Last Updated on December 2, 2025 by Bilal Hasdemir

Nearly 40% of patients with certain types of cancer can’t get immunotherapy. This is because of health issues or how their tumors are structured.

Immunotherapy is a game-changer in cancer treatment. But, it’s not for everyone. Some genetic changes, like MSI-high or dMMR, make tumors more likely to respond to it. Yet, other factors can make it unsafe or not work for some patients.

It’s key for doctors to know when immunotherapy is not a good choice. This helps them make the best decisions for their patients . Explaining the typical treatment protocol and listing the main Immunotherapy contraindications (reasons to avoid it).

Key Takeaways

• Immunotherapy is not recommended for patients with certain health conditions.
• Tumor characteristics, such as MSI-high or dMMR, can affect immunotherapy eligibility.
• Healthcare providers must carefully evaluate patients to determine if immunotherapy is suitable.
• Identifying poor candidates for immunotherapy can help prevent adverse reactions.
• Personalized medicine approaches can help tailor treatment to individual patient needs.

Understanding Immunotherapy and Its Limitations

Immunotherapy has changed cancer treatment a lot. It’s shown great promise in many cancers, giving hope to patients. But, it’s important to know how it works and its possible side effects.

What is Immunotherapy and How Does It Work?

Immunotherapy boosts the body’s fight against cancer cells. It uses immune checkpoint inhibitors, adoptive cell therapy, and immunomodulators. These methods help the immune system target cancer cells better. Yet, this stronger immune action can cause immune-related adverse events (irAEs), affecting various parts of the body.

The Growing Role of Immunotherapy in Cancer Treatment

Immunotherapy’s role in cancer treatment is growing fast. It’s now a key part of many cancer treatments, helping many patients. But, it’s not right for everyone because of possible risks and side effects, like immune-related toxicities. Knowing these risks helps doctors and patients manage treatment better.

Immunotherapy Contraindications: An Overview

Immunotherapy is a new way to fight cancer. But, it has its own set of risks. Doctors must think carefully about using it, considering both its benefits and dangers.

Absolute vs. Relative Contraindications

There are two types of contraindications for immunotherapy. Absolute contraindications are serious conditions that make treatment too risky. These include severe autoimmune diseases or major organ problems.

Relative contraindications are less severe but need extra care. This includes mild autoimmune diseases or some chronic infections.

Contraindication Type	Description	Examples
Absolute	Conditions that make immunotherapy unsafe	Severe autoimmune diseases, significant organ dysfunction
Relative	Conditions requiring caution or treatment adjustments	Mild autoimmune conditions, certain chronic infections

Risk-Benefit Assessment Process

Doctors carefully weigh the risks and benefits of immunotherapy. They look at the patient’s health, cancer type and stage, and possible side effects. This helps decide if the treatment is right for each person.

They check the patient’s medical history and current health. They also consider the cancer’s specifics. This way, doctors can choose the best treatment for each patient.

Autoimmune Diseases and Immunotherapy Risks

Immunotherapy is a new way to fight cancer but it’s risky for those with autoimmune diseases. It’s important to think about the good and bad sides of this treatment.

Pre-existing Autoimmune Conditions

People with autoimmune diseases face a bigger risk of autoimmune flares with immunotherapy. Diseases like rheumatoid arthritis, lupus, and multiple sclerosis can be hard to handle with this treatment.

Risk of Autoimmune Flares

Autoimmune flares are a big worry for those getting immunotherapy. These flares can be mild or very serious and might need extra treatment or even a hospital stay. Careful monitoring and quick action are key.

Autoimmune Condition	Risk Level	Management Strategy
Rheumatoid Arthritis	High	Close monitoring, medication adjustment
Lupus	Moderate to High	Regular assessment, immunosuppressive therapy
Multiple Sclerosis	High	Disease-modifying therapies, careful follow-up

Case-by-Case Evaluation Approach

A case-by-case evaluation is needed to see if immunotherapy is right for patients with autoimmune diseases. This way, doctors can balance the benefits and risks and create a treatment plan just for that person.

Knowing the risks of autoimmune diseases and immunotherapy helps doctors take better care of their patients. This can lead to better results for everyone.

Organ Dysfunction and Immunotherapy Concerns

Patients on immunotherapy often worry about organ problems. This means they need close watching and care. These issues can affect how well and safely the treatment works.

Liver Function Impairment

Liver problems are a big worry for those on immunotherapy. Checking liver enzymes is key to avoiding liver harm.

Monitoring Liver Enzymes During Treatment

Testing liver function regularly is important. It helps catch liver damage early. This way, doctors can act fast.

