Who Qualifies for Immunotherapy?

Immunotherapy has become one of the most exciting treatments in modern medicine, giving hope to many people with diseases like cancer and autoimmune disorders. It works by boosting the body’s immune system to fight off diseases, offering a more targeted approach that can be less harmful than traditional treatments such as chemotherapy or radiation. However, not everyone can receive immunotherapy. Deciding if someone should use it depends on various factors, such as the type of disease, the person’s overall health, and certain biological markers in their body.

In this blog, we’ll explain who is eligible for immunotherapy, what conditions it can treat, the factors that influence whether it’s a good option, and how doctors determine if it’s right for you. Whether you’re thinking about immunotherapy for treatment or just want to learn more, understanding who qualifies will help you navigate this promising and growing field of medicine.

What is Immunotherapy?

Immunotherapy is a type of medical treatment that uses the body’s immune system to fight diseases, including cancer, autoimmune disorders, and certain infections. The immune system protects the body from harmful invaders like bacteria and viruses. Immunotherapy works by stimulating the immune system to work harder or giving it extra components (like antibodies) to help it target and destroy diseased cells more effectively.

In cancer treatment, for example, immunotherapy can help the immune system recognize and attack cancer cells, which might have previously avoided detection. There are different types of immunotherapy, including:

1. Monoclonal antibodies: Lab-made molecules that can help the immune system find and destroy cancer cells.
2. Checkpoint inhibitors: Drugs that help the immune system detect and attack cancer cells by blocking certain proteins that prevent immune cells from attacking tumors.
3. Cancer vaccines: Vaccines designed to trigger an immune response against cancer cells.
4. Adoptive cell therapy: A treatment that boosts the body’s immune cells, often T cells, to help them fight cancer more effectively.

Immunotherapy has become a major breakthrough in cancer treatment, offering new options for patients whose cancers may not have responded to traditional treatments like surgery, chemotherapy, or radiation.

Types of Diseases Treated with Immunotherapy

Immunotherapy is a versatile treatment approach that can be used to manage various diseases, especially those where the immune system plays a central role in fighting the condition. Below are some of the key diseases and conditions that can be treated with immunotherapy:

1. Cancer

Immunotherapy has shown significant promise in the treatment of various cancers, offering hope to patients who may not respond well to traditional therapies like chemotherapy and radiation. Some cancers that benefit from immunotherapy include:

• Lung Cancer: Immunotherapy, especially checkpoint inhibitors, can help patients with advanced or metastatic lung cancer.
• Melanoma: Skin cancer like melanoma has seen remarkable success with immunotherapies, especially immune checkpoint inhibitors like pembrolizumab (Keytruda) and nivolumab (Opdivo).
• Breast Cancer: Certain types of breast cancer, particularly triple-negative breast cancer, may respond to immunotherapy.
• Bladder Cancer: Immunotherapy can be effective for advanced or metastatic bladder cancer.
• Hodgkin Lymphoma: Some forms of lymphoma, including Hodgkin’s, can be treated with immune checkpoint inhibitors.
• Kidney Cancer: Immunotherapies can help treat advanced kidney cancer by boosting the immune system to fight cancer cells.
• Other Cancers: Leukemia, head and neck cancers, and colorectal cancer are also treated with immunotherapy in certain cases.

2. Autoimmune Diseases

While immunotherapy is often associated with cancer treatment, it can also treat autoimmune disorders, where the immune system mistakenly attacks the body’s cells. Some autoimmune diseases treated with immunotherapy include:

• Rheumatoid Arthritis: Immunotherapy drugs, particularly biologics, can help manage inflammation and slow disease progression.
• Crohn’s Disease: Certain biologic drugs suppress the immune system’s inflammatory response, providing relief to those with Crohn’s.
• Psoriasis: Immunotherapy can help manage the overactive immune response that leads to the skin condition psoriasis.
• Multiple Sclerosis: Immunotherapy may be used to reduce the frequency of relapses and manage symptoms of multiple sclerosis (MS).

3. Infectious Diseases

Immunotherapy is also being explored to treat chronic infections, particularly those caused by viruses. Some infections that may benefit from immunotherapy include:

• HIV/AIDS: Research is underway to explore how immunotherapy could help patients with HIV, either by boosting immune responses or helping the body control the virus more effectively.
• Hepatitis B and C: Some immunotherapies are being investigated as potential treatments for chronic hepatitis, particularly in cases where the virus resists other treatments.

4. Other Conditions

• Allergic Diseases: Immunotherapy is commonly used to treat allergies, like hay fever or insect venom allergies, through desensitization treatments.
• Infections with Resistant Pathogens: Immunotherapy may be used in cases where infections do not respond to traditional antibiotics, including certain resistant bacterial infections.

