GEP-NET). This type of treatment may also be referred to as molecular radiotherapy.

How radiation is used with other cancer treatments

For some people, radiation may be the only treatment you need. But, most often, you will have radiation therapy with other cancer treatments, such as surgery, chemotherapy, and immunotherapy. Radiation therapy may be given before, during, or after these other treatments to improve the chances that treatment will work. The timing of when radiation therapy is given depends on the type of cancer being treated and whether the goal of radiation therapy is to treat the cancer or ease symptoms.

When radiation is combined with surgery, it can be given:

  • Before surgery, to shrink the size of the cancer so it can be removed by surgery and be less likely to return.
  • During surgery, so that it goes straight to the cancer without passing through the skin. Radiation therapy used this way is called intraoperative radiation. With this technique, doctors can more easily protect nearby normal tissues from radiation.
  • After surgery to kill any cancer cells that remain.

Lifetime dose limits

There is a limit to the amount of radiation an area of your body can safely receive over the course of your lifetime. Depending on how much radiation an area has already been treated with, you may not be able to have radiation therapy to that area a second time. But, if one area of the body has already received the safe lifetime dose of radiation, another area might still be treated if the distance between the two areas is large enough.

Radiation therapy can cause side effects

Radiation not only kills or slows the growth of cancer cells, it can also affect nearby healthy cells. Damage to healthy cells can cause side effects.

Learn more about the side effects of radiation therapy.

How much radiation therapy costs

Radiation therapy can be expensive. It uses complex machines and involves the services of many health care providers. The exact cost of your radiation therapy depends on the cost of health care where you live, what type of radiation therapy you get, and how many treatments you need.

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for radiation therapy. To learn more, talk with the business office at the clinic or hospital where you go for treatment. If you need financial assistance, there are organizations that may be able to help. To find such organizations, go to the National Cancer Institute database, Organizations that Offer Support Services and search for “financial assistance.” Or call toll-free 1-800-4-CANCER (1-800-422-6237) to ask for information on organizations that may help.

Special diet needs while on radiation therapy

Radiation can cause side effects that make it hard to eat, such as nausea, mouth sores, and throat problems called esophagitis. Since your body uses a lot of energy to heal during radiation therapy, it is important that you eat enough calories and protein to maintain your weight during treatment.

If you are having trouble eating and maintaining your weight, talk to your doctor or nurse. You might also find it helpful to speak with a dietitian. For more information about coping with eating problems see the booklet Eating Hints or read more about side effects.

Working during radiation therapy

Some people are able to work full-time during radiation therapy. Others can work only part-time or not at all. How much you are able to work depends on how you feel. Ask your doctor or nurse what you may expect from the treatment you will have.

You are likely to feel well enough to work when you first start your radiation treatments. As time goes on, do not be surprised if you are more tired, have less energy, or feel weak. Once you have finished treatment, it may take just a few weeks for you to feel better—or it could take months.

You may get to a point during your radiation therapy when you feel too sick to work. Talk with your employer to find out if you can go on medical leave. Check that your health insurance will pay for treatment while you are on medical leave.

Chemotherapy to Treat Cancer

Chemotherapy to Treat Cancer

Seated female patient receives chemotherapy infusion from female nurse.

Chemotherapy works against cancer by killing fast-growing cancer cells.

Credit: National Cancer Institute

Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to kill cancer cells.

How chemotherapy works against cancer

Chemotherapy works by killing or stopping the growth of cancer and other fast-growing cells. Chemotherapy is used for two reasons:

  • Treat cancer: Chemotherapy can be used to cure cancer, lessen the chance it will return, or stop or slow its growth.
  • Ease cancer symptoms: Chemotherapy can be used to shrink tumors that are causing pain and other problems.

Which types of cancer does chemotherapy treat

Chemotherapy is used to treat many types of cancer. For some people, chemotherapy may be the only treatment you receive. But most often, you will have chemotherapy with other cancer treatments. The types of treatment that you need depend on the type of cancer you have, if it has spread and where, and if you have other health problems. To learn more about treatment for your cancer, see the PDQ® cancer treatment summaries for adult and childhood cancers.

How chemotherapy is used with other cancer treatments

When used with other treatments, chemotherapy can

  • make a tumor smaller before surgery or radiation therapy (called neoadjuvant chemotherapy)
  • destroy cancer cells that may remain after surgery or radiation therapy (called adjuvant chemotherapy)
  • help other treatments work better
  • kill cancer cells that have returned or spread to other parts of your body

Chemotherapy can cause side effects

Chemotherapy not only kills fast-growing cancer cells, but also kills or slows the growth of healthy cells that grow and divide quickly. Examples are cells that line your mouth and intestines and those that cause your hair to grow. Damage to healthy cells may cause side effects, such as mouth sores, nausea, and hair loss. Side effects often get better or go away after you have finished chemotherapy.

The most common side effect is fatigue, which is feeling exhausted and worn out. You can prepare for fatigue by

  • asking someone to drive you to and from chemotherapy
  • planning time to rest on the day of and day after chemotherapy
  • asking for help with meals and childcare on the day of and at least one day after chemotherapy

There are many ways you can help manage chemotherapy side effects. For more information, see the section on side effects.

