Immunotherapy in Israel

What is this?

What is immunotherapy

Immunotherapy is one of the modern approaches used in oncology, where the patient’s own immune system is involved in the process.

In practical terms, the goal is not always to destroy the tumor directly, but to help the immune system recognize it and start reacting.

In real clinical situations, the issue is usually not that the immune system “doesn’t work.”
More often, it simply does not identify the tumor as a threat.

How it works?

How immunotherapy works

Under normal conditions, the immune system constantly monitors the body.

It is capable of detecting infections, and in some cases — abnormal or tumor cells.

However, a tumor is not a foreign agent like a virus.
It develops from the body’s own cells and can effectively “hide” from immune surveillance.

As a result:

• the immune system may not detect it 
• or detects it but does not respond 
• or the response is insufficient 

Immunotherapy works through different mechanisms. Some treatments help the immune system recognize tumor cells again, while others enhance an existing immune response or direct it toward specific targets.

In clinical practice, this distinction matters, because different tumors escape immune control in different ways. Treatment is therefore selected based not on the name of the method, but on the biology of the specific tumor.

When is it used?

When immunotherapy is used

Immunotherapy in Israel is rarely used as a standalone treatment.

In most cases, it is considered:

• as part of combination therapy 
• in advanced stages of disease 
• in recurrent disease 
• when standard treatment options are no longer effective 

In certain situations, immunotherapy may be considered as a first-line treatment. However, this is not a universal approach.

The decision depends on the tumor type, its molecular characteristics, and how the disease behaves in a specific case. In practice, this is always an individual decision — there is no single scenario that applies to all patients.

Types

Types of immunotherapy

Immunotherapy is not a single treatment, but a group of different approaches.

• Checkpoint inhibitors

The most widely used group. These drugs block mechanisms that tumors use to suppress the immune response.

Examples include:

• PD-1 
• PD-L1 
• CTLA-4 

The introduction of these therapies significantly changed clinical practice in oncology and expanded treatment options in a number of diseases, especially where previous options were limited.

• Monoclonal antibodies

These drugs target specific molecules on the surface of tumor cells.

Depending on the mechanism, they may:

1. block tumor growth 
2. “mark” cancer cells for the immune system 
3. enhance the effect of other treatments 

• Cell-based therapies (including CAR-T)

One of the most complex and advanced approaches.

The concept involves:

1. collecting immune cells from the patient 
2. modifying them in a laboratory setting 
3. returning them back to the body 

After reinfusion, these cells are able to recognize and respond to tumor cells.

This approach is not used in all cancers. It is most commonly applied in hemato-oncology, where there is already substantial clinical experience and established outcomes.

• Cancer vaccines

Cancer vaccines represent a separate direction within immunotherapy.

Some of these approaches are still under investigation, while others are already used in clinical practice. One example is Sipuleucel-T, used in prostate cancer.

The goal is not direct tumor destruction, but activation of the patient’s immune system to recognize tumor-related antigens.

• Immune response modulators

These drugs affect the immune system more broadly rather than targeting a specific tumor.

Examples include interferons and interleukins.

They were used more frequently in the past, but their role has declined due to side effects and the emergence of more targeted therapies. In selected cases, however, they may still be considered.

What diseases is it used for?

In which cancers immunotherapy is used

Immunotherapy is now considered as part of treatment in a range of oncological diseases.
However, its role varies depending on tumor type, molecular profile, and disease stage.

• Non-small cell lung cancer

One of the key areas where immunotherapy has become standard.

Commonly used drugs include:

1. Pembrolizumab (Keytruda) 
2. Nivolumab (Opdivo) 
3. Atezolizumab (Tecentriq) 

These may be used alone or in combination with chemotherapy.

• Melanoma

One of the first cancers where immunotherapy demonstrated a significant clinical impact.

Used treatments:

1. Nivolumab (Opdivo) 
2. Pembrolizumab (Keytruda) 
3. Ipilimumab (Yervoy) 

Combination therapy (nivolumab + ipilimumab) is used in advanced stages.

• Kidney cancer

Immunotherapy is often combined with targeted therapy.

