Side Effects of Immunotherapy

This content was terminal updated 1 November 2021.

Immunotherapy is a blazon of cancer treatment. It uses the body'southward natural defenses to fight cancer by improving your immune system'due south power to assail cancer cells.

At that place are many types of immunotherapy. Side effects for two types of immunotherapy are discussed on this page: immune checkpoint inhibitors and chimeric antigen receptor (Automobile) T-cell therapy.

Side effects tin can announced as signs, such as changes in something measured like blood force per unit area or lab tests, and equally symptoms, which are changes that you lot can run into or feel in your torso. Additional signs and symptoms that can arise from immune checkpoint inhibitors, CAR T-cells, and other types of immunotherapies, such every bit viral and cellular immune therapies, are also listed further downwardly this page.

Acquire more about the dissimilar types of immunotherapy

Why does immunotherapy cause side effects?

Immunotherapy treats many types of cancer effectively. Merely similar other cancer treatments, they are powerful medications that can cause changes within the body or to how you experience, called side effects. These side furnishings are different for anybody. They depend on the type of immunotherapy, the type of cancer, its location, your general health, and other factors.

Immunotherapy may too cause the immune system to attack healthy cells. This can crusade side effects, as well called "immune-related adverse events." These may occur at any fourth dimension during treatment or sometimes even after stopping immunotherapy.

Dissimilar types of immunotherapy cause different side furnishings. That'due south why information technology is of import to talk with your dr. about the type of immunotherapy used for your cancer, the goals of treatment, and the potential side effects of your immunotherapy.

Are there ways to prevent or treat these side effects?

Your health intendance team can help you prevent or relieve many side effects. Preventing and treating side furnishings is an important part of your overall cancer handling. This is called palliative intendance or supportive care.

Before immunotherapy begins, ask your health intendance team what side effects are likely. During treatment, let them know about whatever new, dissimilar, or worsening health problems every bit presently as possible. This includes issues that you may not think are serious or caused by immunotherapy. It is easier for your health care team to effectively care for a side result when the trouble first appears. Early recognition of symptoms and either pausing immunotherapy or treating side effects can preclude them from condign severe.

Side effects of immunotherapy tin be balmy, moderate, or even life-threatening. Doctors form side effects on a scale of 1 to iv, with 1 existence mild and 4 being the well-nigh astringent. For balmy side effects, your treatment will likely continue and you will be monitored for changes in your symptoms. If you have moderate or astringent side effects, your doctor may pause the treatment and they may prescribe a blazon of medication called a corticosteroid to at-home the immune system. Sometimes, other medications may also exist given later a corticosteroid. If the side effects are relieved, your physician may attempt to start immunotherapy again or adjust your handling regimen, especially if y'all were given a combination of medications. If side effects do non get away or get worse, your doctor may end treatment with immunotherapy.

If a side effect becomes severe, you lot may need to get medical care at a place not familiar with your cancer treatment. For example, you may need to get to an emergency room. Be certain to tell the health intendance team there that yous are on immunotherapy. If possible, give them the name of the drug, your oncologist, and cancer center where you receive immunotherapy. Keep this data in your wallet or phone in case you need it apace. Download and print Cancer.Net's foldable wallet card to organize this information.

What are common immunotherapy side effects and syndromes?

The virtually mutual side effects depend on which kind of immunotherapy you are receiving. Always allow your cancer care team know when you experience a new or worsening medical problem during immunotherapy, even if those symptoms are non listed beneath.

Allowed checkpoint inhibitors

Immune checkpoint inhibitors include medications that modify the interactions between immune cells and cancer cells using molecules called PD-1, PD-L1, CTLA-4, and others. They include drugs such every bit atezolizumab (Tecentriq), avelumab (Bavencio), cemiplimab (Libtayo), dostarlimab (Jemperli), durvalumab (Imfinzi), ipilimumab (Yervoy), nivolumab (Opdivo), and pembrolizumab (Keytruda). Side effects from immune checkpoint inhibitors are usually caused past the immune system attacking normal body parts, the aforementioned style it attacks cancer cells. This is a procedure chosen inflammation. Side furnishings of immune checkpoint inhibitors may affect the following parts of the trunk.

