Immunotherapy is an innovative method of cancer treatment. With immunotherapy, physicians interfere in the interaction of the patient's immune system and a malignant tumor. Immunotherapy can be successfully combined with classical methods of treatment, and German oncologists make it individualized — drugs are selected taking into account the characteristics of the tumor in a particular patient. Treatment in Germany leads to better control of advanced cancer, significantly prolongs life, and in some cases, allows for achieving stable remission.
- What is immunotherapy
- When is immunotherapy administered to treat cancer?
- Types of cancer immunotherapy
- In what types of cancer is immunotherapy effective?
- Comparing the effectiveness of cancer treatment methods
- Cost of cancer immunotherapy in Germany
- Cancer immunotherapy in Germany with Booking Health
What is immunotherapy
The immune system consists of organs (red bone marrow, lymph nodes, spleen), cells (different types of leukocytes), and substances (interferon, interleukins, and others) that detect and destroy foreign objects — viruses, bacteria, fungi, cancer cells, etc. It has information about all normal tissues and substances in the body, recognizing new ones as a potential threats and a target for attack.
It is more difficult for the immune system to fight cancer cells for a number of reasons:
- Sometimes malignant cells are not identified as foreign because they are quite similar to healthy cells
- Sometimes the strength of the immune response is not enough to completely destroy a tumor (normally, the immune system destroys several million atypical cells daily)
- Malignant cells secrete substances that prevent the immune system from finding and attacking them
«The goal of cancer immunotherapy is to make the patient's immune system work in such a way that it can withstand the growth of a malignant tumor.»
This can be done in several ways:
- Stimulate and strengthen the work of the person’s immune system
- Administer artificial drugs that mimic the work of separate parts of the immune system
The effectiveness of this approach, as well as the significance of research in this area, were evaluated by the Nobel Prize for discoveries in the field of immuno-oncology in 2011 and 2018.
When is immunotherapy administered to treat cancer?
Initially, immunotherapy treatments were administered in the advanced stages of cancer when other remedies were ineffective. These are stage 4 lung cancer, metastatic melanoma, stage 4 stomach cancer, kidney cancer, and other malignancies. Immunotherapy increases life expectancy and alleviates the symptoms of the malignant process. In advanced cancers, it works on its own and further enhances the effectiveness of other treatments, such as chemotherapy.
As clinical experience has been accumulated and new drugs have been developed, physicians have noted that the administration of immunotherapeutic drugs allows oncology to be controlled longer and significantly reduces the risk of recurrence. This is due to the fact that the patient's immune system "learns" to find and destroy the remaining malignant cells. Thus, recurrent tumors were included in the list of indications for immunotherapy.
(c) Timeline of non-PD-1/L1 Immuno-Oncology Agent FDA Approvals
Updated May 27, 2022
Sources: CRI, CRI Analytics, and FDA
Today, immunotherapy is also used in the early stages of cancer, sometimes as a first-line therapeutic option. In particular, such treatment is carried out in patients with operable lung cancer, in stages I-II of the disease. Immunotherapy increases life expectancy and the chance of a full recovery. Patients are in remission longer and do not experience cancer-related symptoms.
Types of cancer immunotherapy
Immunotherapy can be active and passive. Active immunotherapy stimulates the attack of the patient's immune system on the tumor, sometimes by strengthening already existing anti-tumor processes and sometimes by helping immune cells overcome the "masking" of the tumor. Passive immunotherapy involves the administration of ready-made substances that increase the sensitivity of a malignant neoplasm to immune attacks.
In German hospitals, physicians use several types of immunotherapy:
- Monoclonal antibodies
- Immune checkpoint inhibitors
- CAR T-cell therapy
- Cancer vaccines
Monoclonal antibodies bind to a specific protein in a cancer cell or immune system. Depending on the protein the monoclonal antibody is specific to, the drug stimulates T-killers (cells of the immune system that directly destroy tumors) or T-helpers (cells of the immune system that help T-killers work). Antibodies can also be a part of targeted cancer therapy. For example, certain types of them block signals that stimulate the uncontrolled division of malignant cells.
Immune checkpoint inhibitors block proteins that prevent the immune system from attacking malignant cells. Depending on the protein, the drugs are called CTLA-4, PD-1, or PD-L1 inhibitors. After the administration of immune checkpoint inhibitors, the patient's anti-tumor immunity is activated.
Cytokines, the best known of which are interferon and interleukin, affect all tumors in the same way. They alter the growth and reproduction of cancer cells, activate T-killers, and also make the tumor synthesize chemicals that disclose it as a target for immune attack.
CAR T-cell therapy is the newest and most advanced of the methods affecting the immune system. This is adoptive immunotherapy. New genetic material is introduced into the patient's leukocytes, thanks to which they acquire the ability to recognize and destroy a specific tumor, despite all its defense mechanisms.
Cancer vaccines with dendritic cells are also manufactured individually, taking into account specific antigens of the tumor in a particular patient. Dendritic cell therapy involves the "acquaintance" of the patient's dendritic cells with tumor components in the laboratory and the infusion of already trained cells back to the patient. Dendritic cell cancer treatment in Germany demonstrates effectiveness in any stage of the disease.