Criteria for Immunotherapy Eligibility

Not everyone is a candidate for immunotherapy, and the decision to use this treatment depends on several factors. Doctors evaluate a patient’s overall health, the specific disease being treated, and various biological markers before determining if immunotherapy is the right option. Here are the main criteria that influence eligibility for immunotherapy:

1. Type of Disease

Immunotherapy is particularly effective for certain diseases, most notably cancer, but its use in other conditions, like autoimmune diseases, is also being explored. Eligibility is largely determined by:

• Cancer Type: Some cancers respond better to immunotherapy than others. For example, melanoma, lung cancer, and certain types of lymphoma are more likely to benefit from immunotherapy. Other cancers, such as pancreatic cancer or some forms of breast cancer, may not respond as effectively to immunotherapy.
• Autoimmune Diseases: Immunotherapy is also used to treat autoimmune conditions like rheumatoid arthritis, Crohn’s disease, and multiple sclerosis. The severity of the disease and how well it responds to other treatments can affect eligibility.
• Infectious Diseases: For chronic viral infections like HIV or hepatitis, immunotherapy may be considered if traditional treatments are not working.

2. Stage of Disease

• Cancer Stage: Immunotherapy is often more effective when the disease is in a specific stage. For cancer, immunotherapy is commonly used in cases where the cancer is advanced, metastatic (spread to other parts of the body), or recurrent. In early-stage cancers, other treatments like surgery or radiation are usually the first line of treatment.
• Progression or Recurrence: In cases where the disease has progressed despite other treatments, immunotherapy may be considered a next step.

3. Tumor Biomarkers

In cancer treatment, specific genetic markers and proteins can influence whether a patient qualifies for immunotherapy:

• PD-L1 Expression: Some cancers express a protein called PD-L1 on their surface, which can prevent immune cells from attacking the cancer. Drugs like checkpoint inhibitors can block this protein, allowing the immune system to target the cancer more effectively. Testing for PD-L1 expression is an important factor in determining eligibility for some immunotherapies.
• Tumor Mutational Burden (TMB): TMB refers to the number of mutations present in a tumor’s DNA. Cancers with a high mutational burden may respond better to immunotherapy, as the immune system may recognize these mutations as foreign.
• Microsatellite Instability (MSI): MSI-high cancers, which have defects in their DNA repair mechanisms, may also be more likely to respond to immunotherapy, particularly checkpoint inhibitors.

4. Overall Health and Organ Function

• General Health: Since immunotherapy can sometimes cause side effects that affect the immune system, doctors will assess whether a patient is healthy enough to tolerate these effects. People with severely weakened immune systems or other serious health conditions may not be candidates.
• Organ Function: Healthy organ function is essential for safely administering immunotherapy. Liver, kidney, and heart function tests help doctors determine if a patient’s organs are healthy enough to handle the potential side effects.
• Age: While immunotherapy can be used in both younger and older patients, age-related factors such as frailty or comorbid conditions may affect eligibility.

5. Previous Treatments

• Treatment Resistance: For many cancers, immunotherapy is considered after traditional treatments (like chemotherapy, radiation, or surgery) have been unsuccessful. If cancer has not responded to these treatments, immunotherapy might be considered as a next option.
• Response to Immunotherapy: Some patients may not respond to immunotherapy even if their cancer appears to be a good candidate. In such cases, doctors may explore alternative therapies or combinations of treatments.

6. Immune System Health

• Existing Autoimmune Conditions: Since immunotherapy works by boosting the immune system, patients with certain autoimmune diseases (where the immune system attacks the body) may not be eligible. In some cases, immunotherapy could make these conditions worse.
• Immunocompromised Patients: Patients with weakened immune systems, such as those with HIV or those undergoing organ transplants, may not be able to tolerate immunotherapy safely.

7. Genetic Testing and Personalized Medicine

Advances in genetic testing and personalized medicine are allowing for more precise selection of patients for immunotherapy. Tests on a patient’s genetic profile, tumor genetics, and biomarkers help doctors determine whether immunotherapy is likely to be effective and which type of treatment would work best.

How Doctors Determine Eligibility for Immunotherapy

When determining if a patient is eligible for immunotherapy, doctors use a thorough and individualized approach, considering various factors including the type of disease, the patient’s overall health, genetic makeup, and prior treatments. Here’s how doctors typically assess whether immunotherapy is a suitable treatment option:

1. Type and Stage of Disease

• Cancer Type: Immunotherapy is more effective for certain cancers, such as melanoma, lung cancer, and some types of lymphoma, among others. Doctors first evaluate the specific cancer type to determine whether immunotherapy is likely to work. Some cancers have a better response to immunotherapy than others.
• Stage of Disease: The stage of cancer plays a significant role in eligibility. Immunotherapy is often considered for advanced or metastatic cancers, where the disease has spread to other parts of the body or recurred after previous treatments. In early stages, surgery, radiation, or chemotherapy may be preferred options.

