This presentation, tailored for oncology nurses, provides an overview of immunotherapy classes, how they work, and how key side effects are typically managed. (Disclaimer: Content is based on peer-reviewed literature; however, it is not a substitute for medical advice. Please consult your doctor)

1. Cancer
Immunotherapies
2018 UPDATE

2. Benefits
• Unlike radiation or chemotherapy, the immune
system can distinguish between healthy and
unhealthy cells
• In many cases, the immune system can mount a
response against the unhealthy cells
• Immunotherapy can be used to treat cancer cells as
they develop, and, in some cases, this can lead to
more lasting results
Becze E. ONS Voice. 2017; https://voice.ons.org/news-and-
views/what-oncology-nurses-need-to-know-about-
immunotherapy-agents.

3. OF
IMMUNOTHERAPIES
MAJOR CLASSES
Becze E. ONS Voice. 2017; https://voice.ons.org/news-and-
views/what-oncology-nurses-need-to-know-about-
immunotherapy-agents.

4. Checkpoint
Inhibitors
Inhibitory and stimulatory pathways form checkpoints that maintain self-
tolerance and assist in immunity against diseases such as cancer
Checkpoint inhibitors prevent cancer cells from using these pathways and
flag them for destruction by activated T cells
Ipilimumab, nivolumab, pembrolizumab, and atezolizumab use different
mechanisms to achieve this goal and are indicated for a range of solid
tumors
The broad inflammatory response elicited may result in toxicities such as
fatigue, colitis, pneumonitis, dermatitis, and hepatitis
Common toxicities are usually amenable to treatment with steroids and anti-
tumor-necrosis-factor agents
Becze E. ONS Voice. 2017; https://voice.ons.org/news-and-
views/what-oncology-nurses-need-to-know-about-
immunotherapy-agents.

5. Chimeric
antigen
receptor
(CAR) T-cell
therapy
Severe toxicities: hypotension, capillary leak, or neurotoxicities
Mild-to-moderate toxicities: headache, fever, and myalgia
The most common toxicity is cytokine release syndrome
CAR for CD22 is open and accruing patients
CART-19 is in phase I and II trials for the treatment of relapsed and refractory acute
lymphoblastic leukemia
Tumor-specific antigen recognition can be achieved with CAR therapies
Becze E. ONS Voice. 2017; https://voice.ons.org/news-and-
views/what-oncology-nurses-need-to-know-about-
immunotherapy-agents.

6. Monoclonal
antibodies
SUBSTANCES CAN EITHER TARGET
A SPECIFIC ANTIGEN OR ACT AS
NATURAL ANTIBODIES
MECHANISM OF ACTION MAY BE
COMPRISED OF INFLAMMATORY
CYTOKINE RELEASE AND/OR
TUMOR INVASION
DRUGS, RECOGNIZABLE BY THE
SUFFIX “-MAB” IN THEIR GENERIC
NAMES, HAVE BEEN DEVELOPED
FOR NUMEROUS CANCERS
MAJORITY OF SIDE EFFECTS ARE
TREATABLE WITH STEROIDS AND
ACUTE INFUSION REACTIONS ARE
RARE
Becze E. ONS Voice. 2017; https://voice.ons.org/news-and-
views/what-oncology-nurses-need-to-know-about-
immunotherapy-agents.

7. Oncolytic viral
immunotherapy
Live-virus vaccines may produce tumor-toxic
cytokines or elicit anti-tumor responses by the
host
Mechanisms of action involve viral cell receptor
response, cytokine release, nuclear replication,
or extracellular immune response
Only therapy currently approved to manage
cancer is talimogene laherparepvec
Approved for intralesional injection of metastatic
melanoma
Best practices need to be considered for live-virus
vaccines, including appropriate education, such as
avoiding immunocompromised individuals, e.g.
older adults and women trying to conceive
Becze E. ONS Voice. 2017; https://voice.ons.org/news-and-
views/what-oncology-nurses-need-to-know-about-
immunotherapy-agents.