Targeted Therapy vs Immunotherapy: What’s the Difference in Cancer Treatment?

Cancer treatment has come a long way since the days of just chemotherapy. Today, many people are hearing about targeted therapy and immunotherapy, which are smarter, more precise ways to treat cancer. But what do these terms really mean? How do they differ? 

To help untangle these ideas, Dr Vasudha N. Rao, Consultant Pediatric Hemato-Oncologist & BMT Physician at Rainbow Children’s Hospital in Bengaluru, explains how these treatments work and why they are changing the face of cancer care.

How Cancer Treatment Has Changed Over Time

Dr Rao reminds us that until the 1950s, scientists knew very little about what actually caused cancer. But a major breakthrough came with the discovery of the Philadelphia chromosome, a genetic change called BCR-ABL in some leukaemia patients. According to her, “When the Philadelphia chromosome was found, it opened a debate: the common thread between all of these cancers was genetic missteps.”

She adds that by the 1990s, this insight led to the development of Imatinib (Gleevec), the first drug to target cancer cells with that exact mutation. That was a turning point. It proved we could design drugs that attack cancer while sparing healthy cells.

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What Is Targeted Therapy?

Targeted therapy is about precision. Instead of a blanket attack, it zeroes in on specific molecular faults inside cancer cells and things they need to grow. Dr Rao explains, “Targeted therapies inhibit some specific molecule or pathway that cancer cells depend upon for proliferation.”

In simpler terms: these drugs block the “wiring” that cancer relies on. That means fewer collateral damages and healthy cells are largely spared. Side effects may still occur, but they often differ and may be milder compared to traditional chemotherapy.

What Is Immunotherapy?

Immunotherapy is a completely different strategy as it empowers the body’s own defence system. Instead of attacking cancer directly, it helps our immune system recognise and destroy tumour cells. Dr Rao puts it like this, “Immunotherapy helps the body’s own defence systems to recognise and kill the cancer cells.”

A landmark moment in this field came in 2018, when Dr James Allison won the Nobel Prize for his work on immune checkpoint inhibitors and drugs that “unlock” the immune system so it can better fight cancer.

Pros and Challenges: A Balanced View

Here’s how targeted therapy and immunotherapy compare, according to Dr. Rao:

Targeted Therapy

• Very precise and tackles cancer’s specific weak points
• Less likely to harm nearby healthy tissue
• Often works quickly

Challenges

• Cancer can become resistant (mutations change)
• Only works if a specific target is identified in the cancer

Immunotherapy

• Long-lasting impact by training the immune system, once it’s on alert, it may keep fighting 
• Can lead to durable remissions or long-term survival in some cancers

Challenges

• Not all cancers respond
• Immune side effects can be serious (inflammation, autoimmune reactions)
• More costly and not equally accessible everywhere

A study of metastatic clear-cell renal cell carcinoma compared first-line targeted therapy, immunotherapy, and their combination. It found that patients receiving immunotherapy or a combination lived significantly longer than those on only targeted therapy. This supports the idea that immunotherapy, alone or paired with targeted treatment, can offer real survival benefits outside of clinical trials.

What About Children?

Dr Rao highlights that while these therapies are making big strides in adult cancers, pediatric cancer care faces unique challenges:

• Childhood cancers are biologically different, with fewer targetable genetic mutations.
• That means fewer drugs are available for kids based on targeted therapy.
• Long-term effects are a big concern: treating children with these newer medications means we need many years of follow-up to understand their impact.
• Access and cost are major barriers. Many families in lower- and middle-income countries may not afford these cutting-edge treatments.

Still, she remains hopeful, “There is hope as we are increasingly using targeted therapies and immunotherapy in leukaemias, low-grade gliomas certain lymphomas. These treatment modalities are already changing the face of difficult-to-treat childhood cancers.”

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Conclusion

Targeted therapy and immunotherapy are revolutionising cancer care by focusing on precision, safety, and long-term outcomes. As Dr Vasudha Rao explains, these treatments are not about stronger weapons as they’re about smarter ones. While both have challenges, their combined promise gives real hope. For many patients, and especially children, the future of cancer treatment looks more personalised, effective, and less traumatic.