Immunotherapy Cancer Treatment in Singapore

Immunotherapy is a novel, precision form of cancer treatment that offers new hope to cancer patients. People commonly hear of surgery, chemotherapy and radiotherapy treatments for cancer. However, immunotherapy cancer treatment in Singapore may be unfamiliar to many of them (unless they themselves are cancer patients or is involved closely in the care of a cancer patient). Indeed, much research and development work is on-going on improving immunotherapy treatments.

What is Immunotherapy Cancer Treatment?

Immunotherapy is a cutting-edge treatment method for cancer that makes use of the body’s immune system to help fight against the cancer. It offers the possibility of more targeted management of cancers. This is made possible by our increased understanding of how cancer cells, healthy cells and immune systems interact.

The survival rates for cancer patients who respond to immunotherapy can be considerably higher than for those without immunotherapy treatment. The effectiveness of immunotherapy has made people considered it as a fourth pillar in cancer treatment, alongside surgery, chemotherapy and radiotherapy.

How Does it Work?

Our immune system protects us by eliminating abnormalities such as viruses in our bodies. Cancer cells, however, are able to hide themselves from the immune system, making them difficult for the immune system to destroy. Immunotherapy either boosts the body’s immune system to better help it fight the cancer, or make it easier for the immune system to recognise and destroy the cancer cells (or slow their growth). There are various forms of immunotherapy:

• Checkpoint Inhibitors – This form of treatment uses drugs that release “brakes” that otherwise prevent T-cells (a part of the immune system) from killing cancer cells. Checkpoint inhibitors do not attack cancer cells. Rather, they release the “brakes” on the immune system. Normally, the immune system is kept in balance by both “activating” and “inhibitory” signals. In cancer patients, checkpoint proteins expressed on cancer cells prevents immune cells from attacking the cancer cells. Checkpoint inhibitors block these proteins and frees the immune cells are free to destroy the cancer cells.
• CAR T-cell Therapy – This is a form of treatment in which a patient’s T-cells are attached (in a lab) with specific receptors that bind to their counterpart proteins on cancer cells. When the T-cells are introduced back into the body, these receptors then allow the immune cells to attack the cancer cells. CAR T-cell therapy can be associated with significant adverse reactions such as neurological toxicity and cytokine release syndrome. In Singapore, CAR T-cell therapy is currently approved for treatment of relapsed or refractory acute B-cell lymphoblastic leukemia in paediatrics and young adult patients, and for relapsed or refractory large B-cell lymphoma.

Other forms of Immunotherapy cancer treatments include:

• Cancer vaccines
• Monoclonal antibodies

How is Immunotherapy Administered?

Immunotherapy can be delivered in a number of ways –

• via injection,
• infusion through the veins, or
• delivered directly into the bladder.

Immunotherapy is often delivered in cycles over a period of time.

Is There A Catch?

There are a number of catches with immunotherapy. While the benefits of immunotherapy can be substantial to patients who respond to the treatment, it must be noted that only a fraction of patients respond to these treatments. On average, about 20% of patients respond to immunotherapy treatments, though the percentage will vary depending on treatment and type of cancer.

Immunotherapy treatment is also costly. Each dose may cost an average of S$9,000.

Side Effects from Immunotherapy Treatment

Side effects from immunotherapy typically arises when patient’s immune system attacks health cells as a result of the treatment. These sides effects can be managed effectively and most patients are able to take immunotherapy well.

Side effects experienced will vary depending on factors such as the patient’s health before treatment, the type and stage of cancer, and the of immunotherapy treatment given. Common side effects are skin reactions at the needle site (e.g. pain, swelling, soreness, rash). Patients may also experience flu-like symptoms (e.g. fever, chills, weakness, nausea, fatigue, etc). Other possible side effects include heart palpitations, sinus congestion, swelling and weight gain from fluid retention, diarrhoea, lung inflammation, liver inflammation and more.

A small proportion of patients (10-20%) may experience more severe side effects (e.g. severe allergic reactions), and the immunotherapy treatment would have to be stopped.

Immunotherapy Cancer Treatment in Singapore

Hospitals and cancer clinics in Singapore offer immunology treatments. A number of immunology drugs such as Opdivo® (nivolumab), Keytruda® (pembrolizumab), and Tecentriq® (atezolizumab) have been approved and included under MOH’s list of cancer drugs (as of 15 Aug 22) and may be eligible for MediShield / MediSave support.

Due to the high cost and novel nature of immunology treatment, patients should discuss with their doctors the pros / cons and expected costs for their specific cases.