Understand how immunotherapy works, who may benefit, how it is given, and what patients and caregivers should know before commencing treatment.
Laparoscopic Surgery
REVIEWED
2024
TIME
read
Oncology
“Immunotherapy is a specialized cancer treatment that harnesses and empowers your
body’s own immune system to recognize, target, and eliminate cancer cells.”
The immune system is your body’s natural defense mechanism, composed of white blood
cells, antibodies, and the lymphatic network. In a healthy body, it constantly identifies and
destroys abnormal, infected, or damaged cells. However, cancer cells frequently develop
sophisticated mechanisms to camouflage themselves or actively turn off immune
responses.
Unlike conventional chemotherapies that introduce potent chemical compounds to attack fast-multiplying
cells directly, immunotherapy functions indirectly: it acts as a molecular lens or key, helping your native immune
defenses detect the hidden threat and resume their protective duties.
Many malignant tumors express a surface protein known as PD-L1. When this attaches to the PD-1 receptor on
cytotoxic T-cells, it sends a biochemical ‘handshake’ signal that commands the T-cell to deactivate. Immune
checkpoint inhibitors interrupt this handshake, keeping the immune surveillance system fully switched on.
Understanding this treatment requires looking at how immune surveillance unfolds in three critical phases:
T-cells and dendritic cells
continuously patrol vascular
pathways and tissues, analyzing
surface proteins (antigens) to
distinguish healthy self-tissue
from foreign pathology.
Tumors evolve inhibitory ligands
(such as PD-L1 or CTLA-4) that
bind with immune receptors,
falsely broadcasting safety and
putting protective T-cells into
cellular exhaustion.
Immunotherapy antibody
molecules block these inhibitory
checkpoint connections. Free of
false deactivation signals, T-cells
proliferate and destroy malignant
cells.
In modern precision surgical oncology, immunotherapy is never prescribed generically. It is selected through
comprehensive molecular profiling and strict evidence-based patient selection criteria.
Immunotherapy is not appropriate or beneficial for every cancer type or every stage. Personalized genomic tests
and biomarker panels must confirm responsiveness before beginning a regimen.
Approved widely in Melanoma,
Non-Small Cell Lung Cancer
(NSCLC), Renal Cell, Urothelial
Bladder, and Hodgkin Lymphoma.
Utilized both in metastatic or
advanced stages and increasingly
as adjuvant therapy after surgical
resection to reduce recurrence.
PD-L1 immunohistochemistry
expression levels, MSI-H / dMMR
status, and Tumor Mutational
Burden (TMB) score determine
efficacy.
Can be deployed as front-line
therapy alone, or in subsequent
lines following targeted therapy,
radiation, or chemotherapy.
Adequate organ function, ECOG
performance score, and
evaluation of preexisting
autoimmune conditions (such as
lupus or Crohn’s).
Monotherapy (single drug) versus
synergistic combinations
(immunotherapy + chemotherapy,
or dual checkpoint inhibition).
The route of administration depends on the specific drug class and clinical protocol determined during your
multidisciplinary oncology review:
The predominant method. Administered slowly
into a vein in an outpatient day-care infusion
suite, usually taking 30 to 90 minutes every 2, 3,
4, or 6 weeks.
Certain newer monoclonal formulations are
delivered via a short, direct injection under the
skin of the thigh or abdomen, reducing clinic
time to mere minutes.
Select immunomodulatory agents are
formulated as capsules taken at home on a
precise daily schedule, monitored through
routine laboratory blood counts.
For early-stage superficial bladder tumors (e.g.
BCG immunotherapy infused directly into the
bladder) or specialized creams for localized
cutaneous carcinomas.
Immunotherapy side effects differ fundamentally from chemotherapy side effects. Because immunotherapy
stimulates the immune system, adverse reactions generally result from the body’s defenses inadvertently
attacking healthy tissues and organs—an immune-related adverse event (irAE).
General feeling of tiredness, mild
low energy levels usually
manageable with rest and
hydration.
patches, or localized
depigmentation (vitiligo).
