Biotherapy

What is biotherapy?

Biotherapy, also called biological therapy, is treatment for cancer that uses living organisms, substances made from them, or lab-made versions of these substances, rather than the chemical drugs used in chemotherapy. It can act on cancer cells directly, or work indirectly by helping your immune system fight the cancer itself.

What conditions does it treat?

Biotherapy is used mainly in cancer care, including for:

• bladder cancer, using a treatment called BCG
• some blood cancers, such as hairy-cell leukaemia, chronic myeloid leukaemia, and some lymphomas
• melanoma and some kidney and gastrointestinal cancers
• some hormone-dependent cancers, including certain prostate and breast cancers
• preventing cervical and some other cancers linked to viral infection, through vaccination.

What are the benefits of having biotherapy?

Because many biotherapies are designed to target cancer cells specifically, rather than affecting all rapidly dividing cells in the way chemotherapy can, they may cause different or more limited side effects for some patients. Biotherapy can be used on its own or alongside other treatments such as chemotherapy, and some types are also used to help reduce the side effects of other cancer treatments, such as supporting bone marrow recovery after chemotherapy.

Are there different types of surgical approaches?

• Monoclonal antibodies: laboratory-made copies of natural proteins that lock onto specific targets on cancer cells, either triggering an immune response against them or delivering treatment directly to the cancer cells.
• Non-specific immune stimulators: boost your immune system generally rather than targeting one particular type of cancer cell; an example is BCG, used for bladder cancer.
• Cytokines: laboratory-made copies of proteins your body produces naturally to help regulate the immune system's response, including interferons and interleukins.
• Vaccines: can help prevent cancer-related infections, such as the HPV vaccine helping to prevent cervical cancer, or can be designed to strengthen your immune response to your own tumour cells.
• CAR T-cell therapy: some of your own immune cells are removed and altered in a laboratory so they can better recognise and destroy cancer cells, before being given back to you.
• Biotherapies that manipulate hormone receptions: work by changing hormone levels in the body or blocking their effects, used for cancers that depend on hormones to grow, such as some prostate and breast cancers.
• Adoptive cell therapy: cells are taken from the body, grown or treated in a laboratory, and then given back to help fight the cancer; this includes some types of stem cell transplant.
• Oncolytic virus therapy: an experimental approach using viruses that multiply inside cancer cells and destroy them while leaving healthy cells largely unharmed.

What happens before the treatment?

Preparation for biotherapy depends on which treatment you're having, since this varies so widely, from a vaccine or infusion given in an outpatient clinic to a treatment that needs a planned hospital admission. Your own care team will talk you through what to expect and how to prepare for your specific treatment.

What happens during the procedure?

How biotherapy is given depends on the specific treatment you're having:

• Many biotherapies are given by infusion into a vein or by injection.
• Some, such as BCG for bladder cancer, are given directly into the affected organ.
• A small number, such as high-dose interleukin therapy, are intensive enough that you need to be admitted to hospital while you have them.
• Vaccine-based biotherapies work by training your immune system to recognise cancer-related targets, rather than being a single procedure with steps in the way surgery is.

What does recovery look like?

Hospital care

Many biotherapies are given as outpatient treatments, with no hospital stay needed. Some, such as high-dose interleukin therapy, need a planned hospital admission because of how intensive the treatment is on your body, and in these cases you'll usually only be treated if you're otherwise young and fit.

At home

It's common to have some soreness, redness, swelling, or itchiness where the treatment was given, though this is usually mild. Other side effects vary a great deal depending on the specific biotherapy you've had, so your care team is the best source of guidance on what to expect and how to manage this at home.

What are the risks and complications?

Side effects vary widely depending on the specific biotherapy and dose used. They can include:

• Pain, swelling, soreness, redness, itchiness, or a rash where the treatment was given
• More general side effects that can be more severe for some types than others
• Skin problems such as folliculitis (inflamed hair follicles), seen in more than half of people having some targeted treatments, although these are generally well tolerated overall
• Reduced strength, muscle mass, and bone density with some hormone therapies
• Serious side effects, including a risk to life, with some intensive treatments such as high-dose interleukin therapy or stem cell transplants; these are only used in carefully selected patients under close hospital supervision.

Your care team will explain the specific risks of your particular treatment before you start, as these vary so much between different types of biotherapy.