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Immunotherapy for Soft Tissue Sarcomas
Immunotherapies are medicines that help a person’s own immune system recognize and destroy cancer cells. They are sometimes used to help treat soft tissue sarcomas.
Immune checkpoint inhibitors
Just as it’s important that immune cells get activated to fight infections and cancer, it’s also important that they turn off when they are no longer needed. Checkpoint proteins on immune cells act as brakes to slow down immune cell attacks.
Cancer cells sometimes use these checkpoints to keep from being attacked by the immune system.
Drugs that target these checkpoint proteins, called checkpoint inhibitors, can help restore the immune response against the cancer cells.
These drugs can be used for people whose sarcomas have tested positive for specific gene changes, specifically a high level of microsatellite instability (MSI-H), changes in one of the mismatch repair (MMR) genes, or high tumor mutational burden (TMB-H).
Pembrolizumab (Keytruda) and nivolumab (Opdivo) are drugs that target PD-1, a protein on immune system cells called T cells. By blocking PD-1, these drugs boost the immune response against sarcoma cells.
Pembrolizumab is given as an IV (intravenous) infusion every 3 or 6 weeks.
Nivolumab can be given alone or with ipilimumab (see below). It can be given by itself as an IV infusion every 2 or 4 weeks. If it is used along with ipilimumab, then it is typically given every 3 weeks.
Atezolizumab (Tecentriq) targets the PD-L1 checkpoint protein on cancer cells and boosts the immune response against cancer cells. This can shrink some tumors or slow their growth.
Atezolizumab can be used in people with alveolar soft-part sarcoma that can’t be removed with surgery or that has spread (metastasized) to other parts of the body.
This drug is given as an IV infusion, typically every 2, 3, or 4 weeks. It can also be given as Tecentriq Hybreza, as an injection under the skin (subcutaneously) over several minutes. Typically, this is done once every 3 weeks.
Ipilimumab (Yervoy) is another drug that boosts the immune response, but it has a different target. It blocks CTLA-4, another protein on T cells that normally helps keep them in check.
This drug can be used along with nivolumab (Opdivo). It is given as an IV infusion, usually once every 3 weeks for 4 treatments.
Possible side effects
Side effects of these drugs include fatigue, cough, nausea, diarrhea, skin rash, loss of appetite, constipation, joint pain, and itching.
Less commonly, more serious side effects can occur.
Infusion reactions: Some people might have an infusion reaction while getting these drugs. This is like an allergic reaction, and can include fever, chills, flushing of the face, rash, itchy skin, feeling dizzy, wheezing, and trouble breathing. It’s important to tell your doctor right away if you have any of these symptoms while getting these drugs.
Autoimmune reactions: These drugs work by disabling one of the safeguards on the body’s immune system. Sometimes the immune system starts attacking other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, nerves, skin, kidney, or other organs.
It’s very important to report any new side effects during or after treatment with any of these drugs to your health care team promptly. If serious side effects do occur, you might need to stop treatment and take high doses of corticosteroids to suppress your immune system.
Autologous T cell immunotherapy
In this treatment, immune cells called T cells are removed from the patient’s blood and altered in the lab to have cancer-specific T cell receptors, or TCRs, on their surface. The T cells are then multiplied in the lab and given back into the patient’s blood, where they can seek out the cancer cells and help launch a precise immune attack against them.
Afamitresgene autoleucel (Tecelra, also known as afami-cel) is a T cell immunotherapy that targets the MAGE-A4 protein found on some people’s cancer cells. It is approved to treat some adults with advanced synovial sarcoma who have already received chemo. People need to have their blood and tumor cells tested to see if they are eligible for this treatment.
The treatment is given as a one-time IV infusion, typically about 6 weeks after the T cells are first collected. You will get chemo for several days in the week before getting this treatment, which helps it work better.
Possible side effects
Because this treatment can have serious side effects, it needs to be given in a medical center that has special training with this type of treatment.
Cytokine release syndrome (CRS): This life-threatening syndrome occurs when immune cells in the body release large amounts of chemicals into the blood. Symptoms can include fever, chills, headache, nausea and vomiting, trouble breathing, very low blood pressure, a very fast heart rate, swelling, diarrhea, feeling very tired or weak, and other problems.
Neurological (nervous system) problems: This treatment can sometimes cause serious problems, such as confusion, trouble speaking, seizures, tremors, or changes in consciousness.
Infusion reaction: This is like an allergic reaction, and can include fever, chills, flushing of the face, rash, itchy skin, feeling dizzy, wheezing, and trouble breathing.
Other possible side effects: These can include serious infections, low blood cell counts (which can last for several weeks), and an increased risk for other cancers.
Other possible side effects include:
- Nausea and vomiting
- Feeling very tired
- Diarrhea or constipation
- Fever
- Belly pain
- Trouble breathing
- Loss of appetite
- Low blood pressure
- Back pain
- Fast heart rate
- Chest pain
- General body swelling
Because of the risk of side effects, you’ll be watched closely at the medical center, typically daily for at least 7 days after the infusion.
More information about immunotherapy
To learn more about how drugs that work on the immune system are used to treat cancer, see Cancer Immunotherapy.
To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.
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- References
Developed by the 黑料大湿Posts Cancer Society medical and editorial content team with medical review and contribution by the 黑料大湿Posts Society of Clinical Oncology (ASCO).
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National Cancer Institute. Adult Soft Tissue Sarcoma Treatment (PDQ?)–Health Professional Version. February 21, 2025. Accessed at www.cancer.gov/types/soft-tissue-sarcoma/hp/adult-soft-tissue-treatment-pdq on Dec 2, 2025.
National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology (NCCN Guidelines?), Soft Tissue Sarcoma, Version 1.2025 – May 2, 2025. Accessed at www.nccn.org/professionals/physician_gls/pdf/sarcoma.pdf on Nov 20, 2025.
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Singer S, Maki R, O’Sullivan B. Soft tissue sarcoma In: DeVita VT, Heilman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.
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Last Revised: February 9, 2026
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