What is immunotherapy?
immunotherapyIt is a cancer treatment that uses your body's immune system to find and kill cancer cells. Yourimmune systemidentifies harmful substances (including germs and abnormal cells) and destroys them to keep you healthy. But cancer cells are good at overcoming your immune system's defenses. Cancer cells can multiply and spread without treatment.
Immunotherapy aims to give your immune system the boost it needs to kill cancer cells in your body. Immunotherapy increases your body's ability to fight cancer by:
- Boost your immune system to make more cancer-fighting immune cells.
- Help your body make cancer-fighting immune cells that effectively find and destroy cancer cells.
Immunotherapy is an effective treatment for many types of cancer because it stimulates the existing immune system.
Why does immunotherapy cause side effects?
Any form of treatment, including immunotherapy, has potential drawbacks. Although immunotherapy is designed to help the immune system attack cancer cells, immune cells can mistakenly attack healthy tissue. This is called an immune-related side effect, or irAE.
As a result, immunotherapy can causeinflammationin healthy tissue, which you may notice as one or more side effects.
How common are the side effects of immunotherapy?
There may be no side effects. About 20% of people receiving immunotherapy will develop irAEs. Side effects are generally mild and easy to control. Still, you should tell your doctor about any changes you notice during or even after immunotherapy.
You are more likely to experience side effects if you are taking a combination of immunotherapy drugs or if you have an autoimmune disease. Inautoimmune diseaseinvolves your immune system mistakenly attacking healthy tissue in your body.
What are the most common side effects of immunotherapy?
The most common side effects of immunotherapy are mild and include:
- itchy rash
- nausea and vomiting.
- Decreased thyroid hormone levels.
How does immunotherapy affect the different organs and systems of the body?
Your immune system protects your entire body. This means that an overloaded immune system (thanks to immunotherapy) can affect multiple organs and systems in the body. Most of the signs and symptoms of immunotherapy are minor. Others are serious and require immediate medical attention. Tell your provider about any symptoms you have, just to be sure.
Immunotherapy can cause an allergic reaction that affects your skin. Symptoms include:
- skin irritation
- skin itch
- cracked skin
- Sores or painful ulcers.
- Skin more sensitive to sunlight.
liver and gastrointestinal system
Immunotherapy can increase enzyme levels in the liver. Most of the time, in this case, people do not notice any related symptoms. The most serious complications of immunotherapy include:
- A liver disease calledHepatitis, which can lead tojaundice, dark-colored urine, right-sided abdominal pain, vomiting, nausea in the stomach, and an increased chance of bleeding or bruising.
- A gastrointestinal disease calledinflammation, which causes diarrhea. It can also cause bloody, dark, tarry, and/or slippery stools and stomach pain.
lungs and respiratory system
In rare cases, immunotherapy can cause pneumonia or pneumonitis. Symptoms include:
- chest pain
- Shortness of breath.
thyroid and endocrine system
Immunotherapy can cause problems with the glands that make hormones, especially in yourthyroid. Your thyroid may not be making enough hormones (hypothyroidism). Less commonly, the thyroid can make too many hormones (hyperthyroidism). Symptoms include:
- Hair loss
- intense tiredness
- weight changes
- Excessive sweat.
- Faster heartbeat.
- feeling dizzy.
- Increased hunger or thirst.
brain and nervous system
Although rare, immunotherapy can cause nervous system disorders. The most common include:
- A brain disease calledencephalitis, which can cause fever, unusual behavior, mood swings, stiff neck, seizures, and eyes that are sensitive to light.
- A disease of the nervous system calledNeuropathythat causes tingling, numbness, or weakness in the hands, feet, or face.
heart and cardiovascular system
Although rare, immunotherapy can affect your cardiovascular system. Immunotherapy can cause irregular heartbeats (Arrhythmia). It can also cause:
- Conditions that cause inflammation in the heart, includingMyocarditismipericarditis.
- A condition that causes inflammation in the blood vessels, calledVasculitis.
Immunotherapy can cause inflammation of the joints (Arthritis). Symptoms include:
- swelling in the joints.
- joint pain
What side effects are associated with the different types of immunotherapy?
Possible side effects depend on the type of immunotherapy you are receiving. Most of the research on side effects has focused on a specific type of immunotherapy called immune checkpoint inhibitors (ICIs). However, there are several types of immunotherapy and possible side effects.
Immune Checkpoint Inhibitor (ICI)
Cancer cells can prevent cancer-fighting immune cells, called T cells, from recognizing cancer as dangerous. Cancer cells can be hidden in plain sight. As a result, the T cells in your body do not attack the cancer. ICIs help T cells recognize cancer cells as harmful so they can destroy them.
