Immunotherapy is a class of cancer drugs based on biologics that find and destroy colorectal cancer cells. There are different types of immunotherapy, and all immunotherapy works with your immune system to fight cancer.
Cancer immunotherapy, also known as immuno-oncology, is a form of cancer treatment that uses the body’s own immune system to help prevent, control, and eliminate cancer. Immunotherapy is also known as biologic therapy.
Over the last few decades, immunotherapy has become an important part of treating certain types of cancer. New immunotherapy treatments are being discovered at a fast pace and are being tested in clinical trials to obtain regulatory approvals.
Immunotherapy can help treat cancer in three ways:
Immunotherapy works with the natural defenses of your immune system so that it can find and attack cancer cells.
It also uses manufactured substances (biologics) that are similar to substances made by your immune system. These substances coordinate with your immune system, which in turn destroys cancer cells.
This short video from the American Cancer Society provides answers to some of the most common questions that people with cancer have about immunotherapy.
You may receive immunotherapy in your doctor’s office or in an outpatient cancer center at a hospital.
There are different forms of immunotherapy. The most common for colorectal cancer treatment are:
Immunotherapy is a cornerstone treatment for people with either early- or advanced-stage colorectal cancer if the tumor has findings of dMMR (deficient mismatch repair) or MSI-H (microsatellite instability-high). In addition, tumors characterized as MSS/pMMR (microsatellite stable or proficient mismatch repair) are being evaluated in clinical trials with immunotherapy treatments to expand use of these promising therapies.
There are also many clinical trials underway to find other strategies for using immunotherapy in those tumors that are not MSI-H (MSS or pMMR) before surgery (neoadjuvant), after surgery (adjuvant) and to treat metastatic CRC . If you are interested in learning more about clinical trials, talk to your doctor about what may be available for your specific colorectal cancer diagnosis.
When your immune system is functioning correctly, it protects your body from infection, viruses, and other pathogens and diseases. However, sometimes the immune system does not work the way it should, and it attacks normal, healthy cells. To prevent this, the immune system uses checkpoints which are proteins on immune and cancer cells that need to be turned “on or off” to induce an immune response.
Colorectal cancer cells may use checkpoints to avoid being attacked by the immune system. Immunotherapy drugs target these checkpoints to restore the immune response against colorectal cancer cells.
Colorectal cancer that has tested positive for a high level of microsatellite instability (MSI-H), or changes in one of the mismatch repair (MMR) genes may be treated with checkpoint inhibitor drugs. Also, treatment of MSS (microsatellite stable) tumors is being evaluated in several clinical trials to increase patient eligibility for checkpoint inhibitor drugs.
Checkpoint inhibitor drugs may be given to patients before surgery (neoadjuvant therapy) for early-stage colorectal cancer.
Checkpoint inhibitor drugs may also be given to patients if their colorectal cancer:
The FDA has approved several checkpoint inhibitor drugs for colorectal cancer treatment for tumors with high microsatellite instability (MSI-H) or DNA mismatch repair deficiency (dMMR). There are also several antibody-based therapies that the FDA has approved for MSI-H/dMMR and MSS/pMMR CRC diagnoses.
Checkpoint inhibitor drugs:
Monoclonal Antibody drugs:
Ramucirumab (Cyramza): a monoclonal antibody that targets the VEGF/VEGFR2 pathway and inhibits tumor blood vessel growth; approved for subsets of patients with advanced colorectal cancer, including as a first-line therapy
Immunotherapy can cause certain side effects. It’s important to remember that each person has different side effects, and that they may occur both during and/or after treatment. Because you may receive immunotherapy for a long period of time, side effects may vary throughout the course of treatment. Very rarely, some types of immunotherapies may cause severe or fatal allergic reactions.
It’s very important to talk with your doctors and nurses about potential side effects before beginning your therapy so you know what signs to look for so that you and your care team can effectively manage symptoms.
Each type of immunotherapy has its own set of potential side effects. Click on the types below to learn about side effects associated with each:
There are some precautions to keep in mind when you are receiving immunotherapy since some forms are considered hazardous.
Protect yourself and others: Your care team may caution you to not let others come into contact with the drug or your body fluids while taking it, and for a period after taking it. You may be advised to wear protective gloves when you are handling the drug.
Disposal: Some drugs and their packaging will need to be disposed of in a certain way. If you are taking an oral immunotherapy drug at home, be sure to ask your care team about any special instructions for using them safely.
Learn how the Colorectal Cancer Alliance is advocating for the passage of the Nancy Gardner Sewell Multi-Cancer Early Detection Act (HR 2407), a bipartisan bill that ensures immediate Medicare coverage for life-saving cancer detection tests once approved by the FDA.
The Alliance’s 45+ Reasons campaign is part of the Cycles of Impact initiative launched and supported by Independence Blue Cross in 2022 to address the urgent public health issue of colorectal cancer among the Black population.
The U.S. Court of Appeals for the Fifth Circuit reversed a district court decision that had ruled provisions in the Affordable Care Act (ACA), which provide for no-cost preventive screening for colorectal cancer and other conditions, unconstitutional.