Immunotherapy is a modern therapeutic approach that stimulates the immune system so that it recognises and destroys cancerous cells. Today, it is used effectively in several types of cancer. It is notably very widespread in the treatment of lung cancer, melanoma (skin cancer), kidney cancer, bladder cancer, and cancers of the head and neck. Furthermore, certain forms of lymphoma and leukaemia also respond very well to immune-based treatments. Thanks to recent advances, immunotherapy is now extending to other cancers such as those of the stomach, colon, and breast, particularly in certain well-defined subtypes. Its effectiveness is especially notable in patients with high PD-L1 expression or high microsatellite instability (MSI-H).
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However, not all cancers respond in the same way to immunotherapy. The genetic structure of the tumour, its interaction with the immune system, and its microenvironment all play a determining role in the response to treatment. Certain tumours have the ability to evade the immune system, and immunotherapy acts precisely by removing these evasion mechanisms. Furthermore, when combined with other treatments such as chemotherapy or targeted therapies, its effectiveness can be enhanced. This is why immunotherapy generally forms part of a comprehensive and personalised therapeutic strategy, tailored to each patient.
How Does Immunotherapy Differ from Chemotherapy?
The main difference between immunotherapy and chemotherapy lies in their mode of action. Chemotherapy acts directly on rapidly dividing cells, which includes not only cancerous cells but also certain healthy cells, thereby causing significant side effects. Immunotherapy, by contrast, strengthens the body's natural defences in order to target cancerous cells more specifically. This makes it a more selective approach. Whilst chemotherapy often causes adverse effects such as hair loss, nausea, or immunosuppression, the side effects of immunotherapy are generally related to excessive activation of the immune system and present a different clinical profile.
Another major difference concerns the duration and persistence of the treatment response. Chemotherapy often acts quickly, but its effects are sometimes temporary, with a risk of disease progression after the treatment is stopped. Immunotherapy, for its part, may take longer to produce effects, but it can offer lasting and prolonged responses in certain cases. This is explained by the immune system's capacity to develop a "memory", enabling it to continue recognising and fighting cancerous cells even after the treatment has ended. This characteristic represents a significant advantage, particularly in advanced cancers, and makes immunotherapy one of the most promising advances in modern oncology.
Which Patients Can Benefit from This Treatment?
Immunotherapy is not suitable for every patient with cancer. Eligibility is based on a thorough clinical and biological assessment. The patient's general condition, their performance level, and the proper functioning of their immune system are all essential elements to consider. Furthermore, the biological characteristics of the tumour play a key role. For example, patients with a high level of PD-L1 are generally more likely to respond favourably to immunotherapy. Similarly, those with high microsatellite instability (MSI-H) or a high tumour mutational burden (TMB) present higher response rates. This is why molecular analyses carried out before treatment are indispensable for identifying the patients most likely to benefit.
Conversely, certain situations require particular caution. Patients with autoimmune diseases may see their condition worsen under immunotherapy, owing to the stimulation of the immune system. Likewise, in patients who have undergone organ transplantation, there is a risk of rejection. The decision to initiate immunotherapy must therefore be made within the framework of a multidisciplinary consultation bringing together oncologists, pathologists, and sometimes immunologists. This approach allows a personalised therapeutic strategy to be developed that is both effective and safe for the patient.
How Long Does Immunotherapy Treatment Last?
The duration of immunotherapy treatment varies according to the type of cancer, the patient's response, and the therapeutic protocol used. In general, treatment is administered in cycles at regular intervals, often every two or three weeks. In some patients, a few months of treatment may be sufficient, whilst in other cases, it may continue for one to two years. When the response is favourable, it is common to continue the treatment in order to maintain control of the disease. However, the duration is regularly reassessed according to the effectiveness of the treatment, tolerability, and the patient's general condition.
One of the most remarkable aspects of immunotherapy is that its effects can persist even after the treatment has been stopped. Once activated, the immune system can continue to recognise and fight cancerous cells, sometimes allowing for a prolonged remission. Nevertheless, this lasting response is not guaranteed in every case, which makes regular medical follow-up indispensable. Imaging examinations and clinical assessments allow the progression of the disease to be monitored. The success of the treatment therefore depends not only on its duration but also on careful management of side effects and ongoing follow-up, ensuring optimal care for the patient.