Chemotherapy vs Immunotherapy: — What Is the Difference?
These two treatments work in completely different ways. Getting them mixed up means reading the wrong advice about side effects, diet, and warning signs — so knowing which one you are on matters.
Medically reviewed by Dr. Owais Mohammed, Medical Oncologist · Last reviewed September 2026
- Different mechanisms — Chemotherapy attacks dividing cells. Immunotherapy activates your immune system to find cancer.
- Different side effects — The warning signs and what to do about them differ between the two treatments.
- Tablets can be either — Not every cancer tablet is chemotherapy. Some tablets are immunotherapy or targeted therapy.
- Sometimes combined — For some cancers, chemotherapy and immunotherapy are given together as the standard regimen.
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Chemotherapy works by attacking rapidly dividing cells with drugs that travel through the body. Immunotherapy activates your own immune system to find and act against cancer. The two work differently, cause different side effects, have different eligibility criteria, and are sometimes used together for certain cancers.
How is chemotherapy different from immunotherapy?
| Chemotherapy | Immunotherapy | |
|---|---|---|
| How it works | Drugs circulate through the body and damage rapidly dividing cells, including cancer cells | Medicines activate or retrain your immune system to recognise and act against cancer cells |
| Why healthy tissue is affected | Rapidly dividing healthy cells — hair follicles, gut lining, blood cells — are caught in the same action | Immune reactions can affect the gut, liver, lungs, or hormone glands when the immune system is overactivated |
| Common side effects | Nausea, hair loss, low blood counts, mouth sores, fatigue — often follows a predictable cycle pattern | Fatigue, skin rash, and immune reactions affecting organs — less predictable than chemotherapy |
| How suitability is decided | Cancer type, stage, and general fitness | Biomarker testing of tumour tissue — markers such as PD-L1, MSI or TMB — plus cancer type, stage, and fitness |
| How it is given | Drip, tablet, or injection — varies by regimen and cancer type | Drip or tablet, usually given as day care with no overnight admission in most cases |
| Can they be combined? | Yes — for several cancers, this combination is the standard recommended approach | Yes — immunotherapy is sometimes added to a chemotherapy regimen from the start of treatment |
Which treatment is used when?
Your oncologist decides based on the specific cancer, its stage, your biomarker test results, and your general fitness — not on a preference between the two.
Chemotherapy is used across a wide range of cancer types and stages. Immunotherapy is used where biomarker testing shows the tumour is likely to respond — NCCN, ASCO and ESMO guidance all link eligibility to specific markers rather than cancer type alone.
For several cancers — including certain lung and head and neck cancers — chemotherapy and immunotherapy are started together because the combination is what the evidence supports.
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What do these terms mean?
- Chemotherapy
- A group of drugs — given by drip, injection, or tablet — that damage cells that divide rapidly. Cancer cells divide quickly, so they are targeted. Some healthy cells that also divide quickly are affected, which is why hair loss and low blood counts happen.
- Immunotherapy
- Medicines that change how your immune system behaves so it can recognise and act against cancer cells. The most common type in use across India right now is checkpoint inhibitors, which remove signals that cancer uses to hide from the immune system.
- Checkpoint inhibitor
- A type of immunotherapy. Checkpoints are signals that normally stop the immune system attacking healthy tissue. Cancer can use these signals to hide. Checkpoint inhibitors block that hiding mechanism. Examples include pembrolizumab, nivolumab, and atezolizumab.
- Biomarker testing
- Laboratory tests done on tumour tissue — usually from your biopsy — that look for markers such as PD-L1 expression, microsatellite instability (MSI), or tumour mutational burden (TMB). The results tell your oncologist whether immunotherapy is likely to be useful for your specific tumour.
- Day care infusion
- Treatment given through a drip during a single visit, with no overnight stay needed. Immunotherapy and some chemotherapy regimens are administered this way.
Did you know?
Several cancer tablets — including some used in lung, kidney, and breast cancer — are targeted therapy or immunotherapy, not chemotherapy. They work by a different mechanism and carry a different set of side effects and warning signs.
Reading chemotherapy advice when you are on a targeted or immune-based treatment means monitoring the wrong symptoms and potentially missing the ones that actually matter for your specific medicine.
Source: NCCN Guidelines: anticancer agents are classified as cytotoxic chemotherapy, targeted agents, immunotherapy, and hormonal therapy — distinct categories with distinct management
Questions families ask when treatment is being planned
My tablet is not labelled chemotherapy — could it be immunotherapy or something else?