Examples:

1. Nivolumab + Ipilimumab 
2. Pembrolizumab + Axitinib 

• Bladder cancer

Used in advanced disease or after progression following chemotherapy.

1. Pembrolizumab 
2. Atezolizumab 
3. Nivolumab 

• Breast cancer (triple-negative)

Used in selected cases with specific biomarkers (e.g., PD-L1).

       – Pembrolizumab (in combination with chemotherapy) 

• Gastric and esophageal cancer

Used in advanced disease.

1. Nivolumab 
2. Pembrolizumab 

• Liver cancer (hepatocellular carcinoma)

Recent combinations include:

1. Atezolizumab + Bevacizumab 
2. Durvalumab 

• Cervical cancer

Used in recurrent or metastatic disease.

         – Pembrolizumab 

• Lymphomas (B-cell)

Includes both antibody-based and cellular approaches:

1. Rituximab 
2. CAR-T therapies (Kymriah, Tecartus) 

• Acute lymphoblastic leukemia (B-ALL)

Used in relapsed or refractory disease:

1. CAR-T therapy 
2. Blinatumomab 

• Multiple myeloma

Emerging CAR-T approaches:

1. Idecabtagene vicleucel 
2. Ciltacabtagene autoleucel 

• Prostate cancer

Limited use, but includes:

        – Sipuleucel-T (Provenge) 

• Head and neck cancers

Used in advanced disease:

1. Pembrolizumab 
2. Nivolumab 

👉 More details about specific drugs and treatment approaches are available in the dedicated section: Immunotherapy: main drug groups

What is important to understand

Despite its broad use, immunotherapy is not suitable for every patient.

The decision depends on:

1. tumor type 
2. molecular markers 
3. stage of disease 
4. previous treatments 

Treatment is always individualized.

Side effects

Side effects

The side effect profile of immunotherapy differs from chemotherapy and is related to its mechanism of action.

Rather than directly damaging rapidly dividing cells, immunotherapy activates the immune system, which may lead to an excessive immune response.

Possible effects include:

• fatigue 
• low-grade fever 
• skin reactions 
• inflammatory changes in different organs 

In some cases, immune-related adverse events may occur, affecting:

• lungs (pneumonitis) 
• intestines (colitis) 
• liver (hepatitis) 
• endocrine system (thyroid or adrenal dysfunction) 

Most side effects can be managed if identified early, which is why regular monitoring is essential.

Treatment decision

How treatment decisions are made

The decision to include immunotherapy in a treatment plan is made individually.

It is based on a comprehensive evaluation of:

• tumor type and stage 
• molecular characteristics (including PD-L1 expression) 
• overall condition 
• previous treatments 

In some cases, multiple treatment options exist, including combination approaches. The final choice depends on expected benefit, safety profile, and clinical context.

Immunotherapy and clinical trials

In certain clinical situations, participation in a clinical trial may be considered as an additional option, particularly when standard treatments are limited.

However, eligibility depends on strict criteria related to tumor type, stage, previous therapy, and overall condition. Therefore, this option is evaluated individually.

Oncology consultation

Oncology consultation in Israel

If immunotherapy is being considered, or if there are questions regarding treatment, it is reasonable to start with a consultation.

During the consultation:

• medical records are reviewed 
• the current clinical situation is assessed 
• possible treatment options are discussed 

📞 Phone: +972-73-374-6844
📧 Email: [email protected]
💬 WhatsApp: +972-52-337-3108

Important information

The information provided on this page is intended for general informational purposes only and does not constitute medical advice, diagnosis, or a substitute for a personal consultation with a qualified physician.

Tel Aviv Medical Clinic is not a pharmacy and does not supply or dispense medications. Information about drug-based treatments, including chemotherapy and immunotherapy, is presented for general understanding only.

All treatment decisions should be made by the treating physician, based on the patient’s individual medical condition.

If you have any medical questions or need guidance regarding treatment options, please consult your physician.

The medical team

Frequently Asked Questions

Frequently Asked Questions – Answered by Dr. Stefansky Irena