ENImmunotherapy in Germany is not one new cancer drug but a group of treatments that do not attack the tumour directly: they take the brakes off the patient’s own immune system or arm it against cancer cells. This page covers anti-cancer treatment, not the allergen immunotherapy of the same name.
It explains which forms German hospitals use, who is eligible and which tests decide, how the infusions run, what the side effects look like and where to read about a specific tumour. One rule comes first: eligibility follows biomarkers and approved indications, not the patient’s preference.
How it works: the brakes on the immune system
Immunotherapy relies on the body’s own defences: immune cells, above all T cells, recognise and destroy altered cells. A tumour, however, learns to display signals that say “I belong here”, and the T cells pass it by. Such signals normally keep the immune response in check so that it spares healthy tissue.
The points where these signals act are called immune checkpoints. Picture a handshake: PD-1 is a “hand” on the T cell, PD-L1 the matching “hand” on the tumour cell, and after the handshake the T cell lowers its weapon. CTLA-4 is another brake on T cells that acts earlier, in the lymph nodes. Checkpoint inhibitors block the handshake or release the brake, so that the immune system, not the drug, fights the tumour, as the cancer information service of the German Cancer Research Center explains.
Two practical consequences follow. The response does not arrive at once: a tumour may shrink slowly, over months. And the side effects look nothing like those of chemotherapy but like inflammation in various organs, because an immune system freed from its brakes can also turn on healthy tissue.
Cancer immunotherapy in Germany: the forms in use
Cancer immunotherapy in Germany mostly means checkpoint inhibitors, the broadest group. They are used in melanoma, lung, bladder and kidney cancer, in some head and neck tumours and in bowel cancers with a particular molecular profile. They are given alone, in pairs or with chemotherapy.
Cell therapy is the second route. In CAR-T therapy the patient’s T cells are collected, given an artificial receptor in the laboratory that recognises a protein on tumour cells, and infused back. So far it is used mainly for certain leukaemias, lymphomas and myeloma. In Germany only specialised centres with intensive care close by provide it, as severe reactions can follow and patients stay under observation; see CAR-T cell therapy in Germany.
Antibodies are the third group. Bispecific antibodies act as an adapter, linking a tumour cell to a killer immune cell; some are approved for leukaemia, lymphoma or lung cancer. Other antibodies mark a specific target on the tumour for the immune system, such as the antibody against the ganglioside GD2 in paediatric oncology, a substance abundant on neuroblastoma cells and scarce on normal ones.
Some approaches are still research. Therapeutic cancer vaccines based on mRNA, proteins or dendritic cells are mostly still being studied, and none is approved in Germany. TIL therapy, in which lymphocytes that have entered the tumour are removed at surgery, multiplied and infused back, is not approved in the EU either: the company withdrew its application for such a product in 2025. Both are used in clinical trials rather than routine care. None of the following is proven immunotherapy or a substitute for it:
- products sold to “strengthen the immune system”, such as herbal remedies and vitamins, for which sound data on benefit and risks in cancer are usually lacking;
- vaccines and dendritic cell preparations sold outside a clinical trial;
- any unapproved “immune” course offered instead of indicated treatment: experts advise using such agents only within controlled trials.
Who is eligible: biomarkers instead of guesswork
Eligibility is decided by biomarkers measured in the tumour tissue. The best known is PD-L1: a tumour section is stained with antibodies and the stained cells counted (see tumour immunohistochemistry). The result is a TPS, the share of tumour cells carrying PD-L1, or a CPS, which also counts nearby immune cells. Thresholds differ by tumour and drug: one lung cancer regimen uses the TPS, head and neck tumours the CPS, so “PD-L1 positive” alone is not an indication.
The second key feature is microsatellite instability (MSI-H), the result of a defect in DNA mismatch repair (dMMR): mutations pile up in the tumour, and with them altered proteins the immune system can recognise. The feature occurs in tumours of many organs and makes them sensitive to checkpoint inhibitors regardless of site, although EU approvals cover specific cancers, such as bowel, endometrial and stomach cancer. Tumour mutational burden (TMB), the total number of mutations, also matters: a high burden is linked to better results in many cancers, but the cut-off varies by tumour type.
The tests are run on the paraffin blocks and slides from a biopsy or operation, so German pathologists ask for the blocks and slides themselves, not just the report. The tumour board discusses the results; for advanced or rare tumours a molecular tumour board (Molekulares Tumorboard) reviews the case. The board’s written recommendation settles whether an indication exists; the treating doctor agrees the plan with the patient.