2. Biomarker Testing

Biomarkers are measurable indicators that help doctors understand how a disease behaves and how it may respond to treatments. For cancer patients, biomarker testing is a key part of determining eligibility for immunotherapy:

• PD-L1 Expression: Some cancers produce high levels of PD-L1, a protein that helps cancer cells evade detection by the immune system. Drugs like checkpoint inhibitors (e.g., pembrolizumab, nivolumab) can block PD-L1, allowing the immune system to recognize and attack the tumor. Doctors may test for PD-L1 expression to see if a patient’s cancer is likely to respond to these therapies.
• Tumor Mutational Burden (TMB): High mutational burden means the tumor has many genetic mutations, making it easier for the immune system to identify and target the cancer. Tumors with high TMB may be more responsive to immunotherapy, so doctors often assess this factor when considering immunotherapy.
• Microsatellite Instability (MSI): MSI-high tumors, which have defective DNA repair mechanisms, are often more responsive to immunotherapy. Testing for MSI can help determine eligibility for certain checkpoint inhibitors.

3. Previous Treatment Response

• Refractory or Resistant Cancer: Immunotherapy is often recommended when cancer has not responded to traditional treatments like chemotherapy, radiation, or surgery. If a cancer is refractory (does not respond) or relapses after treatment, doctors may consider immunotherapy as a next step.
• Treatment History in Autoimmune Diseases: In autoimmune conditions, doctors assess how the patient has responded to previous treatments. If the patient has not had success with other therapies or the disease is not well controlled, immunotherapy might be an option.

4. Patient’s Overall Health and Organ Function

• Physical Health: Immunotherapy can have side effects that impact the immune system. Doctors evaluate whether a patient is healthy enough to tolerate these potential side effects. Those with severe health conditions or organ dysfunction may not be good candidates.
• Organ Function: To safely administer immunotherapy, a patient must have normal organ function. Tests for kidney, liver, and heart health are essential to ensure the body can handle the treatment without serious complications.
• Age and Life Expectancy: While immunotherapy can be used in both young and older patients, doctors consider the patient’s age and overall life expectancy, especially in elderly patients who may have other underlying health conditions.

5. Genetic and Molecular Profiling

• Genetic Testing: Personalized medicine plays an increasingly important role in immunotherapy. Doctors may conduct genetic tests on the patient’s tumor to identify mutations or genetic alterations that could predict how well the cancer will respond to immunotherapy.
• Tumor Sequencing: Advanced tumor sequencing can uncover specific mutations that may make a patient eligible for targeted immunotherapies. This information helps tailor the treatment to the individual, improving its chances of success.

6. Immune System Status

• Pre-existing Autoimmune Diseases: Some patients with autoimmune diseases may not be eligible for immunotherapy because the treatment could worsen their condition. If the immune system is already overactive, boosting it further with immunotherapy may lead to adverse effects.
• Compromised Immune Systems: Patients with weakened immune systems, such as those with HIV/AIDS or those who have undergone organ transplants, may not be suitable candidates for immunotherapy because it could further suppress or overwhelm their immune defenses.

7. Side Effect Management

• Monitoring Potential Side Effects: Immunotherapy has side effects that can range from mild (fatigue, skin rashes) to severe (autoimmune reactions, inflammation in organs). Doctors will assess the patient’s ability to manage these potential side effects and may recommend immunotherapy only if they believe the patient can tolerate them.

8. Consultation with a Multidisciplinary Team

Immunotherapy decisions are often made by a team of doctors, including oncologists, immunologists, and other specialists. This multidisciplinary approach helps ensure that all factors — from disease specifics to treatment history — are considered before making a final decision.

Conclusion

Immunotherapy has changed the way many diseases, especially cancer, are treated by using the body’s immune system to fight the disease. However, not everyone can receive this treatment. Doctors decide if a patient is eligible based on the type and stage of the disease, specific biomarkers, overall health, and how the disease has responded to past treatments.

Doctors rely on tests and collaborate with specialists to assess whether immunotherapy is a suitable treatment option. As research advances, more individuals may become eligible for this promising approach. If you’re wondering what types of cancer can be treated with immunotherapy, discussing your options with your doctor will provide a clearer understanding of whether this treatment is right for you.