How much chemotherapy costs

The cost of chemotherapy depends on

  • the types and doses of chemotherapy used
  • how long and how often chemotherapy is given
  • whether you get chemotherapy at home, in a clinic or office, or during a hospital stay
  • the part of the country where you live

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for chemotherapy. To learn more, talk with the business office where you go for treatment.

If you need financial assistance, there are organizations that may be able to help. To find such organizations, go to the National Cancer Institute database Organizations that Offer Support Services and search for “financial assistance.” Or call toll-free 1-800-4-CANCER (1-800-422-6237) to ask for information on organizations that may help.

What to expect when receiving chemotherapy

How chemotherapy is given

Chemotherapy may be given in many ways. Some common ways include

  • oral: comes in pills, capsules, or liquids that you swallow
  • intravenous (IV): goes directly into a vein
  • injection: given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly
  • intrathecal: injected into the space between the layers of tissue that cover the brain and spinal cord
  • intraperitoneal (IP): goes directly into the peritoneal cavity, which is the area in your body that contains organs such as your intestines, stomach, and liver
  • intra-arterial (IA): injected directly into the artery that leads to the cancer
  • topical: comes in a cream that you rub onto your skin

Of all the methods mentioned above, chemotherapy is most often given with an IV, through a thin needle that is placed in a vein on your hand or lower arm. Your nurse will put the needle in at the start of each treatment and remove it when treatment is over. IV chemotherapy may also be given through catheters or ports, sometimes with the help of a pump.

  • Catheter: A catheter is a thin, soft tube. A doctor or nurse places one end of the catheter in a large vein, often in your chest area. The other end of the catheter stays outside your body. Most catheters stay in place until you have finished your chemotherapy treatments. Catheters can also be used to give you other drugs and to draw blood. Be sure to watch for signs of infection around your catheter. See the section about infection for more information.
  • Port: A port is a small, round disc that is placed under your skin during minor surgery. A surgeon puts it in place before you begin your course of treatment, and it remains there until you have finished. A catheter connects the port to a large vein, most often in your chest. Your nurse can insert a needle into your port to give you chemotherapy or draw blood. This needle can be left in place for chemotherapy treatments that are given for longer than one day. Be sure to watch for signs of infection around your port. See the section about infection for more information.
  • Pump: Pumps are often attached to catheters or ports. They control how much and how fast chemotherapy goes into a catheter or port, allowing you to receive your chemotherapy outside of the hospital. Pumps can be internal or external. External pumps remain outside your body. Internal pumps are placed under your skin during surgery.

How your doctor decides which chemotherapy drugs to give you

There are many different chemotherapy drugs. Which ones are included in your treatment plan depends mostly on

  • the type of cancer you have and how advanced it is
  • whether you have had chemotherapy before
  • whether you have other health problems, such as diabetes or heart disease

Where you go for chemotherapy

You may receive chemotherapy during a hospital stay, at home, or as an outpatient at a doctor’s office, clinic, or hospital. Outpatient means you do not stay overnight. No matter where you go for chemotherapy, your doctor and nurse will watch for side effects and help you manage them. For more information on side effects and how to manage them, see the section on side effects.

How often you receive chemotherapy

Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on

  • your type of cancer and how advanced it is
  • whether chemotherapy is used to
    • cure your cancer
    • control cancer’s growth
    • ease symptoms
  • the type of chemotherapy you are getting
  • how your body responds to the chemotherapy

You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, you might receive chemotherapy every day for 1 week followed by 3 weeks with no chemotherapy. These 4 weeks make up one cycle. The rest period gives your body a chance to recover and build new healthy cells.

Missing a chemotherapy treatment

It is best not to skip a chemotherapy treatment. But, sometimes your doctor may change your chemotherapy schedule if you are having certain side effects. If this happens, your doctor or nurse will explain what to do and when to start treatment again.

How chemotherapy may affect you

Chemotherapy affects people in different ways. How you feel depends on

  • the type of chemotherapy you are getting
  • the dose of chemotherapy you are getting
  • your type of cancer
  • how advanced your cancer is
  • how healthy you are before treatment

Since everyone is different and people respond to chemotherapy in different ways, your doctor and nurses cannot know for sure how you will feel during chemotherapy.

How will I know if chemotherapy is working?

You will see your doctor often. During these visits, they will ask you how you feel, do a physical exam, and order medical tests and scans. Tests might include blood tests. Scans might include MRI, CT, or PET scans.

You cannot tell if chemotherapy is working based on its side effects. Some people think that severe side effects mean that chemotherapy is working well, or that no side effects mean that chemotherapy is not working. The truth is that side effects have nothing to do with how well chemotherapy is fighting your cancer.

Special diet needs while on chemotherapy

Chemotherapy can damage the healthy cells that line your mouth and intestines and cause eating problems. Tell your doctor or nurse if you have trouble eating while you are receiving chemotherapy. You might also find it helpful to speak with a dietitian. For more information about coping with eating problems see the booklet Eating Hints or the section on side effects.  

