Immunotherapy and targeted therapy

There are many types of monoclonal antibodies. Some are targeted therapies that attach to specific proteins on cancer or nearby cells. By blocking these proteins, they can slow or stop the growth of cancer. Other monoclonal antibodies are called immunotherapy. They work by attaching to specific cancer cell proteins to tell your immune system to destroy those cells. They also slow down cancer cell growth. 

Monoclonal antibodies may be given to people not suited to some chemotherapy. They can also be given in combination with chemotherapy or other targeted therapies. Generally, they are given intravenously (IV), but some are subcutaneous (injection under the skin). 

Monoclonal anti-CD20 antibody

Rituximab and obinutuzumab are examples of monoclonal antibodies that target CD20. CD20 is a protein found on the surface of B cells, including some blood cancers. When the protein is present, it is called CD20 positive. The monoclonal anti-CD20 antibody connects to this protein on the blood cancer cell. It destroys the cell by damaging the antibody. 

It can be used to treat non Hodgkin lymphoma (NHL), chronic lymphocytic leukaemia (CLL). 

Monoclonal anti-CD19 antibody

An example of a monoclonal anti-CD19 antibody is blinatumomab.

This antibody: 

• targets the CD19 protein found on some leukaemic cells so the immune system can destroy them
• is used to treat acute lymphoblastic leukaemia (ALL). 

Monoclonal anti-CD22 antibody

Inotuzumab ozogamcin is an example of a monoclonal anti-CD22 antibody. 

This antibody:

• targets the protein CD22 and delivers a drug directly to the cancer cell to destroy it
• is used to treat acute lymphoblastic leukaemia (ALL). 

Monoclonal anti-CD30 antibody

An example of a monoclonal anti-CD30 antibody is brentuximab.

This antibody:

• targets a protein called CD30, sticks to it and delivers a drug to the cell to destroy it
• is used to treat Hodgkin lymphoma and some lymphomas.

Monoclonal anti-CD38 antibody

Daratumumab is an example of a monoclonal anti-CD38 antibody.

This antibody:

• targets the CD38 protein on myeloma cells so the immune system recognises it and destroys the cell
• is used to treat myeloma.

Monoclonal anti-SLAMF7 antibody

An example of a monoclonal anti-SLAMF7 antibody is elotuzumab.

This antibody:

• targets a protein on myeloma cells called SLAMF7 to enhance immune system activity to destroy the myeloma cell
• is used to treat myeloma.

Bispecific T-cell Engagers (BiTEs)

Blinatumomab is a type of bispecific T-cell engager (BiTE). It uses two monoclonal antibodies that can attach to two different targets at the same time. One antibody sticks to cancer cells, and the other sticks to immune cells. This brings the two cells together so the immune system can destroy the cancer cells. 

It is used to treat acute lymphoblastic leukaemia (ALL). 

Side effects from monoclonal antibodies are different from chemo side effects. If you’re having more than one type of drug, you may have a few different side effects at varied times. Your treatment team will talk to you about what you might expect. 

Immune system modulators work by: 

• stimulating the immune system to attack and destroy cancer cells 
• directly destroying and stopping the growth of cancer cells 
• blocking growth of new blood vessels that supply cancer cells. 

Some examples of immune system modulators are thalidomide, lenalidomide and pomalidomide. They are used to treat myeloma, chronic myeloid leukaemia (CML), myelodysplatic neoplasms (MDS), myelofibrosis and are given as oral tablets.

CAR T-cell therapy is a treatment that re-engineers a patient’s T cells with synthetic proteins. These proteins are called chimeric antigen receptors (CARs). CARs help T cells attach to specific proteins so they can recognise and destroy cancer cells. 

Read more about CAR T-cell therapy on our webpage.

Cancer growth inhibitors are a type of targeted therapy. They block the signals that cancer cells need to grow and survive, helping to slow or stop cancer growth. 

B-cell leukaemia/lymphoma-2 (BCL2) inhibitors 

An example of a BCL2 inhibitor is venetoclax. It is used to treat chronic lymphocytic leukaemia (CLL) and acute myeloid leukaemia (AML). BCL2 is a protein that some cancer cells make. BCL2 inhibitors block this protein so the cancer cell dies. It is given as an oral tablet. 

Bruton’s tyrosine kinase inhibitors (BTKi’s) 

Ibrutinib, acalabrutinib and zanubrutinib are examples of BTKi’s used to treat chronic lymphocytic leukaemia (CLL), and some lymphomas. BTK is essential to the growth of B cells. BTKi’s block the B cell receptor on cancer cells causing cell death. They are given as oral tablets. 

Phosphoinositide 3-kinase (PI3K) inhibitors 

Idelalisib is an example of a PI3K inhibitor which is used to treat chronic lymphocytic leukaemia (CLL) and some lymphomas. Phosphoinositide 3-kinase is a protein important to the growth and survival of cells. PI3K inhibitors block the PI3K protein in some cancer cells and slow down growth. They are given as oral tablets and must be taken as prescribed.  

