Immunotherapy for Cancer: What It Is, Who It Helps, and Side Effects

इम्यूनोथेरेपी क्या है? यह शरीर की अपनी रोग-प्रतिरोधक शक्ति को कैंसर से लड़ने में मदद करती है — पर हर मरीज़ के लिए नहीं।

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Immunotherapy is one of the biggest advances in cancer treatment in the last 15 years. Families in India now often hear about it from relatives or the internet and ask, “Can my patient get immunotherapy?” The honest answer: it works very well for some cancers and some patients, and not for others. This guide explains it simply.

How does immunotherapy work?

Our immune system normally finds and destroys abnormal cells. Cancer cells learn to “hide” by switching on brakes (called checkpoints, such as PD-1, PD-L1 and CTLA-4) on immune cells. Checkpoint inhibitor medicines release these brakes so immune cells can attack the cancer. Common names you may hear: pembrolizumab, nivolumab, atezolizumab, durvalumab and ipilimumab.

Other types of immunotherapy

• CAR-T cell therapy — the patient’s own T-cells are modified in a lab to attack cancer. Used for some blood cancers; an Indian-made CAR-T was approved in 2023.
• Monoclonal antibodies such as rituximab, used in some lymphomas.
• Cancer vaccines and BCG — for example BCG washes for early bladder cancer.

Which cancers is it used for?

Approved uses keep growing. Commonly: lung cancer, melanoma, kidney and bladder cancer, head and neck cancers, some stomach, oesophagus, liver and cervical cancers, triple-negative breast cancer, Hodgkin lymphoma, and any cancer with high MSI (microsatellite instability) or dMMR. It is often given together with chemotherapy. Your oncologist decides based on type, stage and tests.

Tests before immunotherapy

• PD-L1 test on the biopsy — higher levels can predict better response in some cancers.
• MSI / MMR testing — important in colon, stomach and endometrial cancers.
• Tumour mutational burden (TMB) — sometimes tested.
• Baseline thyroid, liver, kidney and sugar tests, because immunotherapy can affect these organs.

See biomarker testing: questions before paying.

How is it given?

Usually as an IV drip in day-care, over 30–60 minutes, every 2, 3, 4 or 6 weeks. Many patients continue for up to 1–2 years if it is working and side effects are manageable. Response is checked with scans every few months.

Side effects

Immunotherapy is often easier than chemotherapy — less hair loss and vomiting — but the immune system can attack healthy organs too. Report these early:

• New cough or breathlessness (lung inflammation).
• Loose motions more than 4 times a day or blood in stool (colitis).
• Skin rash or itching.
• Extreme tiredness, weight change, feeling cold (thyroid).
• Yellow eyes, dark urine (liver).
• Excess thirst and urination (sugar).

Most side effects can be treated with steroids if caught early. They can appear even months after the last dose, so always tell any doctor you have had immunotherapy.

Cost and access in India

Immunotherapy medicines are expensive, often lakhs of rupees per month, though prices have come down with biosimilars and patient assistance programmes. Some hospitals use lower or weight-based doses supported by Indian studies; ask your oncologist. Coverage under Ayushman Bharat PM-JAY and insurance varies by package — get a written estimate. See cost and written estimate and financial support.

Questions to ask your oncologist

• Is immunotherapy approved for my cancer type and stage?
• What did my PD-L1 / MSI test show?
• What is the goal, and how will we know if it is working?
• What is the total cost, and are there assistance programmes?
• Which symptoms mean I should call immediately?

Frequently asked questions

Immunotherapy se cancer theek hota hai kya?

For some patients, especially with melanoma, lung or MSI-high cancers, responses can be long-lasting. For many others it does not work. It is not a guaranteed cure; your oncologist can tell you what is realistic.

Is immunotherapy better than chemotherapy?

Neither is better for everyone. In some cancers it is used instead of chemo, in others with chemo, and in many it is not recommended.

Does immunotherapy cause hair loss?

Usually not, unless it is combined with chemotherapy.

How do we know it is working?

Through scans every 2–3 months and how the patient feels. Sometimes tumours look bigger first before shrinking.

Is immunotherapy covered under Ayushman card?

Coverage depends on the package and hospital. Ask the hospital’s Ayushman desk.

Related guides

• Targeted therapy
• Chemotherapy guide
• Second opinion

Sources

• NCI: Immunotherapy to Treat Cancer — cancer.gov
• ESMO: Management of toxicities from immunotherapy, clinical practice guideline
• CDSCO approval of NexCAR19 CAR-T therapy (2023)
• Patil VM et al., Low-dose nivolumab in head and neck cancer, J Clin Oncol 2023