Working during chemotherapy

Many people can work during chemotherapy, as long as they match their work schedule to how they feel. Whether or not you can work may depend on what kind of job you have. If your job allows, you may want to see if you can work part-time or from home on days you do not feel well.

Many employers are required by law to change your work schedule to meet your needs during cancer treatment. Talk with your employer about ways to adjust your work during chemotherapy. You can learn more about these laws by talking with a social worker.

Hormone Therapy to Treat Cancer

Hormone Therapy to Treat Cancer

Woman seated beside man, eyes closed and leaning her head on his chest

Hormone therapy is used to treat cancers that use hormones to grow, such as some prostate and breast cancers.

Credit: iStock

Hormone therapy is a cancer treatment that slows or stops the growth of cancer that uses hormones to grow. Hormone therapy is also called hormonal therapy, hormone treatment, or endocrine therapy.

How hormone therapy is used against cancer

Hormone therapy is used for two main reasons.

  • Treat cancer. Hormone therapy can stop or slow cancer’s growth and reduce the chance it will return.
  • Ease cancer symptoms. Hormone therapy may be used to reduce or prevent symptoms in men with prostate cancer who are not able to have surgery or radiation therapy.

Types of hormone therapy

Hormone therapy falls into two broad groups, those that block the body’s ability to produce hormones and those that interfere with how hormones behave in the body.

Cancers treated with hormone therapy

Hormone therapy is used to treat prostate and breast cancers that use hormones to grow. Hormone therapy is most often used along with other cancer treatments. The types of treatment that you need depend on the type of cancer, if it has spread and how far, if it uses hormones to grow, and if you have other health problems.

How hormone therapy is used with other cancer treatments

When used with other treatments, hormone therapy can

Range of scores for the Decipher test showing low, intermediate, and high risk of prostate cancer metastasis

Genetic Test May Help Predict Whether Prostate Cancer Will Spread

The test may help determine whether to treat with hormone therapy.

  • make a tumor smaller before surgery or radiation therapy (called neoadjuvant therapy)
  • lower the risk that cancer will come back after the main treatment (called adjuvant therapy)
  • destroy cancer cells that have returned or spread to other parts of your body

Hormone therapy can cause side effects

Because hormone therapy blocks your body’s ability to produce hormones or interferes with how hormones behave, it can cause unwanted side effects. The side effects you have will depend on the type of hormone therapy you receive and how your body responds to it. People respond differently to the same treatment, so not everyone gets the same side effects. Some side effects also differ if you are a man or a woman.

Some common side effects for men who receive hormone therapy for prostate cancer include

Learn more about sexual health issues in men with cancer.

Some common side effects for women who receive hormone therapy for breast cancer include

  • hot flashes
  • vaginal dryness
  • changes in your periods if you have not yet reached menopause
  • loss of interest in sex
  • nausea
  • mood changes
  • fatigue

Learn more about sexual health issues in women with cancer.

How much hormone therapy costs

The cost of hormone therapy depends on

  • the types of hormone therapy you receive
  • how long and how often you receive hormone therapy
  • the part of the country where you live

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for hormone therapy for their members. To learn more, talk with the business office where you go for treatment. You can also go to the National Cancer Institute database, Organizations that Offer Support Services and search “financial assistance.” Or call toll-free 1-800-4-CANCER (1-800-422-6237) to ask for help.

How hormone therapy is given

Hormone therapy may be given in many ways:

  • Oral. Hormone therapy comes in pills that you swallow.
  • Injection. The hormone therapy is given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly.
  • Surgery. You may have surgery to remove organs that produce hormones. In women, the ovaries are removed. In men, the testicles are removed.

Where you receive hormone therapy

Where you receive treatment depends on which hormone therapy you are getting and how it is given. You may take hormone therapy at home. Or you may receive hormone therapy in a doctor’s office, clinic, or hospital.

How hormone therapy may affect you

Hormone therapy affects people in different ways. How you feel depends on the type of cancer you have, how advanced it is, the type of hormone therapy you are getting, and the dose. Your doctors and nurses cannot know for certain how you will feel during hormone therapy.

How to tell if hormone therapy is working

If you are taking hormone therapy for prostate cancer, you will have regular PSA tests. If hormone therapy is working, your PSA levels will stay the same or may even go down. But, if your PSA levels go up, this may be a sign that the treatment is no longer working. If this happens, your doctor will discuss treatment options with you.

If you are taking hormone therapy for breast cancer, you will have regular check-ups. Checkups usually include an exam of the neck, underarm, chest, and breast areas. You will have regular mammograms, though you probably won’t need a mammogram of a reconstructed breast. Your doctor may also order other imaging procedures or lab tests.

Special diet needs

Hormone therapy for prostate cancer may cause weight gain. Talk with your doctor, nurse, or dietitian if weight gain becomes a problem for you.

Angiogenesis Inhibitors

Angiogenesis Inhibitors

What is angiogenesis?

Angiogenesis is the formation of new blood vessels. This process involves the migration, growth, and differentiation of endothelial cells, which line the inside wall of blood vessels.

