Survivor Story
Survivor Story
Tami Pream
Diagnosis: Peritoneal Mesothelioma, 2021
Immunotherapy vs. Chemotherapy
Table Of Contents
Chemotherapy and immunotherapy are both systemic treatments for cancer that work by distributing certain drugs throughout the body. When recommending immunotherapy vs. chemotherapy to treat mesothelioma, specialists consider the individual patient as well as the type and stage of the disease.
Written by Dr. Chelsea Alvarado | Edited By Walter Pacheco | Last Update: September 27, 2024
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Written by Dr. Chelsea Alvarado | Edited By Walter Pacheco | Last Update: September 27, 2024
How Do Chemotherapy and Immunotherapy Work?
Chemotherapy blocks a tumor’s ability to grow and spread. Immunotherapy boosts your body’s ability to kill cancer cells. Both therapies can affect the entire body (systemic therapy). Each treatment has a different way of attacking cancer cells.
Most chemotherapy drugs damage cancer cells as they divide and multiply. They prevent the synthesis of DNA and other molecules. These are vital for cell division and survival. Cancer cells grow and divide faster than most healthy cells. So, they’re an ideal target for chemotherapy drugs.
Immunotherapy drugs can help your immune system spot cancer cells. Cancer cells come from your own cells. So, your immune system doesn’t always recognize them as a threat. Boosting the immune system helps the body kill cancer cells.
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Connect NowChemotherapy and Immunotherapy Side Effects
Chemotherapy and immunotherapy have many of the same side effects. These include fatigue and flu-like symptoms. Drug interactions can make it hard to treat side effects. Some medications can reduce how well chemo and immunotherapy work.
Immunotherapy drugs usually have milder side effects. As part of the body’s immune response, inflammation, for example, can cause side effects. This can lead to symptoms such as fever and fatigue. These side effects are usually reversible.
Chemotherapy drugs target cells that divide rapidly. This includes cancer cells and some healthy cells, like hair cells, the lining of the gut and bone marrow. This is why some chemotherapy drugs cause hair loss, mouth sores and nausea.
Both treatments can have serious side effects. Chemotherapy can cause severe infections. It can cause long-term memory problems and “chemo brain,” or brain fog.” Immunotherapy can cause pneumonia, hepatitis, kidney issues and organ damage.
| Chemotherapy Side Effects | Immunotherapy Side Effects | Shared Side Effects |
|---|---|---|
| Cognitive problems | Abnormal blood pressure | Constipation |
| Hair loss | Dizziness | Diarrhea |
| Infections | Injection site reaction | Difficulty breathing |
| Low blood counts | Weakness | Fatigue |
| Nausea and vomiting | Fever and chills | |
| Headaches | ||
| Infection | ||
| Mouth sores | ||
| Pain | ||
| Nausea | ||
| Skin irritation | ||
| Weight loss |
When Side Effects Begin and How Long They Last
Side effects of both therapies usually begin soon after treatment starts. Sometimes, they can last for months or years after treatment. But they usually stop soon after treatment ends.
Chemotherapy side effects vary with different drugs. Immunotherapy side effects are often less predictable than those of chemo. Cancer treatments affect everyone differently. Peritoneal mesothelioma survivor Tami Pream told us she has not yet experienced side effects from chemo or immunotherapy. “It seems to be making somewhat of a difference in how I’m feeling,” she told us. Your doctor can explain the expected side effects and how to treat them.
Onset and duration of side effects
Is Chemotherapy or Immunotherapy More Effective for Treating Mesothelioma?
Trials compared checkpoint inhibitors with chemotherapy. Checkpoint inhibitors are a type of immunotherapy. They improved mesothelioma survival more than chemo did. The difference was significant.
Both chemo and immunotherapy are first-line treatments for advanced mesothelioma. This includes stage 2 or higher and inoperable stage 1. A combo of immunotherapy drugs Opdivo and Yervoy is often used.