Kidney Disease Considerations

Kidney issues can make immunotherapy harder. Nephrotoxicity is a risk. People with kidney problems need extra attention and checks.

Pulmonary Complications

Pulmonary problems, like pneumonitis, can happen. It’s important to spot and treat these issues early.

• Regular monitoring of respiratory symptoms
• Imaging studies to assess lung condition
• Prompt intervention in case of pneumonitis or other pulmonary issues

Cardiovascular Risks and Heart Disease Concerns

Immunotherapy is changing how we fight cancer, but it also affects our hearts. The connection between immunotherapy and heart disease is complex. It involves many risk factors and possible problems.

Heart Disease as a Risk Factor

People with heart disease face higher risks of heart problems when they get immunotherapy. Those with heart conditions need a thorough check before starting treatment to avoid serious issues.

Beta-Blocker Interactions

Beta-blockers help manage heart issues but can affect immunotherapy. Doctors must decide if beta-blockers are needed in patients getting immunotherapy.

Monitoring Cardiac Function During Treatment

It’s important to keep an eye on the heart during immunotherapy. This helps catch and handle any heart problems early. Regular echocardiograms or other heart tests are key to keeping the heart safe.

Cardiovascular Risk Factor	Immunotherapy Consideration	Monitoring Recommendation
Pre-existing Heart Disease	Careful risk assessment	Regular cardiac function tests
Beta-Blocker Use	Potential interaction with immunotherapy	Adjust beta-blocker dosage as needed
Cardiac Function Impairment	Risk of cardiovascular complications	Frequent echocardiograms

Knowing the heart risks of immunotherapy helps doctors keep patients safe. By watching closely and managing treatment, they can make sure cancer treatment works well without harming the heart.

“The cardiovascular risks associated with immunotherapy underscore the need for a multidisciplinary approach to cancer treatment, involving cardiologists and oncologists working together to optimize patient outcomes.”

Immune-Related Toxicities and Side Effects

Immunotherapy is getting better, but we need to know more about its side effects. These can include severe allergic reactions and other immune-related issues. It’s important to manage these to keep treatment going.

Common Immune-Related Adverse Events

Common side effects are skin rash, diarrhea, and feeling very tired. These can usually be handled with basic care. But sometimes, they might need stronger treatments like corticosteroids. It’s vital to watch patients closely for these signs.

Severe Allergic Reactions

Severe allergic reactions, like anaphylaxis, are rare but very serious. They need quick action with epinephrine and other help. People at risk should be watched closely during treatment.

Managing Toxicity vs. Discontinuing Treatment

Deciding whether to keep treating or stop depends on the side effect’s severity. For mild to moderate issues, adjusting the dose or adding support might work. But severe cases might mean stopping treatment for good. Finding the right balance is important for the best results.

Poor Performance Status and End-of-Life Considerations

Checking a cancer patient’s performance status is key to knowing if immunotherapy is right. This status shows how well a patient can do daily tasks and their overall health.

Defining Performance Status in Cancer Patients

Doctors use scales like the Karnofsky Performance Status (KPS) or the Eastern Cooperative Oncology Group (ECOG) to measure it. These scales help doctors see how well a patient can handle treatments, like immunotherapy.

Limited Benefit in Advanced Disease

For those with advanced cancer and poor performance status, immunotherapy’s benefits are often small. The risks of treatment might be too high, making other options better. These might include focusing on managing symptoms and improving quality of life.

Quality of Life Considerations

Quality of life considerations are very important when choosing treatments for advanced cancer. Doctors must weigh the benefits of immunotherapy against its effects on the patient’s life. They aim to choose treatments that make patients comfortable and dignified.

In summary, it’s vital to think about a patient’s performance status and quality of life when deciding on immunotherapy. This is even more true for those with advanced disease.

Immunosuppression and Concurrent Medications

Immunosuppression can make it hard for immunotherapy to work well. The success of immunotherapy depends a lot on how well the patient’s immune system is working.

High-Dose Steroid Use

High-dose steroids weaken the immune system. This can make immunotherapy less effective. Patients on high-dose steroids might not get as good results from immunotherapy because of this.

Other Immunosuppressive Therapies

Other treatments can also affect immunotherapy. These include drugs for autoimmune diseases or to prevent transplant rejection. Careful management of these treatments is key when starting immunotherapy.

Medication Interactions and Conflicts

Medications taken together can cause problems with immunotherapy. Some drugs might make immunotherapy work better or worse. A detailed look at a patient’s medicines is important to avoid these issues.