The process of angiogenesis is controlled by chemical signals in the body. Some of these signals, such as vascular endothelial growth factor (VEGF), bind to receptors on the surface of normal endothelial cells. When VEGF and other endothelial growth factors bind to their receptors on endothelial cells, signals within these cells are initiated that promote the growth and survival of new blood vessels. Other chemical signals, called angiogenesis inhibitors, interfere with blood vessel formation.

Normally, the angiogenesis stimulating and inhibiting effects of these chemical signals are balanced so that blood vessels form only when and where they are needed, such as during growth and healing. But, for reasons that are not entirely clear, sometimes these signals can become unbalanced, causing increased blood vessel growth that can lead to abnormal conditions or disease. For example, angiogenesis is the cause of age-related wet macular degeneration.

Why is angiogenesis important in cancer?

Angiogenesis plays a critical role in the growth of cancer because solid tumors need a blood supply if they are to grow beyond a few millimeters in size. Tumors can actually cause this blood supply to form by giving off chemical signals that stimulate angiogenesis. Tumors can also stimulate nearby normal cells to produce angiogenesis signaling molecules.

The resulting new blood vessels “feed” growing tumors with oxygen and nutrients, allowing the tumor to enlarge and the cancer cells to invade nearby tissue, to move throughout the body, and to form new colonies of cancer cells, called metastases.

Because tumors cannot grow beyond a certain size or spread without a blood supply, scientists have developed drugs called angiogenesis inhibitors, which block tumor angiogenesis. The goal of these drugs, also called antiangiogenic agents, is to prevent or slow the growth of cancer by starving it of its needed blood supply.

How do angiogenesis inhibitors work?

Angiogenesis inhibitors are unique cancer-fighting agents because they block the growth of blood vessels that support tumor growth rather than blocking the growth of tumor cells themselves.

Angiogenesis inhibitors interfere in several ways with various steps in blood vessel growth. Some are monoclonal antibodies that specifically recognize and bind to VEGF. When VEGF is attached to these drugs, it is unable to activate the VEGF receptor. Other angiogenesis inhibitors bind to VEGF and/or its receptor as well as to other receptors on the surface of endothelial cells or to other proteins in the downstream signaling pathways, blocking their activities. Some angiogenesis inhibitors are immunomodulatory drugs—agents that stimulate or suppress the immune system—that also have antiangiogenic properties.

In some cancers, angiogenesis inhibitors appear to be most effective when combined with additional therapies. Because angiogenesis inhibitors work by slowing or stopping tumor growth without killing cancer cells, they are given over a long period.

What angiogenesis inhibitors are being used to treat cancer in humans?

The U.S. Food and Drug Administration (FDA) has approved a number of angiogenesis inhibitors to treat cancer. Most of these are targeted therapies that were developed specifically to target VEGF, its receptor, or other specific molecules involved in angiogenesis. Approved angiogenesis inhibitors include:

Do angiogenesis inhibitors have side effects?

Side effects of treatment with VEGF-targeting angiogenesis inhibitors can include hemorrhage, clots in the arteries (with resultant stroke or heart attack), hypertension, impaired wound healing, reversible posterior leukoencephalopathy syndrome (a brain disorder), and protein in the urine. Gastrointestinal perforation and fistulas also appear to be rare side effects of some angiogenesis inhibitors.

Antiangiogenesis agents that target the VEGF receptor have additional side effects, including fatigue, diarrhea, biochemical hypothyroidism, hand-foot syndrome, cardiac failure, and hair changes.

 

Get Help Finding Clinical Trials of Angiogenesis Inhibitors
Call NCI’s Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) for information about clinical trials of angiogenesis inhibitors.

Immunotherapy Side Effects

Immunotherapy Side Effects

Immunotherapy can cause side effects. Many side effects happen when the immune system that is revved-up to act against the cancer also acts against healthy cells and tissues in the body.

Different people have different side effects. The ones you have and how they make you feel will depend on

  • how healthy you are before treatment
  • your type of cancer
  • how advanced your cancer is
  • the type and dose of immunotherapy you are getting

You might be on immunotherapy for a long time. And side effects can occur at any point during and after treatment. Doctors and nurses cannot know for certain when or if side effects will occur or how serious they will be. So, it is important to talk with your doctors and nurses about what signs to look for and what to do if you start to have problems.

Some side effects are common with all types of immunotherapy. For instance, you might have skin reactions at the needle site, which include:

Investigating Cancer Immunotherapy Side Effects

Researchers aim to better understand, manage the side effects of these new drugs.

  • pain
  • swelling
  • soreness
  • redness
  • itchiness
  • rash

Learn more about skin changes caused by cancer treatment.

You may have flu-like symptoms, which include:

Other side effects might include:

Some types of immunotherapy may cause severe or fatal allergic and inflammation-related reactions. But, these reactions are rare.

Certain side effects might happen depending on the type of immunotherapy you receive. Visit the page for the type of immunotherapy that you are receiving for more details about serious side effects. Types of immunotherapy include:

Immune System Modulators

Immune System Modulators

gloved hand holding a small bottle labeled BCG

When inserted directly into the bladder, BCG can cause an immune response against bladder cancer cells.

Credit: iStock

Immune system modulators are a type of immunotherapy that enhance the body’s immune response against cancer.

