A patient-friendly explainer on immunotherapy — checkpoint inhibitors, CAR-T cell therapy, PD-1/PD-L1 drugs, which cancers respond best, eligibility criteria, and how Indian hospitals offer these at 60–80% less.
What Is Cancer Immunotherapy?
Immunotherapy helps your own immune system recognise and destroy cancer cells. Unlike chemotherapy, which directly kills fast-growing cells, immunotherapy removes the "brakes" that cancer puts on immune response or engineers immune cells to better target tumours.
Over the past decade, immunotherapy has transformed outcomes for melanoma, lung cancer, kidney cancer, and several other tumour types. Some patients with advanced cancers have achieved complete, durable remissions.
Types of Immunotherapy
| Type | How It Works | Examples | Best For |
|---|---|---|---|
| Checkpoint Inhibitors | Block PD-1/PD-L1 or CTLA-4 proteins that hide cancer from immune cells | Pembrolizumab (Keytruda), Nivolumab (Opdivo), Ipilimumab (Yervoy) | Melanoma, NSCLC, kidney, bladder |
| CAR-T Cell Therapy | Patient's T-cells are genetically modified to target a cancer antigen (CD19, BCMA) | Kymriah, Yescarta, Abecma | B-cell leukaemia, lymphoma, myeloma |
| Cancer Vaccines | Train the immune system to recognise cancer-specific antigens | Sipuleucel-T (Provenge), mRNA vaccines (trials) | Prostate cancer, melanoma (trials) |
| Cytokines | Immune-stimulating proteins boost overall immune activation | Interleukin-2 (IL-2), Interferon-alpha | Kidney cancer, melanoma |
Who Is Eligible?
Eligibility depends on:
- Biomarkers — PD-L1 expression (≥50% for first-line Keytruda in NSCLC), MSI-H/dMMR status (for any solid tumour), TMB (tumour mutational burden)
- Cancer type — FDA/EMA-approved indications include melanoma, NSCLC, kidney, bladder, head & neck, Hodgkin lymphoma, hepatocellular carcinoma, and more
- Prior treatment — immunotherapy may be first-line or used after chemo failure
- Autoimmune conditions — active autoimmune disease may be a contraindication (risk of severe flares)
Side Effects and Management
Immunotherapy side effects differ from chemotherapy. They're caused by an overactive immune response attacking healthy tissues:
- Skin — rash, itching (30–40% of patients)
- Gut — colitis, diarrhoea (15–20%)
- Thyroid — hypothyroidism or hyperthyroidism (10–20%)
- Liver — hepatitis (5–10%)
- Lungs — pneumonitis (3–5%)
Most immune-related adverse events (irAEs) are manageable with steroids. However, they require prompt recognition. Your treatment centre should have an irAE protocol in place.
Cost Comparison by Country
| Treatment | US Cost/Cycle | India Cost/Cycle | Savings |
|---|---|---|---|
| Pembrolizumab (Keytruda) | $10,000–$12,000 | $1,500–$2,500 | 75–85% |
| Nivolumab (Opdivo) | $8,000–$10,000 | $1,200–$2,000 | 75–85% |
| CAR-T Cell Therapy | $375,000–$475,000 | $40,000–$65,000 | 85–90% |
Indian hospitals now offer FDA-approved checkpoint inhibitors as well as biosimilars at significantly reduced costs. CAR-T programmes at centres like Tata Memorial and AIIMS are achieving comparable outcomes to US trials.
Questions to Ask Your Oncologist
- Has my tumour been tested for PD-L1, MSI, and TMB?
- Am I eligible for immunotherapy as first-line treatment or after chemotherapy?
- What is the expected response rate for my cancer type with this drug?
- How will immune-related side effects be monitored?
- Can I do some cycles abroad and continue at home?
- Are clinical trials available for newer immunotherapy combinations?
Related Treatment Guides
Looking for the best hospital?
Let our experts help you find the right hospital for your treatment. Get a free consultation today.