Success in immunotherapy depends on managing immunosuppression and other medicines well. This means a thorough assessment of the patient’s health and medicines is needed.

• Careful evaluation of immunosuppressive status
• Adjustment of concurrent medications
• Monitoring for possible interactions

Biomarker Status and Predictive Factors

Biomarkers play a huge role in guiding treatment choices in immunotherapy. They help predict how well a patient will respond to treatment. This information is key for doctors to make the best decisions for their patients.

Lack of Appropriate Biomarkers

A big challenge in immunotherapy is the lack of good biomarkers for some patients. Without these biomarkers, it’s hard to know who will benefit most from immunotherapy. This makes choosing the right treatment tricky.

PD-L1 Expression and Response Rates

PD-L1 expression is a biomarker that helps predict how well some treatments will work. Patients with high PD-L1 levels often do better with PD-1/PD-L1 inhibitors.

Testing Methods and Interpretation

The testing methods for PD-L1 expression differ, and understanding the results can be tough. It’s important to make these tests consistent. This ensures the results are accurate and reliable.

Tumor Mutational Burden Considerations

Tumor mutational burden (TMB) is another important biomarker. It’s linked to how well a patient might respond to immunotherapy. High TMB is often seen in cancers that respond better to treatment.

Biomarker	Description	Clinical Significance
PD-L1 Expression	Measures the expression of PD-L1 on tumor cells	Predicts response to PD-1/PD-L1 inhibitors
Tumor Mutational Burden	Quantifies the number of mutations within a tumor	High TMB associated with improved response rates
Lack of Biomarkers	Absence or insufficient biomarkers for certain patients	Complicates treatment decisions

Treatment Adherence and Practical Challenges

Immunotherapy’s success depends on beating several challenges. Sticking to the treatment is key, but many practical issues can make it hard. These issues affect a patient’s ability to follow the treatment plan.

Frequency of Treatment Sessions

Immunotherapy needs a frequent treatment schedule. This can be tough for patients. Regular visits to healthcare facilities are hard, mainly for those with mobility issues or far from treatment centers.

This regular need can cause fatigue and decreased adherence over time.

Financial and Insurance Barriers

Financial constraints and insurance issues are big hurdles. The cost of immunotherapy is often too high for many. Insurance limits can make it hard to get the treatment needed.

Patients face out-of-pocket expenses and struggle with insurance claims.

Geographic and Access Limitations

Geographic limitations and access to care can also be a problem. Those living far from treatment centers face big challenges. They may have trouble getting to treatment due to lack of nearby centers or transportation issues.

Special Considerations for Allergy Immunotherapy

When giving allergy shots, doctors look at many things about the patient. This makes the treatment better for each person. It helps make the shots work well and keeps risks low.

Uncontrolled Asthma and Allergy Shots

People with uncontrolled asthma face more risks with allergy shots. Asthma getting worse is a big worry. It can cause serious problems. So, it’s key to control asthma first before starting shots.

Doctors check asthma control by looking at symptoms and lung tests. Managing asthma well lowers the risks of allergy shots.

Pregnancy and Allergy Immunotherapy

Pregnancy makes allergy shots more complicated. Shots can help, but starting them during pregnancy is usually not recommended. But, if a woman is already getting shots and gets pregnant, doctors will watch her closely.

Deciding to keep or stop shots during pregnancy depends on each case. It’s about finding the right balance for the mom and the baby.

Age-Related Considerations

Age matters when thinking about allergy shots. Kids as young as 5 can get shots, but it depends on their health and allergies. It’s a big decision.

For older adults, doctors look at other health issues and how medicines might mix. They weigh the good of shots against these risks to keep treatment safe and effective.

Conclusion

Immunotherapy has changed cancer treatment, bringing new hope to many. But, it’s important to know when it’s not safe. This includes autoimmune diseases, organ problems, heart risks, and poor health.

Before starting immunotherapy, doctors must weigh the benefits and risks. They look at the patient’s health history and current condition. They also consider the chance of side effects and the tumor’s characteristics.

Research is moving forward, making immunotherapy even better. By knowing when not to use it, doctors can make treatments safer and more effective. This helps patients live better lives.

FAQ

References

National Center for Biotechnology Information. Evidence-Based Medical Insight. Retrieved from https://pubmed.ncbi.nlm.nih.gov/39536465/

National Center for Biotechnology Information. Evidence-Based Medical Insight. Retrieved from https://pubmed.ncbi.nlm.nih.gov/39536465/

National Center for Biotechnology Information. Evidence-Based Medical Insight. Retrieved from https://pubmed.ncbi.nlm.nih.gov/39536465/