At a glance
Immunotherapy is a cancer treatment that uses the body's own immune system to find and destroy cancer cells. Unlike chemotherapy, which attacks cells directly with toxic drugs, immunotherapy works by either boosting the immune system's natural ability to act or by giving it new tools, such as engineered proteins, to recognise tumours it would otherwise overlook.
Cancer cells often hide from the immune system by displaying signals that tell immune cells to stand down. Immunotherapy blocks those hiding signals, flags the cancer cells for attack, or delivers immune-activating substances directly to the tumour. The result is that the body's own defences do much of the work, sometimes producing responses that last long after treatment ends.
Medical Condition
Immunotherapy is used across a wide range of cancer types, most often when the tumour has spread, has come back after earlier treatment, or carries certain genetic features that make it likely to respond. The oncologist (cancer specialist) will look at the tumour's biology, the patient's overall health, and previous treatments before recommending it.
- Melanoma (a serious form of skin cancer), including cases that have spread to other organs
- Non-small-cell lung cancer, particularly tumours that express a protein called PD-L1
- Bladder and urinary tract cancers
- Kidney (renal cell) cancer
- Head and neck cancers caused by the HPV virus or with high PD-L1 expression
- Colorectal cancer with a specific genetic marker called MSI-H (high microsatellite instability, meaning the cancer's DNA repair system is faulty)
- Liver cancer (hepatocellular carcinoma), usually in combination with other drugs
- Certain lymphomas (cancers of the lymph system) and leukaemias (blood cancers)
- Triple-negative breast cancer (a subtype that lacks the three most common hormone receptors)
- Cervical and endometrial (uterine lining) cancers in selected cases
Immunotherapy is not suitable for every patient or every tumour. Some cancers have a biology that does not respond to currently available immune-based treatments. Your oncologist will usually run specific tests before deciding.
- Tumours that are PD-L1 negative and MSI-low (stable microsatellite status) often respond poorly to checkpoint inhibitors, the most common type of immunotherapy
- Patients with severe autoimmune diseases (conditions where the immune system already attacks the body, such as lupus or active rheumatoid arthritis) face a higher risk of serious side effects
- Patients who have had an organ transplant may not be candidates, because immunotherapy can trigger rejection of the transplanted organ
- Very poor overall physical condition (measured on a standard performance scale) may make the treatment too risky
Risks & Complications
Immunotherapy can cause side effects that are different from those of chemotherapy, because the activated immune system can also attack healthy tissues, a group of reactions doctors call immune-related adverse events (irAEs).
- Fatigue, the most commonly reported side effect across all types of immunotherapy
- Skin rash or itching, which can range from mild to severe
- Diarrhoea or colitis (inflammation of the large intestine), sometimes needing hospital treatment
- Pneumonitis (inflammation of the lung tissue), causing cough or breathlessness
- Thyroid problems, including an underactive or overactive thyroid gland, which may require lifelong hormone replacement
- Hepatitis (inflammation of the liver), detected through blood tests
- Adrenal insufficiency (the adrenal glands stop producing enough hormones), causing extreme tiredness and low blood pressure
- Arthritis-like joint pain and swelling
- Infusion reactions during or shortly after an intravenous (into the vein) dose, including fever, chills, or low blood pressure
- Rarely, severe inflammation of the heart muscle (myocarditis), kidneys, or nervous system, which can be life-threatening
Preparation & Procedure
Before immunotherapy begins, the care team runs a set of tests to confirm the cancer is likely to respond and to get a baseline picture of how the organs are functioning. This baseline matters because the same tests will be repeated during treatment to catch any immune-related organ damage early.
Blood tests typically include a full blood count, liver function tests, kidney function tests, and thyroid hormone levels. The team may also request imaging such as a CT scan or PET scan (a scan that shows metabolically active tissue), and in many cases a biopsy (a small tissue sample from the tumour) to test for PD-L1 protein expression or MSI status.
Fasting requirements depend on whether the immunotherapy is given as an intravenous infusion or as an oral tablet. Most intravenous infusions do not require fasting, but the team will confirm this. Patients on blood thinners or certain other medications may be asked to pause them; the oncologist or a nurse will give specific guidance based on the individual regimen.
Stopping smoking before treatment helps the lungs handle any treatment-related inflammation. Cutting back on alcohol is generally advised, because alcohol can stress the liver, which immunotherapy also sometimes affects.
The typical steps on the day of an intravenous immunotherapy session are listed below. The exact sequence and timing will vary by drug, hospital, and individual patient.
- Check-in and weight measurement, as dosing for some drugs is calculated by body weight
- A blood draw to check that organ function is safe enough to proceed
- Review of the results by the oncologist or nurse, who decides whether to go ahead with the session
- Placement of an intravenous line (a thin plastic tube inserted into a vein, usually in the arm)
- Pre-medication if needed, such as antihistamines or steroids to reduce the risk of an infusion reaction
- The immunotherapy drug is infused slowly over a period that typically ranges from 30 minutes to several hours, depending on the specific agent
- Monitoring for reactions during and for a period after the infusion
- Removal of the line and discharge, once the team is satisfied the patient is stable
Aftercare
Most patients receive immunotherapy as an outpatient, meaning they go home on the same day as each infusion. Recovery between cycles is usually more manageable than with chemotherapy, but the immune system remains active, so new side effects can appear weeks or even months after a dose.
