Immunotherapy Side Effects: ‘No Organ System Potentially Unaffected’


Immunotherapy side effects are a different than those of chemotherapy and other cancer treatments. Patients should know when to seek emergency care and what to communicate to clinicians.

Immune-mediate adverse events – side effects that patients can experience when on immunotherapy – can affect any organ in the body, so it is crucial for patients to know what to look out for.

“These toxicities can occur head to toe, so no organ system is potentially unaffected,” said Dr. Evan J. Lipson, associate professor of oncology at Johns Hopkins Medicine, in a recent interview with OncLive, a sister publication of CURE®. “They differ from the toxicities that we typically associate with other anti-cancer therapies like chemotherapy, both in their predictability in their timing and their clinical presentation, and then also the way that we triage and manage patients.”

While these side effects can be serious, they may actually be a good sign that the therapy is working, according to recent research. Lipson explained that some studies saw that patients who experienced serious side effects were the ones whose tumors shrunk and had the best cancer outcomes.

Immunotherapy-related side effects can often be managed with corticosteroids, which suppress the immune system – something Lipson admitted might sound counter-intuitive.

“It seems like you’d be tugging at both ends of the same rope. In one instance, trying to activate the immune system with the checkpoint blockers and then in the other side trying to pull the reigns back (with the steroids),” Lipson said. “But we’ve seen time and again that the administration of corticosteroids in an effort to treat the (side effect) does not seem to blunt the anti-tumor response. The same cannot be said for starting at the beginning of therapy with corticosteroids – that does seem to have a negative effect on the anti-tumor response.”

Whether a side effect can be treated at the next oncology appointment or is worthy of a trip to the emergency room, it is important that patients know what symptoms to look out for and to keep an open line of communication with their treatment team, Lipson said.

“I encourage all of my patients to give a call to the office with any symptom that feels different from their baseline. I would much rather get a call with something that turns out to be a mild, unrelated issue and help sort out that problem than to have somebody wait and learn later that, in fact, it could have been dealt with more effectively at an earlier time point,” Lipson explained.

If a side effect gets bad enough, the patient may need to go to the emergency department. However, since the doctors and nurses that treat patients in the ER are not up to date on the cancer treatments being administered, patients must speak up. Oftentimes, they will receive a wallet card outlining the drugs that they have been prescribed.

“When patients arrive in the emergency department or an urgent care setting, it’s critical to let the health care teams there know that the patient has received immunotherapy,” Lipson said. “We as oncologists actually appreciate getting a phone call from the emergency department so that we can collaborate and work through what might be a toxicity together. That sort of team-based medicine is the most effective.”

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