How the treatment runs
Immunotherapy is usually an intravenous infusion in a day clinic, so immunotherapy treatment in Germany is rarely a matter of staying on a ward. Depending on the drug, infusions are given, for example, every two, three or six weeks and take half an hour to an hour; some drugs also come as an injection under the skin that lasts a few minutes.
Blood tests before the start and regularly during treatment check thyroid, liver and kidney function. After several cycles, CT or MRI shows the response. A deposit may first look larger: this can be pseudoprogression, when immune cells moving into the tumour cause inflammation rather than growth. One such scan does not mean failure; growth is confirmed or ruled out by a repeat scan a few weeks later.
Duration depends on response, tolerance and the timeframes in the protocol. In advanced disease the drug is usually continued while it helps and side effects stay acceptable, for some patients a year or more. After surgery, when the aim is to lower the risk of recurrence, the course is limited in advance, for example up to one year. No result can be promised: only some patients respond.
Side effects and how they are watched
The side effects differ in nature from those of chemotherapy: an immune system freed from its brakes also attacks healthy tissue. Most often affected are the skin (rash, itching), the bowel (diarrhoea, colitis) and the thyroid, which may become over- or underactive; the liver and the lungs less often. Reactions usually appear in the first weeks and months but can come later.
Report every new complaint to the department at once, even a minor-sounding one: diarrhoea, a cough, a rash or heavy fatigue are reasons for an urgent appointment, not for waiting until the next visit. Mild reactions often allow treatment to continue under close watch; with more marked ones it is paused and corticosteroids, hormones that damp down inflammation, are started; severe reactions may end it altogether.
Before going home the patient should have a report naming the drug, doses and infusion dates, the department’s direct contact and a patient card, which tells doctors at any local hospital about the immunotherapy and its possible reactions. At home a local oncologist usually monitors the blood tests on the schedule from the German report and contacts the department if results change.
Tumours with their own pages
Separate pages cover the tumours in which immunotherapy is used most: melanoma immunotherapy, lung cancer immunotherapy and bladder cancer immunotherapy. It is also used in kidney cancer and in bowel cancers with microsatellite instability. In prostate cancer it is not yet standard: advanced disease is treated mainly with hormone therapy, chemotherapy, targeted drugs and radionuclide therapy. Indications and drugs differ by tumour; the general page does not replace them.
The cost of a course depends on the drug, the dose and the number of infusions: some drugs have a fixed dose, others are dosed by body weight. The calculation, with the number of infusions, is on the page immunotherapy cost in Germany.
Frequently asked questions
How is immunotherapy different from chemotherapy?
Chemotherapy itself damages rapidly dividing cells, including cancer cells, while immunotherapy works through the immune system, releasing its brakes or steering it at the tumour. Their side effects and speed of action therefore differ. They are not mutually exclusive: for several cancers checkpoint inhibitors are approved together with chemotherapy, small cell lung cancer among them.
Does immunotherapy work for every patient?
No. Even with suitable biomarkers only some patients respond, and this cannot be predicted reliably. A response may last a long time in some people, but in far advanced disease a complete cure is generally not expected. The effect is checked on follow-up scans, and treatment is changed if there is no response or reactions are too severe.
Can I get immunotherapy in Germany at my own request?
Not as a rule. Immunotherapy is prescribed for approved indications, when the drug is authorised for that tumour and stage and the tissue tests support it; a request alone is not enough. If no approved indication fits, the tumour board may suggest a clinical trial, where new drugs are given under medical supervision.
Do I have to stay in Germany for the whole course of immunotherapy?
Not always. The infusions are usually outpatient. Some patients travel in for each infusion; others continue at home after the first cycles if the drug is available there and a local oncologist will follow the German protocol. This is agreed with the department in advance; in the first months, when side effects are most likely, staying near the clinic is sensible.
How AlenMed arranges treatment
The work starts with documents: discharge summaries, the histology report, slides and paraffin blocks for re-reading and molecular tests, DICOM imaging and a list of earlier treatment. We translate them, pass them to the hospital’s oncologists, obtain a written answer on whether an indication exists and which test is still missing, and request an estimate with the visa invitation letter.
AlenMed works with 86 partner hospitals in 38 cities and 345 doctors; the company office is in Munich. For immunotherapy we turn to certified cancer centres and university hospitals. A coordinator meets the patient, interprets at appointments and when the tumour board’s recommendation is discussed, and collects the discharge report, the plan for further cycles and the patient card.
This material is for information only and is not an offer. Treatment tactics are decided by a doctor at a face-to-face examination.
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