  • Peel. Pare problems, like rash and itching, are well-nigh common in people with melanoma and not-minor cell lung cancer, but people with any kind of cancer can develop skin problems related to treatment with an immune checkpoint inhibitor .

  • Gastrointestinal tract. Problems with the gastrointestinal tract are some of the most common side furnishings related to allowed checkpoint inhibitors. These include inflammation of the colon, which is chosen colitis, and diarrhea. Less common side effects include swallowing problems, nausea and vomiting, and pain in the upper abdomen.

  • Muscles and skeleton. Problems with the muscles, joints, and bones may occur in people receiving immune checkpoint inhibitors. This can result in arthritis-type pain, swelling in joints, and muscle cramping.

  • Kidneys. Impairment to the kidneys or kidney failure is uncommon, but it sometimes does occur in people receiving allowed checkpoint inhibitors. This is commonly outset noticed by your wellness-intendance provider when they review your lab results.

  • Fretfulness. Immune checkpoint inhibitors may crusade nervous system side effects that touch on your encephalon, senses, or fifty-fifty movements. There can be pain and sensation changes called neuropathy. These are rare but mayhap severe side effects.

  • Blood. Immunotherapy may cause lowered blood counts, which may lead to bleeding, anemia, and other problems.

  • Lungs. Immune checkpoint inhibitors may crusade pneumonitis, which is inflammation of the lungs that tin can crusade a cough or problem breathing. Pneumonitis is uncommon only may exist serious.

  • Endocrine system. The endocrine system controls the hormones that help the body regulate many important functions, similar blood pressure level, energy, and the ability to respond to stresses similar infections and injuries. The thyroid gland is a vital part of the endocrine organization, and it may be triggered to become either more or less productive by immune checkpoint inhibitor treatment. There are rare cases where people develop a type of diabetes related to immune checkpoint inhibitors, called checkpoint inhibitor-associated diabetes (CIADM), which is similar to type 1 diabetes.

  • Heart and blood vessels. Immunotherapy may touch on the center and blood vessels. These side effects are rare but are often very serious and can be life-threatening.

  • Eyes. Treatment with immune checkpoint inhibitors may cause inflammation of the tissues of the optics. These side effects are uncommon overall but may be more common amid people who receive a combination of allowed checkpoint inhibitors.

  • Reproductive organs. Immunotherapy may touch fertility, which is the ability to conceive a child in the future. Patients of reproductive age should take steps to avoid conception during treatment and for at to the lowest degree 5 months after treatment ends.

  • Reactions during the infusion. When an immunotherapy drug is given to the patient through a vein, it is called an infusion. People receiving immune checkpoint inhibitors usually practice not have a reaction when the infusion is given. If an infusion reaction does happen, the symptoms are often mild and go away on their own. There can occasionally be more than severe cases that require adjusting the speed of the infusion, giving medications for pain or other symptoms, or pausing treatment.

CAR T-cell therapy

Machine T-cell therapy is a blazon of immunotherapy that returns adapted immune cells back into the body to observe and destroy cancer cells. This blazon of immunotherapy includes medications like axicabtagene ciloleucel (Yescarta), brexucabtagene autoleucel (Tecartus), idecabtagene vicleucel (Abecma), lisocabtagene maraleucel (Breyanzi), and tisagenlecleucel (Kymriah). The most common side furnishings related to CAR T-cell therapy are described below and outcome from immune system changes that commonly involve more than one body role.

  • Cytokine release syndrome (CRS). Machine T cells release a poly peptide called a cytokine into the claret. This process can ship the allowed system into overdrive, leading to a syndrome called CRS. It may bear witness up between ii and 21 days after treatment begins. Some cases can exist serious and crusade issues with many organs in the body, requiring medical treatment. A medication called tocilizumab (Actemra) and a steroid may exist given. The symptoms of CRS include fever, fast heartbeat, nausea, headache, rash, shortness of breath, and low blood pressure level. If y'all are receiving Machine T-cell therapy and experience the symptoms of CRS, contact your wellness-care team right away.