- Blood tests and physical checks are scheduled regularly throughout the treatment course, usually before every cycle, to monitor organ function and catch immune-related problems early
- Any new symptom, particularly rash, breathing difficulty, diarrhoea, joint swelling, or unusual tiredness, should be reported to the care team promptly rather than waiting for the next scheduled visit
- The infusion site (usually the arm vein) is generally straightforward to care for; if a central venous catheter (a longer-term line placed in a larger vein) is used, the hospital will provide specific cleaning and dressing instructions
- Strenuous exercise is usually acceptable between cycles unless fatigue or other side effects make it unsafe; the oncology nurse can advise on what level of activity is appropriate
- Vaccinations with live vaccines (such as yellow fever or live flu vaccines) are avoided during treatment; inactivated vaccines may be used but timing is discussed with the oncologist
- Some immune-related side effects, particularly thyroid or adrenal problems, may need ongoing management with hormone replacement even after immunotherapy ends
- Follow-up imaging, usually CT or PET scans, is arranged at intervals decided by the oncologist to assess how the tumour is responding
- Mental health support is available at most oncology centres and is genuinely useful, because living on an active treatment cycle, with uncertainty about response, is stressful
Cost & What Determines It
Immunotherapy is among the most variable-cost treatments in oncology. The final bill depends on which specific drug or combination of drugs is used, how many cycles are needed, and whether serious side effects arise that require additional hospital care.
- Drug complexity and type: checkpoint inhibitors (such as anti-PD-1 or anti-CTLA-4 drugs), CAR-T cell therapy (a treatment where the patient's own immune cells are genetically modified and reinfused), and bispecific antibodies (engineered proteins that link immune cells to cancer cells) each sit at very different price points
- Number of treatment cycles: immunotherapy is often given for months or years, so the total cost compounds with each additional cycle
- Disease stage and tumour genetics: extensive testing for PD-L1 levels, MSI status, and tumour mutational burden (how many genetic mutations the tumour carries) adds to the diagnostic cost before treatment even starts
- Hospital class and country: the same drug costs significantly more at a private tertiary hospital than at an academic public centre, and prices differ substantially between countries
- Management of immune-related side effects: a serious episode of colitis, pneumonitis, or myocarditis can require hospitalisation, high-dose steroids, and specialist consultations that were not in the original estimate
- Combination regimens: immunotherapy is frequently combined with chemotherapy, targeted therapy, or another immunotherapy drug, and each added agent raises the cost
- Supportive medications: anti-nausea drugs, growth factors to support blood cell production, and hormone replacements for thyroid or adrenal side effects are often billed separately
- Imaging and laboratory monitoring: CT or PET scans every two to three cycles and frequent blood tests are necessary but add to the running total
A hospital package for immunotherapy typically covers the drug itself, the infusion room fee, nursing care during the session, and standard pre-infusion blood work. Items that are often billed separately include additional imaging, management of side effects that require admission, specialist consultations outside the oncology team, and any drugs taken at home between cycles.
Indonesian patients considering immunotherapy abroad should know that BPJS Kesehatan and most Indonesian private insurance policies do not cover treatment outside Indonesia. This means the full cost is typically paid out of pocket or through a private international health insurance plan that explicitly includes overseas oncology care. Before travelling, asking the treating hospital for a written cost estimate that covers at least the first few cycles, common side effect management, and required scans is the most reliable way to plan finances and avoid unexpected bills.
Frequently Asked Questions
How many sessions of immunotherapy will I need?
The number of sessions varies widely depending on your cancer type, stage, and how your body responds to treatment. Some patients receive treatment every two to four weeks for several months, while others continue for a year or longer. Your oncologist will reassess the plan regularly and adjust it based on how the cancer is responding.
What does immunotherapy feel like, and what are the side effects?
Many patients tolerate immunotherapy better than traditional chemotherapy, but side effects do occur because the treatment works by activating your immune system, which can sometimes affect healthy tissue as well. Common effects include fatigue, skin rash, joint aches, and flu-like symptoms. Less commonly, inflammation can develop in organs such as the lungs, hati (liver), or usus besar (large intestine), so your care team will monitor you closely throughout treatment.
How soon will immunotherapy start working?
It often takes several weeks to a few months before doctors can see a measurable response, because immunotherapy works gradually by training your immune system rather than attacking cancer cells directly. Some patients notice symptom improvement earlier, while others see a delayed response. Regular scans and blood tests are used to track how the treatment is progressing.
How much does immunotherapy cost?
The cost depends on several factors specific to your situation, including the type of immunotherapy drug used, how many treatment cycles are planned, the class of hospital or clinic, and whether additional tests or supportive care are needed alongside it. Because these factors combine differently for each patient, the only reliable way to know your number is to request a written cost estimate from the hospital based on your treatment plan.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
