Treating gynecologic cancers with immunotherapy

Your immune system is made up of cells, tissues, and organs that work together to protect your body from disease. When your immune system finds something that doesn't belong in your body, it attacks. However, because cancer cells are good at evading this immune response, your body sometimes struggles to fight them off. Immunotherapy can help.

Immunotherapy can be used to help your immune system locate cancer cells and intensify the immune response to destroy them. Immunotherapy for gynecological cancers is typically offered during the later advanced stages of the disease.

How does immunotherapy work for gynecologic cancers?

There are several methods used to deliver immunotherapy, but the main type for gynecologic cancers, particularly cervical cancer and endometrial cancers, is with an immune checkpoint inhibitor.

The immune system has certain checkpoints that prevent responses from being too strong or excessive, so that the immune system does not attack our normal cell and tissues. Checkpoint inhibitors prevent that from happening and instead allow the immune cells to attack cancer at full force. These treatments basically remove the brakes from the immune system of cancer patients.

Immunotherapy for different areas of gynecologic oncology, such as ovarian and other types of uterine cancer, are still being researched. However, some studies show that as an alternative to immunotherapy, certain PARP inhibitors (targeted therapy drugs) may help women diagnosed with ovarian cancer by preventing cancer cells from repairing their DNA.

PD-1 immune checkpoint inhibitors

The immune checkpoint inhibitors used for cervical and endometrial cancers are called PD-1 inhibitors. PD-1 is a protein on T cells — a type of immune cell that may help fight cancer. According to the National Cancer Institute, the PD-1 protein attaches to another protein, called PD-L1 which is found on on cancers cells, and helps keep the immune response in check. When the PD-1 protein is active, it helps keep the T cells from killing other cells, including cancer. However, PD-1 immune checkpoint inhibitors block the PD-1 protein, allowing T cells to attack cancer and shrink tumors or slow their growth.

Certain lab tests need to be performed before PD-1 inhibitors can be used. This type of immunotherapy is usually given via intravenous (IV) infusion every three to six weeks.

Side effects of immunotherapy

You may or may not experience side effects from immunotherapy, and not everyone experiences the same ones. Side effects include:

• Constipation and diarrhea
• Cough
• Dizziness
• Fatigue
• Fever
• Headache
• Itching and rash
• Joint and muscle pain
• Loss of appetite
• Nausea and vomiting
• Shortness of breath
• Weakness

Other rare but serious side effects include infusion and autoimmune reactions.

Infusion reactions typically occur during an IV infusion of the immune checkpoint inhibitors and feel like an allergic reaction. If you experience any side effects during an infusion, such as fever, chills, dizziness, itching, or trouble breathing, let your provider know right away.

Autoimmune reactions indicate your immune system has started to damage other organs in your body. Because of the way immunotherapy medicines work, your immune system may start attacking healthy parts of the body. Pay attention to any side effects you experience and let your healthcare provider know of anything new.

Other cancer treatment options

Other common treatments for gynecologic cancers include:

• Chemotherapy — Chemotherapy are strong medications used to kill rapidly growing cancer cells. It can be used to treat all gynecologic cancers.
• Hormone therapy — Some cancers are fueled by hormones, so hormone therapies stop the body from making new hormones, block hormones from attaching to cancer cells, or keep hormones from working as they should. Progesterone, or progestin, is one of the main hormones used to treat gynecologic cancers.
• Radiation therapy — Radiation therapy uses high-energy X-rays to destroy cancer cells. Radiation beams are aimed directly at diseased cells while avoiding healthy cells. Radiation therapy is sometimes prescribed alongside chemotherapy.
• Surgery — For gynecologic cancers, surgery is often used to remove the tumor or perform a hysterectomy.
• Targeted therapy — Targeted therapy uses medicine to identify and attack cancer cells. Targeted therapy typically leaves healthy cells alone.

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