Tyrosine kinase inhibitors (TKIs) 

Imatinib, nilotimib, dasatinib, asciminib, ponatinib, gilteritinib and ruxolitinib are exmaples of TKI’s. They are used to treat chronic myeloid leukaemia (CML), acute lymphoblastic leukaemia (ALL), acute myeloid leukaemia (AML), and myelofibrosis. 

TKIs work in different ways to stop cancer cells from growing. They are taken as tablets and should be taken exactly as prescribed. Your doctor will check how well the treatment is working and if you have any side effects. If the TKI is causing problems or is not working well enough, your doctor may switch you to a different type of TKI. 

There are some foods and drugs that you should avoid if you’re taking a TKI. Your pharmacist will advise you. This may include grapefruit, Seville oranges, pomegranate, star fruit, licorice and St John’s Wort. They may also advise you to limit paracetamol. 

There are many types of monoclonal antibodies which can be referred to as a targeted therapy or an immunotherapy. For further information on monoclonal antibodies refer to the types of immunotherapy section above.

Bortezomib, ixazomib,carfilzomib are examples of proteasome inhibitors. They are used to treat myeloma.  

Proteasomes break down unwanted proteins in cells. Cells need proteasomes to grow and work properly. Proteasome inhibitors block proteasomes, causing proteins to build up inside the cell. This can cause cancer cells to die. Proteasome inhibitors can be given as an injection under the skin, through a drip into a vein (IV), or as tablets.

Immunotherapy can cause inflammation to the heart muscles. Symptoms can also affect your lungs. They can include: 

• chest pain 
• palpations 
• irregular heartbeat 
• unexplained swollen feet or legs 
• breathlessness 
• unexplained fatigue. 

Your thyroid gland and hormones are part of your endocrine system. Immunotherapy can cause hypothyroidism or hyperthyroidism. Hypothyroidism means your thyroid is not producing enough thyroid hormones. Hyperthyroidism means your thyroid produces too much thyroid hormone. 

Symptoms of hypothyroidism include: 

• unexplained fatigue 
• feeling weak 
• being unable to tolerate the cold 
• constipation. 

Symptoms of hyperthyroidism include: 

• being unable to tolerate the heat 
• heart palpitations 
• restlessness and anxiety 
• diarrhoea 
• tremors 
• increased sweating. 

The digestive system includes your mouth, oesophagus, stomach, and bowel. If you have inflammation of this system, you might experience: 

• watery diarrhoea 
• going to the toilet more frequently, especially at night 
• blood or mucous in your poo 
• dark or sticky poo 
• stomach cramping or pain 
• unexplained fever 
• nausea and vomiting.

There is a small risk of developing autoimmune blood disorders when you are having immunotherapy. 

Symptoms you might notice include: 

• unexplained fatigue 
• pale skin 
• red spotty rash (petechiae) 
• easy bleeding and bruising 
• unexplained fever 
• changes to your full blood count including red cells, white cells and platelets.

If you have inflammation of your liver, you might experience: 

• yellowing of your skin and the whites of your eyes (jaundice) 
• pain on the right side of your abdomen 
• drowsiness 
• dark coloured urine 
• bleeding or bruising more easily 
• loss of interest in food (anorexia) 
• changes to your liver blood test results.

If you have inflammation of this system, you might experience: 

• joint pain or swelling 

• morning stiffness, or stiffness after sitting for a while. 

Inflammation of the brain, spinal cord, and nerves is rare but could lead to neurological disorders such as Guillain-Barré syndrome and meningitis.  

Symptoms of neurological toxicity include: 

• unexplained weakness 
• headaches 
• balance problems 
• double vision 
• trouble concentrating.

Inflammation of the eye is rare but can lead to sight loss if left untreated. If you have inflammation of the eye, you might experience: 

• persistent dry eye 
• pain in the eye 
• eyes that are sensitive to light 
• weeping and red eyes (conjunctivitis) 
• double vision 
• droopy eyelids.

Symptoms of lung inflammation include: 

• breathlessness 
• new cough, or one that is getting worse 
• discoloured lips 
• racing heart 
• chest pain 
• unexplained fever.

If you have inflammation of this system, you might experience: 

• passing small amounts of urine 
• blood in your urine 
• loss of interest in food (anorexia) 
• dark coloured urine 
• pain in your abdomen 
• nausea and vomiting 
• confusion or drowsiness.

Your skin is your largest organ. Inflammation of the skin is more common than other systems. Symptoms can include: 

• rash 
• new skin blisters or lesions 
• hand and foot syndrome 
• patches of discoloured skin (pigmentation) 
• itchy rash.