This newer mode of administration for immunotherapy comes with benefits and risks. It is important for a person to work with a doctor when making treatment decisions for upper gastrointestinal (GI) cancer.
Immunotherapy is a type of treatment that harnesses the power of the immune system to target cancer cells. Many new therapies have become available in recent years, some of which have changed the administration of these treatments.
With new ways to receive care, people with upper GI cancer have more options to find the treatment that works best for them based on their disease as well as personal preferences.
This article explores types of immunotherapy for upper GI cancer, how subcutaneous immunotherapy injections work, and considerations for when a doctor may add these types of therapies to a cancer treatment plan.
Traditionally, immunotherapy for upper GI cancer
- nivolumab (Opdivo)
- pembrolizumab (Keytruda)
- tislelizumab (Tevimbra)
However, in December 2024, the Food and Drug Administration (FDA)
- esophageal carcinoma
- gastric cancer
- gastroesophageal junction cancer
- esophageal adenocarcinoma
More subcutaneous injection treatment options for upper GI cancer may be available in the future.
Nivolumab belongs to a group of medications known as immune checkpoint inhibitors.
Immune checkpoint proteins are molecules expressed on the surface of cells that allow the immune system to recognize the tissues of the body as part of the “self.” As a result, interactions between these proteins prevent the immune system from attacking regular tissue cells.
Many cancer cells express high levels of these types of proteins on their surface. This allows them to evade detection from the immune system. Therefore, immune checkpoint inhibitors block the activity of these proteins to unleash the immune system against tumor cells.
In a clinical trial involving people with kidney cancer, subcutaneous nivolumab was found to exhibit the same degree of efficacy as IV nivolumab in terms of both response rate and duration of response. These results suggest subcutaneous immunotherapy may be a reasonable alternative for people who do not wish to continue or start IV treatment.
Among people who have tried both subcutaneous and IV nivolumab, most report a preference for the subcutaneous option.
This may be due to subcutaneous therapies offering a variety of potential benefits over IV therapies.
Improved comfort and convenience are a notable benefit. Compared with IV infusions — which must occur at an infusion center — a person can receive subcutaneous injections relatively easily at just about any clinic. This means that people who do not live near an infusion center may save time and money by getting treatment closer to home. Subcutaneous injections do not require a port like an IV, eliminating the risk for port-related complications such as infections.
Additionally, subcutaneous injections are much quicker than IV infusions. This may save some time in the clinic, although the healthcare team may also want to monitor people for some time after the injection.
It is not yet clear how the cost of subcutaneous injections will compare with IV infusions for upper GI cancer.
As with any medication, subcutaneous immunotherapy injections may cause some side effects. In the clinical trial of subcutaneous nivolumab, the most common adverse events were:
- anemia (low red blood cell counts)
- pruritus (itchiness)
- joint pain
- elevated creatinine (a measure of kidney function)
- cough
- diarrhea
- hyperglycemia (high blood sugar)
- hypothyroidism
- decreased appetite
- fatigue
These side effects also occurred in people who received IV nivolumab, meaning they were not unique to the subcutaneous formulation. However, some unique injection-site reactions may occur with the subcutaneous injection, such as:
- redness or discoloration
- itching
- pain
The choice to switch to or begin subcutaneous immunotherapy for upper GI cancer will depend on a variety of factors, including both the nature of a person’s disease and their individual preferences.
An oncologist can help determine whether an immune checkpoint inhibitor such as nivolumab is suitable for the treatment of a person’s cancer. They may consider factors such as:
- treatment history
- prior response to treatment, including how well a person has tolerated other medications
- PD-1 status — the immune checkpoint protein that nivolumab targets
- stage of cancer
If the oncologist recommends treatment with immunotherapy, they can discuss whether subcutaneous or IV therapy is the right choice. In addition to efficacy and safety, factors to consider may include:
- ease of access to an infusion center
- logistics of traveling for treatment — for example, whether someone requires child care or transportation
- whether other medications need IV infusion
- concerns or fears about needles
Additionally, some people may value the connections they have made during their infusion appointments and may prefer the face time they have with their healthcare team and others while receiving treatment.
Immunotherapy options for upper GI cancer are expanding rapidly, both in the types of medications available and the ways in which they can be administered.
An injectable subcutaneous version of nivolumab is now available for the treatment of certain upper GI cancers. The landscape of subcutaneous immunotherapies is also likely to grow in the coming years. Subcutaneous injections offer various benefits over IV infusions, including improved comfort, convenience, and ease of treatment.
However, there is no one-size-fits-all approach to cancer treatment. It is important for people to consider all aspects of their care before choosing the right option for them. Those considering subcutaneous immunotherapy injections can talk with their healthcare team to determine their suitability for this type of treatment.
