Balancing Immunotherapy Benefits and Risks in Cancer Care

As immunotherapy continues to transform cancer treatment, managing its side effects remains a critical part of care. During the NCCN Annual Conference, Dr. Brittany Dulmage spoke on “Maximizing Benefit, Minimizing Risk: Managing Immune Checkpoint Inhibitor Toxicities,” highlighting how clinicians can balance treatment effectiveness with patient safety.

Dulmage, an oncodermatologist at The Ohio State University Comprehensive Cancer Center, sat down with CURE live on site to discuss the importance of selecting targeted approaches to manage side effects.

Transcript

How do you balance treatment benefits with potential risks?

I think that's a really important question. We don't want to use treatments that are going to suppress the immune system. The whole point of immunotherapy, as we discussed, is to rev up the immune system to let the immune system do the work of targeting the cancer cell. If we use a medication that suppresses the immune system, we may lessen the effect of immunotherapy. A great example is steroids. A lot of dermatologic conditions will respond to oral steroids, but if we give a patient oral steroids, they may not be able to get their immunotherapy, or their immunotherapy may not be as effective if given.

So, I think one of the really big roles that we can play as dermatologists is that we can help pick a more targeted therapy for a patient's individual skin toxicity that isn't just high-dose steroids. I can say to the patient with eczema, "If your eczema is flaring, what is an eczema-specific medication I can give you that doesn't suppress your immune system as a whole?" It really just treats this narrow type of inflammation with eczema and, therefore, allows you to still get your immunotherapy at the appropriate dose. So, we often ask: Is the treatment compatible with immunotherapy? Can it be given alongside immunotherapy?

What's tough is we don't always know the answer because a lot of the medications that become FDA-approved for dermatologic conditions are not studied in cancer patients when they are in clinical trials, but we can look at what that medicine is doing from an inflammation standpoint to try and pick things that are going to be the lowest risk to combine with immunotherapy.

References

1. “Maximizing Benefit, Minimizing Risk: Managing Immune Checkpoint Inhibitor Toxicities,” by Dr. Brittany Dulmage, et al. Presented at: The NCCN 2026 Annual Conference.

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