What are the types of immune system modulators? 

Types of immune system modulators include cytokines, BCG, and immunomodulatory drugs.

Cytokines are proteins made by white blood cells. They play important roles in your body’s normal immune responses and in the immune system’s ability to respond to cancer.

Cytokines that are sometimes used to treat cancer:

  • Interferons (INFs). Researchers have found that one type of interferon, called INF-alfa, can enhance your immune response to cancer cells by causing certain white blood cells, such as natural killer cells and dendritic cells, to become active. INF-alfa may also slow the growth of cancer cells or promote their death.
  • Interleukins (ILs). There are more than a dozen interleukins, including IL-2, which is also called T-cell growth factor. IL-2 boosts the number of white blood cells in the body, including killer T cells and natural killer cells. Increasing these cells can cause an immune response against cancer. IL-2 also helps B cells (another type of white blood cell) produce certain substances that can target cancer cells.

Cytokines that are sometimes used to reduce side effects from cancer treatment are called hematopoietic growth factors. They promote the growth of blood cells that are damaged by chemotherapy:

  • Erythropoietin, which increases the production of red blood cells.
  • IL-11, which increases the production of platelets.
  • Granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF), which both increase the number of white blood cells. Boosting white blood cells reduces the risk of infections. G-CSF and GM-CSF can also enhance the immune system response against cancer by increasing the number of cancer-fighting T cells.

BCG is a weakened form of the bacteria that causes tuberculosis. It does not cause disease in humans. BCG is used to treat bladder cancer. When inserted directly into the bladder with a catheter, BCG causes an immune response against cancer cells. It is also being studied in other types of cancer. BCG stands for Bacillus Calmette-Guérin.

Immunomodulatory drugs (also called biological response modifiers) stimulate the immune system. They include

Thalidomide, lenaliodomide, and pomalidomide cause cells to release IL-2. They also stop tumors from forming new blood vessels. Tumors need to form new blood vessels to grow beyond a certain size. These three drugs may also be called angiogenesis inhibitors.

Imiquimod is a cream that you rub on the skin. It causes cells to release cytokines.

Nonspecific Immune Stimulation

Learn about nonspecific immune stimulation, one type of immunotherapy used to treat cancer.

Which types of cancer are treated with immune system modulators?

Most immune-modulating agents are used to treat advanced cancer. Some are used to help manage side effects.

What are the side effects of immune system modulators?

Immune-modulating agents can cause side effects, which affect people in different ways. The side effects you may have and how they make you feel will depend on how healthy you are before treatment, your type of cancer, how advanced it is, the type of immune-modulating agent you are getting, and the dose.

Doctors and nurses cannot know for sure when or if side effects will occur or how serious they will be. So, it is important to know which signs to look for and what to do if you start to have problems.

Immune-modulating agents can cause flu-like symptoms, which include

Learn more about flu-like symptoms caused by cancer treatment.

Cytokines can also cause many serious side effects

  • trouble breathing
  • low or high blood pressure
  • severe allergic reactions
  • lowered blood counts, which can raise the risk of infections and cause bleeding problems
  • blood clots
  • problems with mood, behavior, thinking, and memory
  • skin problems, such as rash, burning at injection site, and ulcers
  • organ damage

BCG can also cause urinary side effects.

Thalidomide, lenalidomide, and pomalidomide can cause

  • blood clots
  • nerve problems that lead to pain, numbness, tingling, swelling, or muscle weakness in different parts of the body
  • birth defects, if used during pregnancy

Imiquimod can cause skin reactions.

Cancer Treatment Vaccines

Cancer Treatment Vaccines

This scanning electron microscope image shows dendritic cells, colored in green, interacting with T cells, colored in pink.

Treatment vaccines can help the immune system learn to recognize and react to antigens and destroy cancer cells that contain them.

Credit: Victor Segura Ibarra and Rita Serda, Ph.D.

How do cancer treatment vaccines work against cancer?

Cancer treatment vaccines are a type of immunotherapy that treats cancer by strengthening the body’s natural defenses against the cancer. Unlike cancer prevention vaccines, cancer treatment vaccines are designed to be used in people who already have cancer—they work against cancer cells, not against something that causes cancer.

The idea behind treatment vaccines is that cancer cells contain substances, called tumor-associated antigens, that are not present in normal cells or, if present, are at lower levels. Treatment vaccines can help the immune system learn to recognize and react to these antigens and destroy cancer cells that contain them.

Cancer treatment vaccines may be made in three main ways.

  1. They can be made from your own tumor cells. This means they are custom-made so that they cause an immune response against features that are unique to your cancer.
  2. They may be made from tumor-associated antigens that are found on cancer cells of many people with a specific type of cancer. Such a vaccine can cause an immune response in any patient whose cancer produces that antigen. This type of vaccine is still experimental.
  3. They may be made from your own dendritic cells, which are a type of immune cell. Dendritic cell vaccines stimulate your immune system to respond to an antigen on tumor cells. One dendritic cell vaccine has been approved, sipuleucel-T, which is used to treat some men with advanced prostate cancer.

