Types of immunotherapy

Immunotherapy can trigger the immune system to fight cancer in different ways.

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Current immunotherapy treatments

Checkpoint inhibitors

On the surface of T-cells are proteins called “checkpoints” that stop the immune system from attacking cancer cells.

Drugs called checkpoint inhibitors block certain proteins so the T-cells can recognise and destroy cancer cells.

The checkpoint inhibitors that are currently available can block the following proteins:

  • Programmed death-1 (PD-1)
  • Programmed death-ligand 1 (PD-L1)
  • Cytotoxic T-lymphocyte-associated antigen (CTLA-4).

Checkpoint inhibitors are now the most widely used form of immunotherapy. The types currently subsidised by the Australian Government through the Pharmaceutical Benefits Scheme (PBS) include pembrolizumab (Keytruda), nivolumab (Opdivo) and ipilimumab (Yervoy). These drugs are approved and reimbursed for people with advanced melanoma. Nivolumab has recently been approved and will soon be reimbursed for kidney and lung cancers.

They are also being tested for other cancers, and may soon be approved and reimbursed for cancers of the head and neck, and bladder.

Like all treatments, checkpoint immunotherapy can cause side effects. Because checkpoint immunotherapy acts on the immune system, it can cause inflammation in any part of your body. This can lead to a variety of side effects such as skin rash, diarrhoea and breathing problems.

Learn about the side effects you may expect if you are having checkpoint immunotherapy.

Immune stimulants

Some treatments have been used to stimulate the immune system so it reactivates and attacks the cancer.

Examples include:

  • In non-muscle-invasive bladder cancer, the vaccine Bacillus Calmette-Guérin (BCG) is given into the bladder through a catheter to stimulate a person’s immune system to stop or delay bladder cancer coming back or becoming invasive.
  • In some types of skin cancers, a cream called imiquimod is applied directly to the affected area to stimulate a local immune response.

Immunotherapy in clinical trials

Adoptive cell transfer 

This boosts the ability of the body’s T-cells to fight cancer.

Chimeric antigen receptor (CAR) T-cell therapy is a type of adoptive cell transfer that is showing benefits for some people with some types of leukaemia and lymphoma.

First, T-cells are removed from the blood and a new gene is introduced into the cells to enable them to recognise cancer. The T-cells are then returned to the blood by an intravenous drip (infusion). The altered T-cells multiply and trigger a number of immune responses that attack the cancer cells.

Cytokines (immune hormones) 

These are proteins made by white blood cells that stimulate the immune system.

The two main types of cytokines that have been used to treat cancer are interferons, which help the immune system to slow the growth of cancer cells, and interleukins, which stimulate anti-cancer T-cells.

Interferons were once used at high doses to help people with melanoma and kidney cancer, but they were found to be toxic. They are currently being trialled at lower doses and given with checkpoint inhibitors. If these trials are successful, interferons may be used to treat cancer in the future.

Oncolytic viruses

These viruses directly infect tumour cells and cause an immune response against the infected cells.

Other immune treatments

Vaccines help train the immune system to prevent cancer. There are prevention and treatment vaccines, but treatment vaccines have not been successful.

The human papillomavirus (HPV) vaccine is used to prevent cervical cancer, and it is hoped it will also prevent penile and anal cancers and some cancers of the head and neck. Vaccines against hepatitis B and hepatitis C viruses help prevent liver cancer.


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Apple devices

The iBooks application must be installed on your Apple device before you can read the EPUB.
Different ways to download an EPUB file to your Apple device:

  • email EPUB files to yourself and transfer the attachment to iBooks.
  • copy EPUB files into DropBox (or a similar service) and use the DropBox app to send them to iBooks.
  • open EPUB files directly from Mobile Safari and open them in iBooks, where they are saved automatically by downloading the EPUB from the website.

Need more help? Visit: http://support.apple.com/kb/HT4059

Kobo

To download an EPUB file to your Kobo from a Windows computer:

  • download and save the EPUB directly onto your desktop.
  • connect your Kobo to your computer using the USB cable and tap “Connect” on your eReader.
  • select “Open folder to view files” to view the contents of your Kobo.
  • navigate to where you have stored your EPUB file in “Finder”, in documents or downloads, and drag and drop it into the Kobo window. You can now disconnect your Kobo to read the eBook.

To download an EPUB to your Kobo from a Mac:

  • download and save the EPUB directly onto your desktop.
  • connect your Kobo to your computer using the USB cable and tap “Connect” on your eReader.
  • open your “Finder” application.
  • select “Kobo eReader” from the listed devices to view the contents of your Kobo.
  • navigate to where you have stored your EPUB file in “Finder”, probably in documents or downloads, and drag and drop it into the Kobo window. You can now disconnect your Kobo to read the eBook.

Turn on your Kobo and your EPUB will be located in “eBooks”, while a PDF will be located in “Documents”.
Need more information? Visit: http://www.kobo.com/help/koboaura/response/?id=3784&type=3

Sony Reader

To download an EPUB file on your Sony Reader™:

  • ensure you have already installed the Reader™ Library for PC/Mac software
  • select the eBook you want from our website and click the link to download it.
  • connect the Reader™ to your computer.
  • open the Reader™ Library software and click “Library” in the left-hand pane and select the eBook to view it.

Need more help? Visit: https://au.readerstore.sony.com/apps_and_devices/

Amazon Kindle 2nd Generation devices

EPUB files can’t be read on the Amazon Kindle™. However, like most eReaders, Kindle™ 2nd Generation devices are able to display PDFs. We recommend that you download the PDF version of this booklet if you would like to read it on a Kindle™.
To transfer a PDF to your Kindle™ via USB cable from your computer or Mac:

  • download the PDF directly onto your computer.
  • connect the USB cable to your computer’s USB port, and the micro USB end of the cable to your Kindle™. Note: the Kindle™ won’t be available as a reading device while it is connected to your computer until it has been disconnected.
  • open the Kindle™ drive and several folders will appear inside. The “Documents” folder is where you will need to copy or drag the PDF to.
  • safely eject your Kindle™ from your computer and unplug the USB cable. Your content will appear on the Home Screen.

Kindle also provides a Kindle Personal Documents Service that allows users to send documents as an attachment directly to your eReader. For more information on this service, visit http://www.amazon.com/gp/help/customer/display.html/ref=help_search_1-1?ie=UTF8&nodeId=200767340&qid=1395967989&sr=1-1
For more information on accessing a PDF on your Kindle™, visit www.amazon.com/manageyourkindle, log in to your account and click on Personal Document Settings.
Need more help? Visit https://www.amazon.com/gp/help/customer/display.html?nodeId=200375630

Android and PC

You can also download and open eBooks on Android devices and PCs with appropriate apps or software installed. Suitable eReader apps for Android include Google Play Books, FBReader and Moon+ Reader. Suitable software for PCs include Calibre and Adobe Digital Editions.


This information was last reviewed in June 2017
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