ICIs can cause symptoms such as fatigue, diarrhea, and skin rashes. The most serious side effects are conditions that cause inflammation in your organs.
Cell therapy adoptivo (T cell transfer therapy)
With foster cell therapy, your provider removes your cancer-fighting T cells and alters them in a laboratory to improve their detection and destruction of cancer cells. Your provider then puts the T cells back into your body.
Side effects depend on the type of adoptive cell therapy you receive:
- Tumor Infiltrating Lymphocyte (TIL) Therapyit can cause a rare condition called capillary leak syndrome. Tiny blood vessels called capillaries leak fluid, causing low blood pressure or more serious symptoms.
- CAR-T-Zell Therapycan cause cytokine release syndrome (CRS). With CRS, your immune system releases proteins called cytokines that stimulate your immune system. Various symptoms may occur, including fever, headache, rapid heartbeat, and shortness of breath. Your doctor can help you manage the symptoms of cytokine release syndrome.
CAR T cell therapy can also cause side effects that affect your immune system, including:
monoclonal antibodiesare lab-made proteins designed to target specific vulnerabilities in different types of cancer cells. Possible side effects are:
- Complain- Similar symptoms (fatigue, fever, chills, muscle or joint pain, sore throat, shortness of breath).
- Abnormal blood pressure (too low or too high).
- bleeding or blood clots.
- wounds that heal slowly
- skin irritation
vaccines for treatment
Vaccines teach your immune system to recognize signs of cancer cells so that your cancer-fighting immune cells can find and destroy them.
Side effects can be:
- Flu-like symptoms.
Immune system modulators (immunomodulators)
Immunomodulators alter your immune system in ways that help your body fight cancer. Immunomodulators can boost your immune cells, stimulate the cells you already have to fight cancer more aggressively, etc.
Thalidomide, lenalidomide, and pomalidomide are immunomodulators that can cause the following side effects:
- fatigue and sleepiness.
- Nerve damage (neuropathy).
- blood clot.
Imiquimod is an immunomodulator that is applied as a cream. Some people who use it experience skin reactions.
When do the side effects of immunotherapy appear?
There is no set time when the side effects will start. It usually takes some time for immunotherapy to start working. Side effects can take months or even years to show up, if at all. Some side effects do not appear until more than a year after starting therapy.
When do the side effects of immunotherapy end?
Most side effects are temporary. In rare cases, they cause long-term effects. If you do have side effects, they may continue for some time after the medicine has left your body. The effects of immunotherapy last because it is not a drug that works while it is in your system and stops working when it is gone. Instead, it has long-lasting effects on your immune system, allowing your immune cells to fight cancer effectively.
How can I deal with the side effects of immunotherapy?
It's important to talk to your doctor about any symptoms you have during (or after) immunotherapy treatments, no matter how minor or unimportant they may seem. Your doctor can often adjust your treatment or prescribe additional medications to relieve your symptoms and prevent complications.
Your provider can:
- Stop treatment at short notice to allow your immune system to cool down.
- Prescribe medication to lower your immune response. medicines belongsteroidsmiimmunosuppressants.
Your doctor may also suggest lifestyle changes to help control your symptoms.
Do the side effects mean that the treatment is working?
Some studies suggest that the side effects associated with ICI could be a sign that the treatment is killing the cancer. Just because it doesn't have any side effects doesn't mean immunotherapy won't help. More research is needed to determine the relationship between side effects and the effectiveness of different immunotherapy treatments.
What are the benefits of immunotherapy?
Understanding the potential risks and side effects of immunotherapy naturally raises the question: is it worth it? While there are no guarantees that cancer treatment will work for everyone, immunotherapy has many potential benefits. Immunotherapy:
- It improves the long-term survival of many types of cancer.
- It destroys many types of tumors and, in many cases, can prevent them from coming back.
- It can prevent the spread of many types of cancer.
- It supercharges your immune system so it can continue to fight cancer even after treatment ends.
- It causes less serious side effects (on average) than more traditional cancer treatments like chemotherapy.
Discuss the pros and cons of immunotherapy with your doctor to determine if this is the right treatment option for you.
A note from the Cleveland Clinic
Immunotherapy is not a one-size-fits-all treatment. Rather, it depends on the strength of your immune system. Also, it is impossible to know what side effects you will experience. The type of cancer you have, the location of the cancer in your body, and your general health can affect your experience. The specific type and dose of immunotherapy you receive also play a role. Ask your doctor about all the factors that may influence your experience. Keep them informed of any symptoms or side effects you experience during treatment.