Immunotherapy

Before starting immunotherapy, we test the hypothesis: “Will this tumor benefit from immunotherapy or not?” through the following tests on the tumor sample:

1. PD-L1 Protein Test: Determines the presence of “brakes” on tumor cells; the higher the percentage, the greater the chance of a response.

2. MSI-H / dMMR (Microsatellite Instability) Test: Looks for genetic mutations that make the tumor highly visible to the immune system, making immunotherapy very effective regardless of the tumor’s location.

3. TMB (Tumor Mutational Burden): Assesses the number of mutations in cancer cells (an increase means a better response).

Common Types of Tumors Treated with Immunotherapy

• Lung tumors (various types).

• Skin cancer (Melanoma).

• Kidney and bladder tumors.

• Colon and gastrointestinal tumors (when specific genetic mutations are present).

• Breast tumors (especially triple-negative).

• Head and neck tumors.

Differential Diagnosis of Side Effects (How to Distinguish Side Effects?)

Immunotherapy side effects differ from chemotherapy (it rarely causes hair loss or severe nausea); instead, they result from increased immune system activity mistakenly attacking healthy tissues:

• Immunotherapy-Induced Pneumonitis: Suspected when a new cough or shortness of breath appears (must be distinguished from bacterial pneumonia or tumor progression).

• Immunotherapy-Induced Colitis: Suspected when frequent diarrhea or abdominal pain occurs (must be distinguished from food poisoning or intestinal infections).

• Endocrine Disorders: Such as hypothyroidism, hyperthyroidism, or pituitary gland involvement (manifesting as severe fatigue or weight changes).

• Skin Inflammation: Rash or itching.

Red Flags Requiring Urgent Medical Intervention

If any of these symptoms appear during immunotherapy treatment, you should go to the hospital or contact your doctor immediately:

1. Sudden shortness of breath or worsening cough.

2. Severe diarrhea (more than 3–4 times daily) or blood in the stool.

3. High fever or severe chills.

4. Yellowing of the eyes or skin (jaundice) or dark urine.

5. Unexplained severe fatigue with dizziness or severe low blood pressure.

6. Rapidly spreading skin rash or skin peeling.

Contraindications (When to Avoid or Be Cautious with Immunotherapy)

• Absolute Contraindications: Proven severe hypersensitivity/allergy to the same immunotherapy drug previously.

• Relative Contraindications (Require careful evaluation and risk-benefit balancing):

  • Active Autoimmune Diseases: Such as systemic lupus erythematosus, ulcerative colitis, or active rheumatoid arthritis (because the drug may trigger a flare-up).

  • Previous Organ Transplants: (such as kidney or liver transplants) because immunotherapy may lead to organ rejection.

  • High-Dose Corticosteroid Use: Corticosteroids suppress immunity and may reduce the efficacy of immunotherapy.