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Systemic therapy
Immunotherapy
Treatment that works on the immune system rather than directly on the tumour.
What it is
Checkpoint inhibitors release brakes that stop immune cells attacking tumour tissue. They do not act on the tumour directly, which is why their side effects look nothing like chemotherapy's.
Because the mechanism is immune, side effects can appear in any organ, can start weeks or months after a dose, and can continue after treatment stops. Recognising them early matters more than with most other treatments.
When it is used
- Where a biomarker suggests it may be appropriate, mismatch-repair status, microsatellite instability, tumour mutational burden or PD-L1 expression, depending on the disease
- In specific disease settings where it is an established option
- Combined with chemotherapy or targeted therapy, in defined situations
How the decision is made
- Biomarker testing first. Immunotherapy is the highest-cost decision in oncology, and selecting patients properly is the single most valuable thing testing does.
- Baseline autoimmune, thyroid, liver, kidney and cardiac assessment before starting.
- A written plan for what to do if an immune-related side effect appears, including who to call and how quickly.
Infusion at a partner day-care unit. The medicines are billed by the pharmacy or hospital that supplies them.
Who does what
What we handle, and what happens elsewhere
KPCIRC handles
- Biomarker strategy and test ordering, signed by a named oncologist
- Candidacy assessment at the board
- Baseline organ and autoimmune workup
- Immune-related toxicity monitoring and the written escalation plan
- Cardio-oncology and onco-nephrology input where organs are at risk
Performed and billed elsewhere
- Infusion
- The medicine itself
- Imaging for response assessment
- New diarrhoea, a rash, breathlessness, unusual fatigue, or unexplained weight change on immunotherapy is not something to wait out. Report it the same day.
- Carry a card or note saying you are on immunotherapy. If you attend any emergency department, that single fact changes how you should be assessed.
Questions to ask your own doctor
Take these with you. They work whether or not you are treated here.
- What biomarker result supports using this for me?
- What is the total cost of a full course, and for how long would I take it?
- What immune side effects should I watch for, and who do I call?
- What happens if it has to be stopped?
Support that goes with it
Research behind this
Where this is used
Cancers this commonly forms part of
Lung & thoracic cancer
Non-small cell and small cell lung cancer, mesothelioma, thymic tumours
Skin cancer & melanoma
Melanoma, basal cell and squamous cell carcinoma
Colorectal cancer
Colon and rectal cancer, bowel cancer
Kidney cancer
Renal cell carcinoma
Bladder cancer
Urothelial carcinoma of the bladder
Stomach cancer
Gastric cancer
Not sure this is the right option for you?
That is exactly what a second opinion is for. Bring what you have, we will tell you what is missing and what the alternatives actually are, in writing.