Immunotherapy is a biological treatment technique that harnesses the body's immune system to fight diseases, primarily applied in cancer, autoimmune diseases, and infectious diseases. Its core principle involves activating or regulating immune cell functions to enable the immune system to more effectively identify and eliminate abnormal cells. Recently, due to its breakthrough results in the treatment of advanced cancers, it is regarded as an important component of modern precision medicine.
This therapy differs from traditional chemotherapy, focusing on enhancing the patient’s own defense mechanisms rather than directly killing cancer cells. Based on the patient’s disease stage and biomarker characteristics, physicians may combine it with chemotherapy, targeted therapy, or radiotherapy to form an integrated treatment plan.
Immunotherapy is mainly divided into four categories: immune checkpoint inhibitors, cellular therapy, therapeutic vaccines, and cytokine therapy. Immune checkpoint inhibitors (such as PD-1/PD-L1 inhibitors) can relieve the suppression of T cells by cancer cells, restoring immune recognition ability. CAR-T cell therapy involves genetically modifying the patient’s T cells and re-infusing them to directly attack cancer cells expressing specific antigens.
Therapeutic vaccines include cancer vaccines and adjuvants, used to induce specific immune responses; cytokines such as IL-2 or IFN-α are used to modulate immune cell activity. Different therapies may be used alone or in combination, and the most suitable approach is selected based on the patient’s genotype and tumor microenvironment characteristics.
In the field of oncology, immunotherapy has been approved for use in melanoma, non-small cell lung cancer, urothelial carcinoma, and head and neck cancers. In hematologic malignancies, CAR-T therapy has shown significant efficacy in certain lymphomas and leukemias. Additionally, some autoimmune diseases such as rheumatoid arthritis and multiple sclerosis are managed with immune regulation therapy to control disease progression.
Latest clinical trials are expanding the scope to include refractory tumors such as liver cancer, gastric cancer, and pancreatic cancer. Physicians assess patient sensitivity to immunotherapy through biomarker testing (such as PD-L1 expression levels, TMB tumor mutational burden) to determine treatment suitability.
Immune checkpoint inhibitors are usually administered via intravenous infusion every two to three weeks, with treatment duration adjusted based on response. CAR-T therapy requires staged procedures: T cell collection → genetic modification → expansion → re-infusion, with hospitalization for observation throughout. Dosages are calculated based on body surface area or weight, with regular monitoring of immune markers and organ functions.
Local immunotherapy, such as intratumoral injections or mucosal administration, may be used for skin cancers or head and neck tumors. Treatment cycles may last from several months to several years, with dosage and frequency adjusted according to tumor response assessment (RECIST criteria).
Immunotherapy offers high long-term remission rates, with some patients experiencing a 30-50% increase in five-year survival. It selectively targets diseased cells, reducing damage to normal tissues, and has fewer side effects compared to chemotherapy. CAR-T therapy achieves complete remission rates of over 50% in relapsed hematologic malignancies, demonstrating its groundbreaking efficacy.
Potential immune-related adverse events (irAEs) include dermatitis, colitis, hepatitis, and pneumonitis, with organ toxicity. About 15-30% of patients may experience grade 3-4 severe side effects requiring immediate corticosteroid or immunosuppressant intervention. CAR-T therapy may cause cytokine release syndrome (CRS) and neurotoxicity, requiring monitoring at specialized centers.
Contraindications include severe immunodeficiency, uncontrolled autoimmune diseases, and active infections. Patients receiving CAR-T therapy should avoid immunosuppressants for at least 3 months. Pre-treatment assessment of cardiac and pulmonary function is necessary, along with regular monitoring of liver and kidney functions and hematological indicators. Pregnant or breastfeeding women should avoid use due to potential impacts on fetal or infant immune development.
During treatment, live vaccines are prohibited, and contact with infectious sources should be avoided. If fever, difficulty breathing, or neurological symptoms occur, immediate medical consultation is required.
Combination with chemotherapy may increase immune toxicity, requiring dose adjustments and close monitoring of liver enzymes and blood counts. When combined with corticosteroids or other immune modulators, the balance between immunosuppression and enhancement should be evaluated. Targeted drugs may influence T cell activation, necessitating adjustments in dosing intervals.
KEYNOTE-002 trial showed that PD-1 inhibitors in melanoma patients achieved a median progression-free survival of 18.0 months, superior to traditional chemotherapy. CheckMate-238 confirmed that adjuvant immunotherapy post-surgery reduced the recurrence risk by 40% in high-risk melanoma patients. CAR-T therapy in diffuse large B-cell lymphoma achieved complete remission rates of 50-80%, redefining treatment standards for refractory hematologic tumors.
The 2020 Lancet Oncology analysis indicated that combined immunotherapy increased the five-year survival rate in non-small cell lung cancer to 35%, with lower adverse event rates than chemotherapy. Genomic studies show that patients with high TMB (tumor mutational burden) have a 60% response rate to immunotherapy, emphasizing the importance of biomarker-guided treatment.
Chemotherapy involves the use of chemical drugs to directly kill rapidly dividing cells but may damage normal tissues. Targeted therapy focuses on tumor-specific molecular targets, such as EGFR inhibitors, but resistance often develops. Radiotherapy locally eradicates lesions but has limited scope. These traditional methods can serve as alternatives when immunotherapy is ineffective.
In cases with unfavorable tumor microenvironments, initial chemotherapy may be used to eliminate suppressive cells before immunotherapy. Emerging oncolytic virus therapy and cancer vaccines are additional strategies, though not yet widely adopted.
What physical examinations or preparations are needed before immunotherapy?
Before starting immunotherapy, physicians typically arrange blood tests, imaging studies, and baseline biomarker assessments to confirm the patient’s current health status. Patients should also inform doctors of allergies and current medications (including Chinese medicine or supplements), as some components may affect treatment response or increase risks. Lifestyle adjustments such as quitting smoking and improving diet are recommended to enhance treatment efficacy.
If a fever or fatigue occurs during treatment, should the medication be stopped immediately?
Mild fever or fatigue may be common reactions to immunotherapy, but symptoms should be closely monitored. If body temperature exceeds 38.5°C, persists with weakness affecting daily activities, or is accompanied by breathing difficulties, immediate contact with the medical team is necessary. Dose adjustments or supportive medications may be prescribed; self-discontinuation is not advised to avoid compromising treatment outcomes.
Can vaccines be administered or other surgeries performed during treatment?
Immunotherapy may suppress or enhance immune functions; therefore, live vaccines (such as measles or chickenpox vaccines) should be avoided during treatment, and timing of other vaccines should be discussed with the doctor. If surgery is needed, surgeons should be informed about ongoing immunotherapy, as medications may prolong bleeding times or affect tissue healing. Surgical timing should be carefully evaluated.
How can diet or exercise help alleviate side effects during treatment?
It is recommended to follow a high-protein, low-processed food diet, including quality meats, whole grains, and fresh vegetables and fruits, to maintain strength and immune function. Mild aerobic exercises (such as walking or yoga) can help improve fatigue, but overexertion should be avoided. For gastrointestinal discomfort, small frequent meals are advised, and consulting a nutritionist for personalized plans is recommended. Avoid unverified supplements.
How long after treatment should follow-up examinations be scheduled?
Follow-up frequency depends on the condition. Typically, blood tests and imaging are performed every 3-6 months in the first two years, then gradually extended to once a year. Doctors monitor tumor markers, organ functions, and potential long-term side effects (such as hormonal imbalances). Patients should record any body changes, such as unexplained rashes or persistent fatigue, and report promptly for early detection of abnormalities.
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