In what types of cancer is immunotherapy effective?
Numerous clinical studies have demonstrated that immunotherapy can be effectively used to treat a wide range of malignancies and is well tolerated. For example, trials KEYNOTE-059, CP-MGAH22-05, and EPOC1706 demonstrated the efficacy and safety of immune checkpoint inhibitors in gastric cancer. The PACIFIC study showed excellent prospects for the treatment of non-small cell lung cancer with monoclonal antibodies.
«More than 150 clinical studies of immunotherapy for melanoma have been conducted to date. All of them confirm the effectiveness of this group of drugs even in patients with stage 4 cancer.»
What types of cancer can be treated with immunotherapy? The following types of tumors demonstrate a good response to treatment:
- Thyroid tumors
- Lung cancer
- Esophageal tumors
- Mammary cancer
- Stomach tumors
- Liver cancer
- Pancreatic tumors
- Colon cancer
- Rectal cancer
- Ovarian tumors
- Uterine cancer
- Prostate cancer
- Soft tissue sarcoma
The scientific search does not stop. Scientists identify new potential tumor molecules that immunotherapy can target and develop new medications. The range of indications for this type of treatment is also expanding.
Comparing the effectiveness of cancer treatment methods
When choosing between systemic therapeutic options (chemotherapy, immunotherapy, targeted therapy, hormonal therapy), doctors evaluate the patient's condition, possible side effects, and the expected outcome of treatment. For example, chemotherapy works faster but is more toxic; immunotherapy provides a better long-term result but requires more time for the anti-tumor effect to develop.
As for immunotherapy vs. chemotherapy, in most cases, their combination is the most effective option. For example, a dendritic cell vaccine may be administered between cycles of chemotherapy, or chemotherapy may precede CAR T-cell therapy. Certain chemotherapy regimens can enhance the immune response against tumors, allowing patients to achieve remission more quickly.
|Toxicity||Speed of the effect onset||Duration of treatment effect|
|Chemotherapy||High||A few days||Short-term effect, limited to the course of treatment|
|Immunotherapy||No severe side effects||A few weeks||Reliable long-term result, long-lasting remission|
|Hormone therapy||No severe side effects||A few days||The effect is present only during treatment|
|Targeted therapy||No severe side effects||A few weeks||The effect is quite long-lasting in the presence of specific mutations in the tumor|
Targeted therapy also modulates the immune response and further disrupts the molecular mechanisms necessary for tumor growth and metastasizing. Targeted therapy may be preferable for patients with a specific antigenic composition of the tumor when drugs destroy only malignant cells. In other cases, a combination of targeted drugs with immunotherapeutics demonstrates a higher efficiency.
Cost of cancer immunotherapy in Germany
The cost of immunotherapy in German clinics depends on the diagnosis, the duration of the therapeutic course, and the recommended drug. As a rule, immunotherapy is carried out as an outpatient procedure, in a doctor's office or clinic department, without a mandatory hospitalization.
For example, in stage 4 malignant melanoma, immunotherapy drugs may be administered over several weeks in combination with chemotherapy. Such a treatment course, including all preliminary and follow-up examinations, can cost in the €20,000 to €30,000 range.
In patients with non-small cell lung cancer, the course of treatment can last up to 2 years. The drugs are administered intravenously slowly (over 30-60 minutes) every 2-4 weeks. In such a clinical case, the price of immunotherapy in Germany is determined for each person individually.
The choice of the drug also affects the financial aspect of treatment. For example, the solution for vaccinating with dendritic cells is made for the patient individually. This is a high-tech process that is associated with additional costs. Preparations of monoclonal antibodies are standardized, but their administration requires preliminary tests in order to determine the genetic composition of the tumor.
Cancer immunotherapy in Germany with Booking Health
If you want to undergo immunotherapy cancer treatment at a specialized medical center in Germany, Booking Health will help you. Booking Health is an international medical tourism operator that has been organizing treatment of patients with oncology from 75 countries for over 12 years.
Booking Health specialists will arrange your medical trip to Germany and help you:
- Choose a specialized clinic with the best treatment success rates for your disease
- Make an appointment for the desired date, avoid being on the long waiting list
- Communicate with a foreign doctor directly
- Understand the expected medical program in advance, avoid repeating previous diagnostic tests
- Receive medical care at a favorable cost, exclude additional fees for foreigners (save up to 50% of the initial treatment cost)
- Find and buy medicines for the maintaining treatment in your country
- Communicate with the healthcare facility after the treatment completion
- Control the bills from the clinic and return the unspent funds of the medical deposit
- Undergo additional examinations and treatment procedures, if necessary
- Book accommodation, plane tickets, transfer; receive a visa for yourself and an accompanying person
You can check up-to-date information about physicians and oncology hospitals on the Booking Health website and send a request for treatment. If necessary, doctors will elaborate for you on a comprehensive medical program: from surgery to immunotherapy and subsequent rehabilitation. In the clinic, you will be accompanied by an interpreter, and a personal medical coordinator will constantly stay in touch, ready to help with any issues.
Choose treatment abroad and you will for sure get the best results!
The article was edited by medical experts, board certified doctors Dr. Vadim Zhiliuk, Dr. Nadezhda Ivanisova. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!