Chemotherapy drugs are also often combined. Pemetrexed with either cisplatin or carboplatin is often given before surgery to remove a tumor. Doctors may treat peritoneal mesothelioma with surgery and heated chemo. HIPEC is a type of localized chemotherapy. It’s performed during surgery.
Dr. Jeffrey Velotta is a thoracic surgeon at Kaiser Permanente Oakland Medical Center. When we interviewed him about chemotherapy, he told us patients “live the longest” when they undergo surgery first, then chemotherapy followed with immunotherapy.
Who’s Eligible?
The main factors for chemo or immunotherapy eligibility are health and cancer type. Some therapies may not be suitable for those with heart problems or serious health issues.
Some cancers respond better to these therapies than others. This is also true for cancers with certain biomarkers.
Criteria for Chemotherapy and Immunotherapy
- Chemotherapy Eligibility: Your cancer type must be one that responds to chemotherapy. You must also be healthy enough for the therapy.
- Immunotherapy Eligibility: Your cancer type must be one that responds to immunotherapy. You must have a healthy immune system.
Underlying conditions can limit therapeutic options. For example, those with severe heart issues may not be eligible for chemo. A person with an autoimmune disease may not qualify for immunotherapy.
Benefits of Combined Immunotherapy and Chemotherapy Treatment
Research published in the journal Cancers shows that for some cancers, a combo of immunotherapy and chemo is better than either alone. If cancer recurs after using only one therapy, doctors may then use a mix of the two.
Key Trials Show Combined Therapy Benefits
- DREAM trial: Chemotherapy with cisplatin and pemetrexed plus immunotherapy with durvalumab was tested. Most patients survived progression-free after 6 months.
- IND227 trial: Chemotherapy with pemetrexed and either cisplatin or carboplatin plus immunotherapy with pembrolizumab was tested. This therapy was better than chemotherapy alone. It significantly improved survival and response rates.
- JME-001 trial: Chemotherapy with cisplatin and pemetrexed plus immunotherapy with nivolumab was tested. Most participants had a partial response to the treatment.
- PrE0505 trial: Chemotherapy with cisplatin and pemetrexed plus immunotherapy with durvalumab was tested.It worked better in people with certain gene mutations related to DNA repair.
The BEAT-meso and DREAM3R trials are testing new drug combos for mesothelioma. They use a mix of immunotherapy and chemotherapy.
Ongoing clinical trials offer access to the latest in cancer treatment. Discuss open trials with your mesothelioma doctor.
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Get a RecordingCommon Questions About Immunotherapy vs. Chemotherapy
- Is there a cost difference between immunotherapy and chemotherapy?
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The cost of immunotherapy vs. chemotherapy varies. It depends on the treatment length, cancer type and its stage. Chemotherapy is usually less expensive than immunotherapy. A 2020 study on non-small cell lung cancer found chemotherapy cost $147,801 and immunotherapy $202,202 in 2016.
Insurance doesn’t always cover all cancer treatment costs. Patient Advocates at The Mesothelioma Center can help you find financial aid.
- Are there differences in the length of treatment time?
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Chemotherapy and immunotherapy vary in how long they last. It depends on the cancer stage, type, and side effects. Immunotherapy for advanced pleural mesothelioma usually lasts 2 years. Chemotherapy for pleural mesothelioma usually lasts for 5 months.
- Is immunotherapy, chemotherapy or a combination recommended depending on mesothelioma type?
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Doctors use chemo or immunotherapy for epithelioid pleural mesothelioma. Immunotherapy is recommended for biphasic or sarcomatoid pleural mesothelioma. Chemotherapy is approved for peritoneal mesothelioma. Immunotherapy isn’t approved yet for this type.
- Does the recommended therapy depend on your mesothelioma stage?
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Yes, mesothelioma treatment depends on the stage. People with early-stage disease may be eligible for surgery with chemo and/or radiation. However, those with advanced disease often don’t qualify for surgery. The first-line treatment is systemic therapy.
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