A different type of cancer treatment, called oncolytic virus therapy, is sometimes described as a type of cancer treatment vaccine. It uses an oncolytic virus, which is a virus that infects and breaks down cancer cells but does not harm normal cells.

The first FDA-approved oncolytic virus therapy is talimogene laherparepvec (T-VEC, or Imlygic®). It is based on herpes simplex virus type 1. Although this virus can infect both cancer and normal cells, normal cells are able to kill the virus while cancer cells cannot.

T-VEC is injected directly into a tumor. As the virus makes more and more copies of itself, it causes cancer cells to burst and die. The dying cells release new viruses and other substances that can cause an immune response against cancer cells throughout the body.

Which cancers are treated with cancer treatment vaccines?

Sipuleucel-T is used to treat people with prostate cancer:

  • that has spread to other parts of the body
  • who have few or no symptoms
  • whose cancer does not respond to hormone treatment

T-VEC is used to treat some people with melanoma that returns after surgery and cannot be removed with more surgery.

What are the side effects of cancer treatment vaccines?

Cancer treatment vaccines can cause side effects, which affect people in different ways. The side effects you may have and how they make you feel will depend on how healthy you are before treatment, your type of cancer, how advanced it is, the type of treatment vaccine you are getting, and the dose.

Doctors and nurses cannot know for sure when or if side effects will occur or how serious they will be. So, it is important to know which signs to look for and what to do if you start to have problems.

Cancer treatment vaccines can cause flu-like symptoms, which include:

Learn more about flu-like symptoms caused by cancer treatment.

You may have a severe allergic reaction.

Sipuleucel-T can cause stroke.

T-VEC can cause tumor lysis syndrome. In this syndrome, the tumor cells die and break apart in the blood. This changes certain chemicals in the blood, which may cause damage to organs like the kidneys, heart, and liver.

Since T-VEC is made from herpesvirus it can sometimes cause a herpesvirus infection that can lead to:

  • pain, burning, or tingling in a blister around the mouth, genitals, fingers, or ears
  • eye pain, sensitivity, discharge from the eyes, and blurry vision
  • weakness in the arms and legs
  • extreme fatigue and drowsiness
  • confusion

T-cell Transfer Therapy

T-cell Transfer Therapy

Illustration of CAR T-cell Therapy. The process begins with blood removal from a patient to isolate T cells. In the lab, a gene for a Chimeric Antigen Receptor (CAR) is inserted into T cells, creating CAR T cells. These cells are then grown in the millions. The CAR T cells are infused back into the patient, where they bind to cancer cell antigens and kill the cancer cells. Arrows connect the stages of the therapy in the order described. Enlarge

CAR T-cell therapy is a type of treatment in which a patient’s T cells (a type of immune cell) are changed in the laboratory so they will bind to cancer cells and kill them.

Credit: © Terese Winslow

How does T-cell transfer therapy work against cancer?

T-cell transfer therapy is a type of immunotherapy that makes your own immune cells better able to attack cancer. There are two main types of T-cell transfer therapy: tumor-infiltrating lymphocytes (or TIL) therapy and CAR T-cell therapy. Both involve collecting your own immune cells, growing large numbers of these cells in the lab, and then giving the cells back to you through a needle in your vein. T-cell transfer therapy is also called adoptive cell therapy, adoptive immunotherapy, and immune cell therapy.

The process of growing your T cells in the lab can take 2 to 8 weeks. During this time, you may have treatment with chemotherapy and, maybe, radiation therapy to get rid of other immune cells. Reducing your immune cells helps the transferred T cells to be more effective. After these treatments, the T cells that were grown in the lab will be given back to you via a needle in your vein.

  • TIL therapy uses T cells called tumor-infiltrating lymphocytes that are found in your tumor. Doctors test these lymphocytes in the lab to find out which ones best recognize your tumor cells. Then, these selected lymphocytes are treated with substances that make them grow to large numbers quickly.

    An illustration of a T cell, depicted in bright red, with long tentacle-like appendages grabbing onto a cancer cell, depicted in red and blue.

    Research on CAR T-Cell Therapy Rapidly Advancing

    Researchers hope to expand use of these immunotherapies, while making them safer, more effective.

    The idea behind this approach is that the lymphocytes that are in or near the tumor have already shown the ability to recognize your tumor cells. But there may not be enough of them to kill the tumor or to overcome the signals that the tumor is releasing to suppress the immune system. Giving you large numbers of the lymphocytes that react best with the tumor can help to overcome these barriers.

  • CAR T-cell therapy is similar to TIL therapy, but your T cells are changed in the lab so that they make a type of protein known as CAR before they are grown and given back to you. CAR stands for chimeric antigen receptor. CARs are designed to allow the T cells to attach to specific proteins on the surface of the cancer cells, improving their ability to attack the cancer cells.

What cancers are treated with T-cell transfer therapy?

A TIL therapy called lifileucel (Amtagvi) has been approved by the Food and Drug Administration (FDA) to treat melanoma. And it has produced promising findings in other cancers, such as cervical squamous cell carcinoma and cholangiocarcinoma. However, this treatment is still experimental for those cancers.

