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Immunotherapy is the use of medicines to help boost a person’s own immune system to find and destroy cancer cells more effectively. It typically works on specific proteins in the immune system to enhance the immune response. It has different (sometimes less severe) side effects than chemotherapy.

Some immunotherapy drugs, for example, monoclonal antibodies, work in more than one way to control cancer cells and may also be considered targeted drug therapy because they block a specific protein on the cancer cell to keep it from growing.

Immunotherapy is used to treat many kinds of cancer, but this type of drug has not been well studied for treating most kinds of nasal cavity and paranasal sinus cancers since they are so rare. Some immunotherapy drugs are used to treat melanomas in these areas. They are used for nasal cavity and paranasal sinus cancers based on information from studies done on more common head and neck cancer types.

Immune checkpoint inhibitors for nasal cavity or paranasal sinus cancers

An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses “checkpoint” proteins on immune cells that need to be turned on (or off) to start an immune response. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system.

Drugs that target these checkpoints (called checkpoint inhibitors) can be used to treat some people with nasal cavity and paranasal sinus cancer.

PD-1 inhibitors

Pembrolizumab (Keytruda) and nivolumab (Opdivo) are drugs that target PD-1, a protein on T cells in the immune system. PD-1 normally helps keep these cells from attacking other cells in the body. By blocking PD-1, these drugs boost the immune response against cancer cells. This can shrink some tumors or slow their growth.

Pembrolizumab is commonly used first in people with certain types of nasal cavity or paranasal sinus cancer that has returned after treatment or that has spread to other parts of the body. It can be used either alone or in combination with chemotherapy drugs, unless the patient is not a candidate for immunotherapy. Both nivolumab and pembrolizumab can be used when chemotherapy stops working.

Pembrolizumab is also an option as the first treatment in some people.

These immunotherapy drugs are given as intravenous (IV) infusions, typically every 3, 4, or 6 weeks.

Possible side effects of immune checkpoint inhibitors

Side effects of these drugs can include feeling tired, cough, nausea, diarrhea, skin rash, loss of appetite, constipation, joint pain, and itching.

Other, more serious side effects occur less often:

Infusion reactions: Some people might have an infusion reaction while getting these drugs. This is like an allergic reaction, and can include fever, chills, flushing of the face, rash, itchy skin, feeling dizzy, wheezing, and trouble breathing. It’s important to tell your doctor or nurse right away if you have any of these symptoms while getting these drugs.

Autoimmune reactions: These drugs work by basically removing one of the safeguards on the body’s immune system. Sometimes the immune system starts attacking other normal parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, skin, or other organs.

It’s very important to report any new side effects during or after treatment with any of these drugs to your health care team right away. If serious side effects do occur, your treatment might be stopped and you will be given high doses of corticosteroids to suppress your immune system.