Immunotherapy vs Chemotherapy — Clinical Trial Comparison
Immunotherapy
Harnesses the immune system to fight cancer
VS
Chemotherapy
Uses cytotoxic drugs to kill rapidly dividing cells
Immunotherapy and chemotherapy are two of the most fundamental cancer treatment approaches, and both are heavily studied in UK clinical trials. While chemotherapy has been the backbone of cancer treatment for decades, immunotherapy represents one of the most exciting shifts in oncology — offering durable responses in some patients where chemotherapy could not. Understanding the trial landscape for each can help you find the right study for your situation.
Key Differences at a Glance
| Feature | Immunotherapy | Chemotherapy |
|---|---|---|
| Mechanism | Stimulates or supports the immune system to recognise and attack cancer cells | Directly kills rapidly dividing cells (including cancer cells) using cytotoxic drugs |
| Selectivity | Highly targeted — works with immune system specificity | Non-selective — affects all rapidly dividing cells (hair, gut, bone marrow) |
| Response timing | Can take weeks to months; responses may deepen over time | Usually faster initial response, measured in weeks |
| Duration of response | Can be durable — responses lasting years after treatment stops | Responses often last only while treatment continues |
| Common types in trials | Checkpoint inhibitors (PD-1, PD-L1, CTLA-4), CAR-T, cancer vaccines, bispecific antibodies | Alkylating agents, antimetabolites, taxanes, platinum compounds, anthracyclines |
| NICE-approved examples | Pembrolizumab, nivolumab, atezolizumab, ipilimumab, durvalumab | Cisplatin, carboplatin, paclitaxel, 5-FU, capecitabine, doxorubicin |
| Typical treatment duration | Weeks to months (or up to 2 years for adjuvant) | Usually 4–6 cycles over 3–6 months |
Clinical Trial Availability
| Trial Aspect | Immunotherapy | Chemotherapy |
|---|---|---|
| UK trials actively recruiting | 200–350 studies | 150–250 studies |
| Most common phases | Phase 2–3 | Phase 2–3 |
| Top cancers studied | Lung cancer, melanoma, kidney cancer, bladder cancer, head & neck, lymphoma | Breast cancer, lung cancer, colorectal, ovarian, pancreatic, gastric |
| Combination trials | Major focus — immuno + chemo, immuno + targeted, dual checkpoint | Common — chemo + targeted, chemo + immuno, chemo + radiation |
| Neoadjuvant/adjuvant | Rapidly expanding — checkpoint inhibitors before/after surgery | Well-established — standard neoadjuvant/adjuvant backbone |
| Biomarker requirements | PD-L1 expression, TMB, MSI-H/dMMR, BRCA, NTRK often required | Usually fewer biomarker requirements (some need specific mutations) |
Exciting Emerging Treatments
Immunotherapy Trials
- Bispecific antibodies — engaging T-cells directly at the tumour site
- Cancer vaccines — mRNA-based personalised cancer vaccines (like melanoma)
- Novel checkpoint targets — LAG-3, TIGIT, TIM-3 inhibitors
- Adoptive cell therapy — TIL therapy, next-gen CAR-T for solid tumours
- Combination immunotherapy — dual checkpoint, immuno + anti-angiogenic
- Neoadjuvant immunotherapy — giving checkpoint inhibitors before surgery
Chemotherapy Trials
- Nanoparticle drug delivery — targeted chemo delivery to reduce side effects
- Antibody-drug conjugates (ADCs) — chemo attached to antibodies for precision
- Dose-optimisation trials — finding the minimum effective dose
- Metronomic chemotherapy — low-dose continuous scheduling
- Chemo + immunotherapy combinations — chemo as immune priming
- Organoid-guided therapy — testing chemo on patient-derived tumour organoids
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Eligibility Differences
Immunotherapy Trial Criteria
- Measurable disease per RECIST criteria
- PD-L1 expression level ( CPS ≥ 1, TPS ≥ 1%, or ≥ 50% depending on trial)
- Adequate organ function (liver, kidney, cardiac)
- No active autoimmune disease requiring immunosuppression
- No prior checkpoint inhibitor treatment (for some trials)
- ECOG performance status 0–1 (sometimes 0–2)
Chemotherapy Trial Criteria
- Measurable disease, adequate blood counts (ANC, platelets, haemoglobin)
- Cardiac ejection fraction within normal limits
- No uncontrolled infections or recent major surgery
- Adequate renal and hepatic function
- Peripheral neuropathy ≤ Grade 1 (for taxane/platinum trials)
- ECOG performance status 0–2
Immunotherapy Trials
Find actively recruiting immunotherapy clinical trials across the UK
Immunotherapy TrialsCancer Condition Trials
Browse all cancer conditions with active UK clinical trials
Cancer Condition TrialsFrequently Asked Questions
Can I have immunotherapy after chemotherapy (or vice versa)?
Yes — this is very common. Many treatment pathways use chemotherapy first-line, followed by immunotherapy on progression. Some trials specifically look at sequencing these treatments. Your oncologist can advise on the best order for your specific cancer type and stage.
Is immunotherapy safer than chemotherapy?
Not necessarily safer — differently toxic. Chemotherapy causes more predictable side effects (hair loss, nausea, low blood counts) while immunotherapy can cause immune-related adverse events that affect any organ (colitis, pneumonitis, hepatitis, endocrine disorders). Both require careful monitoring.
Which has more UK clinical trials available?
Immunotherapy trials have overtaken chemotherapy trials in recent years, particularly in lung cancer, melanoma, and urothelial cancers. However, chemotherapy remains a core component of many combination trials.