Immunotherapy vs. Chemotherapy: Differences, Uses, Side Effects, and More

After a cancer diagnosis, several thoughts will likely run through your head. Alongside an understandable sense of worry about the path ahead, you may begin to question what the diagnosis may mean for your life, loved ones, and even personal finances.

There are a lot of steps to tackling and defeating cancer. Treating your cancer is typically the central focus of this effort. This may involve some combination of surgery, radiation therapy, and/or medications.

If your treatment includes medications, your cancer specialist may opt to give you chemotherapy or immunotherapy. Here, we’ll talk about immunotherapy versus chemotherapy medications — how they work, when they’re used, and who usually gets them.

Key differences between chemotherapy and immunotherapy

Hundreds of medications are considered to be immunotherapy or chemotherapy drugs. There are several types of immunotherapy medications, and there are even more chemotherapy medications. But how do they generally work?

Chemotherapy

When you think of cancer treatments, you probably think of chemotherapy. It’s also often called standard or traditional chemotherapy. This helps distinguish it from other cancer treatments, such as radiation therapy or targeted therapy. Chemotherapy medications aim to kill cancer cells that divide and spread quickly in the body.

Your cell cycle has a number of phases (stages). Each of these phases allows cells to develop or multiply. Chemotherapy medications target various phases of the cell cycle. They treat cancer by interfering with different parts of the cell cycle. This helps slow down a cancer’s growth and help make it go away.

Traditional chemotherapy medications aren’t specific to cancer cells, though. They can also affect healthy cells. This can lead to a number of side effects, many of them being potentially serious. This is discussed more later on.

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Immunotherapy

Immunotherapy is a newer type of cancer treatment. It helps make your immune system more effective at finding and killing cancer cells. Immunotherapy medications use various strategies to boost the immune system’s ability to fight cancer.

The way immunotherapy works is discussed in a previous GoodRx Health article.

Chemotherapy vs. immunotherapy: Which is more effective?

One isn’t better than the other. They can both be useful in different ways. They both aim to stop the spread of cancer. 

What are the side effects of chemotherapy and immunotherapy?

Although side effects slightly vary for every individual medication, chemotherapy and immunotherapy both have side effects that are frequently seen.

Common side effects of chemotherapy include:

• Nausea and vomiting 

• Diarrhea or constipation

• Tiredness

• Hair loss

• Skin problems, such as rashes

• Changes in your appetite 

• Sores in your mouth 

• Difficulty concentrating or focusing 

• Higher chance of getting an infection 

• Loss of red blood cells (anemia)

Common side effects of immunotherapy include:

• Flu-like symptoms, such as fever or chills

• Reactions near the injection site, such as pain, redness, or itching

• Inflammation, especially in your internal organs

• Diarrhea

• Stuffy nose

• Fast heartbeat

• Rash

• Fluid retention

• Higher chance of getting an infection

Talk to your cancer specialist to learn more about side effects that are possible with your specific medication(s).

Can chemotherapy and immunotherapy be used for all types of cancer?

Chemotherapy can treat, or attempt to treat, essentially all types of cancer. It may also be given to help lessen bothersome symptoms caused by cancer.

Immunotherapy treats most major types of cancer, too. The use of immunotherapy to treat cancer has grown over time, and it's now the standard of treatment for several cancers. As of November 2024, over 60 immunotherapy medications have been FDA approved for use.

Immunotherapy medications generally treat:

• Leukemia

• Lymphoma

• Multiple myeloma

• Cancers that involve solid organs in your body, such as your lungs, brain, or breasts

• Skin cancer

Researchers are continuing to study new immunotherapy treatments. Some existing immunotherapies are also being approved to be used earlier in treatment, including as first-choice options.

Can you receive chemotherapy and immunotherapy at the same time?

Yes, chemotherapy and immunotherapy can be given at the same time. But keep in mind that cancer treatment plans are unique for every person and cancer type. You may receive both, one or the other, or neither.

How are chemotherapy and immunotherapy administered?

The manner in which chemotherapy and immunotherapy medications are given to you can vary. They’re usually given at an infusion center, healthcare professional’s office, or hospital. Some can also be administered at home.

Regardless of location, chemotherapy medications can be given as:

• Intravenous (IV) infusions

• Oral medications

• Topical medications applied to the skin

• Injections under the skin

• Injections into the fluid that surrounds your spine

• Injections into an artery

• Injections into a muscle

• Injections into the bladder

Immunotherapy medications are often given as:

• IV infusions

• Oral medications

• Topical medications applied to the skin

• Injections into the bladder

If you’re planning on receiving medications to treat cancer, your cancer specialist will tell you how, when, and where you should receive your treatments.

Who is a good candidate for chemotherapy or immunotherapy?

Unsurprisingly, it depends. Many people with cancer are candidates to get chemotherapy and/or immunotherapy. The type of cancer you have and your health background both play essential roles. The type of cancer a medication is approved to treat is another big factor.

Your cancer specialist may also take some of these additional factors into consideration: 

• If you’re trying to cure or treat your cancer, both chemotherapy and immunotherapy may be prescribed.

• If you have an earlier-stage cancer that can be removed with surgery, chemotherapy is often given before or after surgery to help make the tumor smaller.

• A process called biomarker testing is becoming more common, especially for more advanced cancers. Many cancers have traits or features (biomarkers) that can help predict if certain treatments might be effective. If a biomarker test shows that your cancer might respond well to an immunotherapy medication, your cancer specialist may decide to give it to you.

• If your cancer is very far along, it’s possible that it can’t be controlled. In this case, your cancer specialist may give you chemotherapy to help manage bothersome symptoms caused by your cancer.

This isn’t a full list of considerations. Your cancer specialist will look at your full situation when deciding if you’d be a good candidate for chemotherapy, immunotherapy, or other forms of treatment.

Is immunotherapy a last-resort option?

Not necessarily. Different cancer treatment guidelines suggest that immunotherapy medications can be used in several situations. They might be preferred treatments up front, last-choice options, or somewhere in between.

For example, immunotherapy medications like pembrolizumab (Keytruda) and atezolizumab (Tecentriq) are often first-choice options for metastatic non-small cell lung cancers that have a high amount of PD-L1. PD-L1 is a protein that can be found on cancer cells. A biomarker test determines if you have high, low, or no PD-L1. They can be used alone or in combination with chemotherapy medications like carboplatin (Paraplatin) and pemetrexed (Alimta).

This isn’t always the case. There are times when immunotherapy medications are used if a first- or second-choice treatment didn’t work as well as intended.

For example, surgery is often an ideal way to treat certain types of melanoma, a form of skin cancer. But if cancer cells are still around after surgery, immunotherapy medications like pembrolizumab or nivolumab (Opdivo) might be recommended.

There are countless other situations where immunotherapy medications could be used. They could be used in situations like the ones described above, or they could be used only after other medications are unsuccessful. Depending on your cancer, medical history, and potential results of tests like biomarker tests, your cancer specialist can decide if immunotherapy is a viable option for you.

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Written by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Sonja Jacobsen, PharmD, BCPS, BCOP

Sonja Jacobsen, PharmD, BCPS, BCOP,  is a clinical oncology pharmacy specialist currently practicing in Seattle. She has been practicing as a pharmacist since 2015 and is licensed to practice in Washington state and North Carolina.

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