Tumor-infiltrating lymphocyte therapy or TIL

First Cancer TIL Therapy Gets FDA Approval for Advanced Melanoma

The new treatment, lifileucel, was originally developed by NCI researchers and is the first cell therapy approved for a solid tumor.

Six CAR T-cell therapies have been approved by the FDA for blood cancers.

CAR T-cell therapy has also been studied for the treatment of solid tumors, including breast and brain cancers, but use in such cancers is still experimental.

What are the side effects of T-cell transfer therapy?

T-cell transfer therapy can cause side effects, which people experience in different ways. The side effects you may have and how serious they are will depend on how healthy you are before treatment, your type of cancer, how advanced it is, the type of T-cell transfer therapy you are receiving, and the dose.

Doctors and nurses cannot know for sure when or if side effects will occur or how they will affect you. So, it is important to know which signs to look for and what to do if you start to have problems.

CAR T-cell therapy can cause a serious side effect known as cytokine release syndrome. This syndrome is caused when the transferred T cells, or other immune cells responding to the new T cells, release a large amount of cytokines into the blood.

Cytokines are immune substances that have many different functions in the body. A sudden increase in their levels can cause:

  • fever
  • nausea
  • headache
  • rash
  • rapid heartbeat
  • low blood pressure
  • trouble breathing

Most people have a mild form of cytokine release syndrome. But in some people, it may be severe or life-threatening.

Also, although CAR T cells are designed to recognize proteins that are found only on cancer cells, they can also sometimes recognize normal cells. Depending on which normal cells are recognized, this can cause a range of side effects, including organ damage.

TIL therapy can cause capillary leak syndrome. This syndrome causes fluid and proteins to leak out of tiny blood vessels and flow into surrounding tissues, resulting in dangerously low blood pressure. Capillary leak syndrome may lead to multiple organ failure and shock.

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Immune Checkpoint Inhibitors

Immune Checkpoint Inhibitors

Two-panel illustration showing the interaction between T cells and tumor cells. The left panel is titled "PD-L1 binds to PD-1 and inhibits T cell killing of tumor cell" and shows an antigen and T cell receptor, illustrating the inhibition of T cell activity. The right panel is titled "Blocking PD-L1 or PD-1 allows T cell killing of tumor cell" and shows tumor cell death, indicating successful T cell activity. Enlarge

Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).

Credit: © Terese Winslow

How do immune checkpoint inhibitors work against cancer?

Immune checkpoints are a normal part of the immune system. Their role is to prevent an immune response from being so strong that it destroys healthy cells in the body.

Immune checkpoints engage when proteins on the surface of immune cells called T cells recognize and bind to partner proteins on other cells, such as some tumor cells. These proteins are called immune checkpoint proteins. When the checkpoint and partner proteins bind together, they send an “off” signal to the T cells. This can prevent the immune system from destroying the cancer.

Immunotherapy drugs called immune checkpoint inhibitors work by blocking checkpoint proteins from binding with their partner proteins. This prevents the “off” signal from being sent, allowing the T cells to kill cancer cells.

One such drug acts against a checkpoint protein called CTLA-4. Other immune checkpoint inhibitors act against a checkpoint protein called PD-1 or its partner protein PD-L1. Some tumors turn down the T cell response by producing lots of PD-L1.

Which cancers are treated with immune checkpoint inhibitors?

What side effects are caused by immune checkpoint inhibitors?

Immune checkpoint inhibitors can cause side effects that affect people in different ways. The side effects you may have and how they make you feel will depend on how healthy you are before treatment, your type of cancer, how advanced it is, the type of immune checkpoint inhibitor you are receiving, and the dose.

Doctors and nurses cannot know for sure when or if side effects will occur or how serious they will be. So, it is important to know which signs to look for and what to do if they occur.

Common side effects of immune checkpoint inhibitors include:

Rarer side effects of immune checkpoint inhibitors can include widespread inflammation. Depending on the organ of your body that is affected, inflammation can lead to:

  • changes in skin color, rash, and feeling itchy, caused by skin inflammation
  • cough and chest pains, caused by inflammation in the lungs
  • belly pain and diarrhea, caused by inflammation in the colon
  • diabetes, caused by inflammation in the pancreas
  • hepatitis (inflammation of the liver)
  • hypophysitis (inflammation of the pituitary gland)
  • myocarditis (inflammation of the heart muscle)
  • nephritis (inflammation of the kidney) and impaired kidney function
  • overactive or underactive thyroid
  • nervous system problems such as muscle weakness, numbness, and trouble breathing

Learn more about organ inflammation and immunotherapy.

Immune Checkpoint Inhibitors

Learn about immune checkpoint inhibitors, one type of immunotherapy used to treat cancer.

Immunotherapy to Treat Cancer

Immunotherapy to Treat Cancer

Immunotherapy is a type of cancer treatment that helps your immune system fight cancer. The immune system helps your body fight infections and other diseases. It is made up of white blood cells and organs and tissues of the lymph system.

Immunotherapy is a type of biological therapy. Biological therapy is a type of treatment that uses substances made from living organisms to treat cancer.

How does immunotherapy work against cancer?

