Esophageal Cancer: Immunotherapy

Immunotherapy is the use of medicines to help your body’s immune system fight cancer. It’s also called biologic therapy. The medicines help boost your immune system in ways that help it find and kill cancer cells. It’s not the same as chemotherapy (chemo). Immunotherapy medicines work in different ways. They can cause different side effects.

When might immunotherapy be used for esophageal cancer?

Immunotherapy may be used for advanced esophageal cancer that can’t be treated with surgery, cancer that has spread, or cancer that comes back. It may be used on its own. Or it may be used along with other types of treatments like chem.

How is immunotherapy given for esophageal cancer?

The main type of medicine is called an immune checkpoint inhibitor. This type of medicine blocks proteins on cancer cells that stop them from being killed by the immune system. Checkpoint inhibitor medicine helps the immune system identify and attack cancer cells. There are different medicines that block different proteins. You may have medicine to block the protein CTLA-4. Or you may have medicine to block the proteins PD-1 and PD-L1. These medicines are given by IV (intravenous) infusion every few weeks.

What are possible side effects of immunotherapy?

Immunotherapy may have fewer or different side effects than chemo used for esophageal cancer. Side effects can vary for each person and depend on the medicine and dose you receive. Your healthcare team will work with you during treatment to manage any side effects you have. It is common to have more than 1 side effect. Side effects can include:

• Tiredness

• Cough

• Shortness of breath

• Chest pain

• Fever

• Muscle aches

• Skin rash, itching, and dryness

• Diarrhea

• Nausea or vomiting

• Inflammation of the liver (hepatitis)

Less often, you may have an infusion reaction, such as flushing, dizziness, and trouble breathing. Tell your healthcare team right away if you have any of these symptoms.

In rare cases, immunotherapy can cause the immune system to attack healthy tissues. This is called an autoimmune reaction. It can lead to side effects that affect various organs. Your healthcare team will tell you what signs and symptoms to look for. Report these to your team right away if you have them.

Report side effects to your healthcare team right away. If you have serious side effects, they may stop your treatment and give you corticosteroid medicine to suppress your immune system.

How to work with your healthcare team

• Learn your medicines. Write down the names of all your medicines. Ask your healthcare team how they work and what side effects they might cause.

• Ask what symptoms to watch for. Ask your healthcare team when to call them.

• Find out what number to call with questions or problems. Ask if there is a different number to call when the clinic is closed, such as on weekends or holidays.

• Keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to ask questions at appointments. You can work with your healthcare team on a plan to manage your side effects.

During your treatment

You are an important part of your own care team. During this time, make sure to:

• Talk with your healthcare team. Discuss any concerns, side effects, or changes in your condition right away with your team.

• Stick to your treatment schedule. Follow the treatment plan and don’t miss appointments.

• Practice self-care. Focus on your well-being by keeping a healthy lifestyle. Eat a balanced diet, and get regular exercise and rest.

• Ask for support. Reach out to friends, family, and support groups. Share your experiences and get emotional help during your treatment journey.