Introduction
Immunotherapy or biological therapy is the treatment of a disease by activating or suppressing the immune system.
Definition
Immunotherapy is a type of cancer treatment that helps the immune system to fight cancer. The immune system helps the body to fight infections and other diseases.
Types
There are different types of immunotherapy agents.
| Types | Action |
| Immune checkpoint inhibitors. | Drugs that block immune checkpoint, these drugs allow immune cells to respond more strongly to cancer. |
| T-cell transfer therapy. | Boosts the natural ability of T cells to fight cancer, may also be called adoptive cell therapy, adoptive immunotherapy, or immune cell therapy. |
| Monoclonal antibodies. | Designed to bind to specific targets on cancer cells, may also be called therapeutic antibodies. |
| Treatment vaccines. | Treatment vaccines are different from the ones that help prevent disease. |
| Immune system modulators. | To enhance the body’s immune response against cancer. |
Indication
- Lung Cancer – Immunotherapy is effective for non-small cell lung cancer (NSCLC).
- Bladder Cancer – Used when chemotherapy is ineffective.
- Lymphoma & Leukemia – CAR-T cell therapy is a breakthrough treatment.
Drugs
PD-1 inhibitors – Nivolumab, pembrolizumab
PD-L1 inhibitors – Atezolizumab, durvalumab, avelumab
CTLA-4 inhibitors – Ipilimumab, nivolumab (melanoma only)
Administration – 2-4 weekly
Routes of Administration
- Intravenous (IV).
- Oral.
- Topical.
- Intravesical (into the bladder).
Complications
- Swelling.
- Weight gain from extra fluids.
- Heart palpitations.
- Diarrhea.
General Guidelines on Immune Therapy
- Ensure proper hand washing before performing the procedure.
- Use personnel protective equipment (gown, mask, caps, chemotherapy gloves/double gloves, goggles) and biological safety cabinet (laminar hood).
- The examinations required to be conducted prior to immunotherapy are history taking, physical examination, and blood investigations such as liver function, kidney function, anemia, fasting blood sugar, and blood tests of serum lipid profile followed by confirmatory diagnosis.
- Monitor for adverse reactions such as fever, chills, weakness, dizziness, nausea or vomiting, muscle or joint aches, fatigue, headache, shortness of breath, low or high blood pressure. Immediately report to the physician for withholding the therapy.
- Monitor the IV site for any signs of infection.
- Teach the patient about the complications of therapy
Documentation
- Document the date, time, number of cycles, duration of therapy, and condition of the patient before and after the procedure.
- Document if any side effects were experienced.
Special Considerations
- Monitor liver, kidney, and thyroid function before starting treatment.
- Encourage adequate fluid intake to support immune function.
- Immunotherapy is often given in cycles, requiring strict adherence to schedules.
- Watch for infusion reactions, including fever, chills, and hypotension.
- Patients should not receive live vaccines during treatment due to immune suppression.
- Monitor for skin rashes, colitis, pneumonitis, and endocrine dysfunction.
- Report severe diarrhea, breathing difficulties, or neurological changes immediately.
- Some effects may appear weeks or months after treatment ends.
- Patients should avoid excessive sun exposure and maintain a healthy diet.
- Offer counseling and support groups to help with emotional challenges.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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