Frequent watery stools, abdominal
cramping, or blood in stool
reflecting bowel lining
inflammation.
Symptoms
fluctuations, headache, and mild
body aches after infusions.
Joint stiffness, transient arthralgia,
or muscular discomfort
responding well to mild anti-
inflammatories.
New or worsening shortness of
breath, persistent dry cough, or
chest tightness.
Always inform your oncology nursing team or doctor about any new, persistent, or changing
symptom immediately. Do not wait for symptoms to worsen before your next appointment. When
detected early, immune-related side effects are quickly and effectively managed with standard
corticosteroid tapers without losing long-term cancer control.
Patients frequently confuse the two treatments. This structured monograph breakdown outlines key
differences in mechanism, tolerability, and clinical durability:
Attribute
Action
seek and destroy tumors.
chemical pathways.
Selectivity
checkpoint signals.
Non-specific; damages rapid normal cells
(hair follicles, gut lining, bone marrow).
Timeline
Can take several weeks; may exhibit delayed
pseudo-progression followed by deep
shrinkage.
initial 2-3 cycles.
Profile
thyroiditis). No hair loss.
Alopecia (hair loss), severe nausea, low
white cell counts (neutropenia), mouth
sores.
Benefit
Potential long-term durability & immune
memory even years after finishing cycles.
receiving the scheduled drug courses.
Immunotherapy has revolutionized modern oncology, achieving unprecedented, long-lasting remissions in diseases once deemed untreatable. However, it is not an across-the-board miracle, and oncologists frame outcomes through evidence, disease control, and biological response.
In select cancers—most notably advanced metastatic melanoma, specific subsets of lung cancer, and
mismatch repair-deficient colorectal cancers—immunotherapy has achieved complete and sustained
responses that persist for a decade or more without progression. For these fortunate patients, the immune
system appears to retain lasting immunological memory against recurrence.
However, for many other tumors, immune resistance mechanisms persist. The cancer may lack the inflammatory
biomarkers needed to attract T-cells (“cold tumors”), or secondary resistance pathways can evolve over time.
This is why Dr. Sunil Navalgund and our multidisciplinary tumor boards always evaluate combined modalities—
pairing surgery to physically debulk tumors alongside systemic immune therapy to mop up microscopic
circulating disease.
Take an empowered, structured role in your consultation. Check off each question as you discuss it with your
clinical team:
1. Specific Candidacy: Is immunotherapy recommended for my exact type, histological subtype, and
stage of cancer?
2. Diagnostic Testing: What molecular or biomarker tests (PD-L1 percentage, MSI/MMR, TMB) have
been performed on my biopsy specimen?
3. Treatment Goal: Is the intent curative, adjuvant (post-surgery prevention), neoadjuvant (shrink
before surgery), or long-term disease maintenance?
4. Toxicity & Safety: What are the specific immune side effects I should watch for at home, and who
do I call 24/7 if severe diarrhea or shortness of breath begins?
5. Assessing Efficacy: How frequently will we perform PET-CT or MRI scans to evaluate response, and
what is our backup roadmap if resistance occurs?
MS, MCh (Surgical Oncology) • Robotic & Complex GI/Thoracic Cancer Surgeon
Dr. Sunil Navalgund leads advanced oncology interventions, integrating precision
surgical resection with modern immunotherapeutic protocols. Head of Multidisciplinary
Tumor Boards, prioritizing clinical transparency and tailored patient care.
Beginners: 5 Fundamentals
Explained
for newly diagnosed patients and
Immunotherapy Infusions in
the Day Clinic
infusion hydration to day-of…
Checkpoint Inhibitors, CAR-T
& Vaccines
pharmacological classifications…
Dr. Sunil Navalgund provides tele-oncology second
opinions for complex or recurrent cancers within 24–48
hours. Submit your PET scans, biopsy blocks, or
histopathology reports.
Visit any of our cancer care centers across Bengaluru for expert consultations and
advanced surgical oncology care.