Yes, it could be. Cancer tablets fall into several different categories: chemotherapy, targeted therapy, hormone therapy, or immunotherapy. Each works differently and carries a different side effect profile and set of warning signs. If you are not certain which category your tablet belongs to, ask your oncologist or the pharmacist to name it clearly. Reading advice written for chemotherapy patients when you are actually on targeted therapy or immunotherapy means you may manage the wrong symptoms and miss the warning signs that apply to your treatment.
If I am having immunotherapy, can I follow chemotherapy side-effect advice I find online?
No, and doing so can cause real harm. On chemotherapy, a very low white cell count is one of the most serious risks, and the precautions that go with it — avoiding crowds, checking temperature, watching for infection — are specific to that mechanism. On immunotherapy, the serious risks are immune reactions affecting the gut, liver, lungs, or hormone-producing glands, and the response to those is different again. Following chemotherapy advice on immunotherapy could mean missing an immune reaction that needs prompt treatment. Always check with your team before acting on general cancer side-effect guidance found online.
Can chemotherapy and immunotherapy be given at the same time?
Yes, and for several cancers the combination is the standard approach from the start of treatment — not chemotherapy first and immunotherapy later. NCCN and ASCO guidelines recommend combined regimens for certain lung cancers, some gastric cancers, and others. Whether combination treatment applies to your situation depends on your specific cancer type and biomarker results, which your oncologist will explain at the time of planning.
Which one is more effective?
There is no general answer to this question, and any comparison not tied to a specific cancer type and biomarker result is not useful to act on. Each treatment is effective where it is indicated and does very little where it is not. Being told you are having chemotherapy rather than immunotherapy — or the reverse — is not information about how well your treatment is likely to work overall. Your oncologist can explain what the regimen you are being given is intended to achieve for your specific cancer.
Are the side effects of immunotherapy milder than chemotherapy?
Not necessarily. Chemotherapy side effects — nausea, hair loss, low blood counts — are often predictable and tied to the treatment cycle, which makes them manageable. Immunotherapy side effects can be less predictable and include immune reactions that affect organs unrelated to the cancer, such as the thyroid, liver, or lungs. Some of these reactions are serious and need prompt treatment if they occur. Neither treatment is uniformly milder than the other; both have side effects that your team will monitor for and manage throughout your treatment.
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Frequently asked questions
Is targeted therapy the same as chemotherapy?
No. Targeted therapy works by blocking specific proteins or signals that cancer cells depend on to grow. Chemotherapy works by attacking all rapidly dividing cells regardless of those signals. They have different side effect profiles and different eligibility criteria — targeted therapy usually requires a specific gene mutation to be present in the tumour. The category your treatment belongs to is worth confirming with your oncologist, because the monitoring and warning signs differ between them.
How does my oncologist decide between chemotherapy and immunotherapy?
The decision is based on your cancer type, its stage, biomarker test results from your tumour tissue, and your general fitness. It is not a choice between two equally available options — one may not be indicated for your tumour at all. For some cancers, the combination is what the evidence supports from the start. Your oncologist will explain which approach applies to you and the reason for it.
Is immunotherapy available in India?
Yes. Several checkpoint inhibitors are approved by CDSCO and are used across India. CION administers immunotherapy as day care at its centres, with no overnight admission needed in most cases. Whether immunotherapy is appropriate for you is a separate question from availability — eligibility depends on biomarker testing and your specific cancer type, which your oncologist determines.
Can I have immunotherapy if I have already had chemotherapy?
In some situations yes, and in others immunotherapy is given before chemotherapy or alongside it from the start. Prior chemotherapy does not automatically rule out immunotherapy later, but your current fitness, your test results, and how the cancer has responded to previous treatment all affect what is appropriate next. Your oncologist will assess this at each stage rather than applying a fixed sequence.
Will immunotherapy cause hair loss the way chemotherapy does?
Hair loss is not a typical side effect of immunotherapy. It is common with many chemotherapy drugs because those drugs target rapidly dividing cells, and hair follicle cells divide quickly. Immunotherapy works through the immune system rather than that mechanism, so the side effects differ — skin rash and fatigue are more common than hair loss, though individual experience varies. Your team will tell you which specific side effects to watch for on your regimen.
Should I ask my oncologist to confirm exactly which category of treatment I am receiving?
Yes, and it is a reasonable question to ask directly. Ask them to name the category clearly: chemotherapy, targeted therapy, immunotherapy, or hormone therapy. Each has different side effects, different dietary considerations, and different warning signs to watch for. If your regimen includes more than one medicine, ask whether they all belong to the same category — combination regimens sometimes include more than one type, and the monitoring for each part differs.
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