As part of its normal function, the immune system detects and destroys abnormal cells and most likely prevents or curbs the growth of many cancers. For instance, immune cells are sometimes found in and around tumors. These cells, called tumor-infiltrating lymphocytes or TILs, are a sign that the immune system is responding to the tumor. People whose tumors contain TILs often do better than people whose tumors don’t contain them.

Even though the immune system can prevent or slow cancer growth, cancer cells have ways to avoid destruction by the immune system. For example, cancer cells may:

  • Have genetic changes that make them less visible to the immune system.
  • Have proteins on their surface that turn off immune cells.
  • Change the normal cells around the tumor so they interfere with how the immune system responds to the cancer cells.

Immunotherapy helps the immune system to better act against cancer.

What are the types of immunotherapy?

Several types of immunotherapy are used to treat cancer. These include:

  • Immune checkpoint inhibitors, which are drugs that block immune checkpoints. These checkpoints are a normal part of the immune system and keep immune responses from being too strong. By blocking them, these drugs allow immune cells to respond more strongly to cancer.

    Learn more about immune checkpoint inhibitors.

  • T-cell transfer therapy, which is a treatment that boosts the natural ability of your T cells to fight cancer. In this treatment, immune cells are taken from your tumor. Those that are most active against your cancer are selected or changed in the lab to better attack your cancer cells, grown in large batches, and put back into your body through a needle in a vein.

    T-cell transfer therapy may also be called adoptive cell therapy, adoptive immunotherapy, or immune cell therapy.

    Learn more about T-cell transfer therapy.

  • Monoclonal antibodies, which are immune system proteins created in the lab that are designed to bind to specific targets on cancer cells. Some monoclonal antibodies mark cancer cells so that they will be better seen and destroyed by the immune system. Such monoclonal antibodies are a type of immunotherapy.

    Monoclonal antibodies may also be called therapeutic antibodies.

    Learn more about monoclonal antibodies.

  • Treatment vaccines, which work against cancer by boosting your immune system’s response to cancer cells. Treatment vaccines are different from the ones that help prevent disease.

    Learn more about cancer treatment vaccines.

  • Immune system modulators, which enhance the body’s immune response against cancer. Some of these agents affect specific parts of the immune system, whereas others affect the immune system in a more general way.

    Learn more about immune system modulators.

Which cancers are treated with immunotherapy?

Immunotherapy drugs have been approved to treat many types of cancer. However, immunotherapy is not yet as widely used as surgery, chemotherapy, or radiation therapy. To learn about whether immunotherapy may be used to treat your cancer, see the PDQ® adult cancer treatment summaries and childhood cancer treatment summaries.

What are the side effects of immunotherapy?

Immunotherapy can cause side effects, many of which happen when the immune system that has been revved-up to act against the cancer also acts against healthy cells and tissues in your body.

Learn more about immunotherapy side effects.

How is immunotherapy given?

Different forms of immunotherapy may be given in different ways. These include:

  • intravenous (IV)
    The immunotherapy goes directly into a vein.
  • oral
    The immunotherapy comes in pills or capsules that you swallow.
  • topical
    The immunotherapy comes in a cream that you rub onto your skin. This type of immunotherapy can be used for very early skin cancer.
  • intravesical
    The immunotherapy goes directly into the bladder.

Where do you go for immunotherapy?

You may receive immunotherapy in a doctor’s office, clinic, or outpatient unit in a hospital. Outpatient means you do not spend the night in the hospital.

How often do you receive immunotherapy?

How often and how long you receive immunotherapy depends on:

  • your type of cancer and how advanced it is
  • the type of immunotherapy you get
  • how your body reacts to treatment

You may have treatment every day, week, or month. Some types of immunotherapy given in cycles. A cycle is a period of treatment followed by a period of rest. The rest period gives your body a chance to recover, respond to immunotherapy, and build new healthy cells.

How can you tell if immunotherapy is working?

You will see your doctor often. He or she will give you physical exams and ask you how you feel. You will have medical tests, such as blood tests and different types of scans. These tests will measure the size of your tumor and look for changes in your blood work.

What is the current research in immunotherapy?

Researchers are focusing on several major areas to improve immunotherapy, including:

  • Finding solutions for resistance.
    Researchers are testing combinations of immune checkpoint inhibitors and other types of immunotherapy, targeted therapy, and radiation therapy to overcome resistance to immunotherapy.
  • Finding ways to predict responses to immunotherapy.
    Only a small portion of people who receive immunotherapy will respond to the treatment. Finding ways to predict which people will respond to treatment is a major area of research.
  • Learning more about how cancer cells evade or suppress immune responses against them.
    A better understanding of how cancer cells get around the immune system could lead to the development of new drugs that block those processes.
  • How to reduce the side effects of treatment with immunotherapy.

How do you find clinical trials that are testing immunotherapy?

To find clinical research studies that involve immunotherapy visit Find NCI-Supported Clinical Trials or call the Cancer Information Service, NCI’s contact center, at 1-800-4-CANCER (1-800-422-6237).

NCI’s list of cancer clinical trials includes all NCI-supported clinical trials that are taking place across the United States and Canada, including the NIH Clinical Center in Bethesda, MD.