Entering Immunotherapy: A Complete Guide for Hong Kong Patients
Understand immune mechanisms and manage side effects to make informed choices
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We have entered a new era of cancer treatment: immunotherapy. This approach harnesses the body’s own immune cells to identify and fight cancer, representing a major step forward beyond surgery, chemotherapy, radiotherapy, and targeted therapy. This guide explains the science behind immunotherapy, its benefits, limitations, and practical advice for Hong Kong patients considering or undergoing treatment.
1. How does the immune system detect and attack cancer cells?
Our immune system consists of innate immune cells (like macrophages) and adaptive immune cells (like T lymphocytes). Macrophages “present” antigens to T cells, which then patrol the body, identifying and destroying abnormal cells—including cancer. This process is known as immune surveillance.
2. How do cancer cells evade immune attack?
According to the immunoediting hypothesis, cancer cells evolve through three stages:
- Elimination: Immune cells recognize and destroy highly antigenic tumor cells.
- Equilibrium: A balance forms where some tumor cells persist but remain dormant.
- Escape: Mutated tumor cells evade detection and grow into clinically visible tumors.
3. Why can tumors become “invisible” to the immune system?
Within the tumor microenvironment, certain immune cells are hijacked—such as tumor-associated macrophages and regulatory T cells (Tregs). Instead of fighting cancer, they suppress active T cells. This immune suppression occurs through “brake molecules” like CTLA-4 and PD-1.
4. What are immune checkpoint inhibitors?
Checkpoint inhibitors are antibodies that block these brake signals (CTLA-4, PD-1, PD-L1). By “releasing the brakes,” they reactivate T cells, enabling them to attack cancer cells more effectively. This innovation has revolutionized immunotherapy.
5. What are the success stories—and why the Nobel Prize?
- CTLA-4 inhibitor (Ipilimumab) showed dramatic results in melanoma.
- PD-1 inhibitors (Pembrolizumab, Nivolumab) transformed treatment for lung cancer and other malignancies.
These breakthroughs led to James Allison and Tasuku Honjo receiving the 2018 Nobel Prize in Medicine, cementing immunotherapy as the “fourth pillar” of cancer treatment.
6. Why combine checkpoint inhibitors?
Clinical trials show that combining CTLA-4 and PD-1 inhibitors can improve outcomes (especially in melanoma). However, combination therapy also increases the risk of immune-related side effects.
7. What is CAR-T cell therapy?
CAR-T therapy involves genetically engineering a patient’s own T cells to recognize and target tumor antigens. It has shown remarkable success in leukemia and lymphoma, but remains challenging in solid tumors due to antigen variability and side effects like cytokine release syndrome (CRS).
8. Why isn’t immunotherapy effective for everyone?
Only 20–30% of patients respond. Effectiveness depends on factors such as:
- Tumor immune microenvironment
- Biomarkers (e.g., PD-L1 expression, MSI-H, TMB)
- Cancer type
Future strategies aim to better identify suitable patients through biomarker testing.
9. How are side effects managed?
Immune overactivation can cause immune-related adverse events (irAEs), such as:
- Skin rashes
- Colitis (diarrhea, bowel inflammation)
- Thyroid or adrenal dysfunction
- Pneumonitis (lung inflammation)
These require close monitoring. Severe cases may need immunotherapy paused and treated with steroids or immunosuppressants.
10. Practical advice for Hong Kong patients
- Boost immunity naturally: Sleep well, eat balanced nutrition, and maintain moderate exercise.
- Ask about biomarkers: Check whether your tumor expresses PD-L1 or other predictive markers.
- Stay informed: Understand expected benefits and possible side effects.
- Communicate with your team: Keep close contact with oncologists and nurses.
- Explore clinical trials: Hong Kong and regional hospitals often run trials offering new options.
- Integrative support: Nutrition, acupuncture, and psychological counseling can improve quality of life and treatment tolerance.
Conclusion
Immunotherapy is a groundbreaking cancer treatment, but it is not a miracle cure for all. For some, it delivers durable remission; for others, the benefit is limited. Success depends on cancer type, biomarkers, and immune environment. By combining medical guidance, lifestyle support, and patient education, Hong Kong patients can make informed choices and maximize the potential of immunotherapy.
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References
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- Journal of Experimental & Clinical Cancer Research. (2019). Combination of CTLA-4 and PD-1 blockers for treatment of cancer.
- Wired. (2018). Nobel Prize-winning treatment for cancer. Wired.
- Axios. (2018). Immunotherapy as the fourth pillar. Axios.
- Verywell Health. (2024). Lung cancer immunotherapy. Verywell Health.
- NCI. (2017). T-cell transfer therapy: CAR-T. Cancer.gov.
- GenRNA. (2025). Comparative analysis of immunotherapy vs. gene editing therapy. GenRNA.