  • Immune effector cell-associated neurotoxicity syndrome (ICANS). ICANS is a syndrome that affects a person's nervous system. It is the second well-nigh mutual side effect of Motorcar T-jail cell therapy. ICANS can cause many symptoms, including defoliation and behavioral changes; inability to speak or sympathise speech, which is called aphasia; problems with attention, thinking, and retentivity; weakness in the muscles; tremors; muscle jerks and twitching; headache; and seizures. Treatment includes corticosteroids and supportive care.

  • Infections. Infections are common later on Auto T-cell therapy. They most frequently happen soon after the infusion because infection-fighting allowed cells may be weakened. Symptoms of infection include fever, nausea, fatigue, headache, weakness, and general feeling of discomfort.

  • Os marrow suppression. Auto T-prison cell therapy may lower the function of your os marrow, the trunk'southward manufacturing plant for your blood cells. This can lower the numbers of cells produced and released by your bone marrow, resulting in anemia, thrombocytopenia, leukopenia, and neutropenia.

  • Hemophagocytic lymphohistiocytosis (HLH). In HLH, immune cells chosen histiocytes and white blood cells build up in the skin, spleen, and liver and destroy other blood cells. This is an uncommon side result of CAR T-prison cell therapy. Signs and symptoms are very similar to those of infections (see in a higher place).

  • B-jail cell aplasia. B cells, also chosen B lymphocytes, are immune cells in the body. Sometimes CAR T cells will set on healthy B cells, resulting in low numbers of B cells in the trunk. When this happens, it is called B-jail cell aplasia. This increases the risk of infections (run across above).

  • Disseminated intravascular coagulation (DIC). Automobile T-cell therapy may touch the proteins of the claret that command the thickness and thinness of your claret. This can effect in bleeding and/or clotting problems and can be serious.

Boosted signs and symptoms of side furnishings from dissimilar types of immunotherapies

  • Cough

  • Animate problems

  • Blood in urine or dark urine

  • Hurting, swelling, or weakness in muscles or joints

  • Stiff cervix

  • Swollen lymph nodes

  • Diarrhea

  • Constipation

  • Hurting

  • Enlarged spleen or liver

  • Bleeding or bruising hands

  • Sweating more than

  • Feeling faint or passing out

  • Headaches

  • Defoliation

  • Difficulty concentrating

  • Rash, itching, blisters

  • Yellow peel or optics

  • Numbness or tingling

  • Common cold hands and feet

  • Trouble walking

  • Seizures

  • Fast heartbeat

  • More sensitive to lite

  • Weight gain or weight loss

  • Changes to the optics, such as dryness or redness

  • Changes in vision, such as blurry or double vision

  • Hair loss or extra hair growth

  • Swelling

This is not a complete listing of the signs and symptoms that may bear upon someone taking immunotherapy. Talk with your doc most what y'all should spotter for based on the specific medications you are prescribed.

Many side effects and their related symptoms will go abroad on their own or can be treated effectively over fourth dimension. However, there are some that can be very serious and need medical attention correct away. Talk with your wellness care team virtually which side effects you can expect and how to manage them. Also ask who to contact and what you should do if y'all have unexpected side effects. Learn more than about when to call the dr. during cancer treatment.

What intendance is needed afterwards immunotherapy ends?

It is important to continue getting intendance for side effects after immunotherapy ends. Many side furnishings will get away when you terminate treatment. But some effects tin last beyond the treatment period. Other effects may appear months or years afterward. Your health care team tin can help you watch for and manage late or long-term side effects. This includes problems with fertility. Work with your doctor to create a survivorship care plan afterward you lot finish treatment with immunotherapy. This is an of import tool to help watch for additional side effects in the hereafter.

Coping with side effects of immunotherapy

Everyone's experience with immunotherapy is different. Side effects vary from person to person, even when given the aforementioned type of treatment. Before your treatment, ask your wellness care team which concrete side furnishings are possible and what to watch for. In that location tin also exist emotional side effects, and seeking out mental health support to aid with anxiety or stress is important.

Ask your health care squad virtually means to have intendance of yourself during and after the treatment period, including getting enough residue, eating well, and staying hydrated.

And, keep talking with the team during and afterward treatment. E'er tell your health care team when side effects kickoff appear, worsen, or continue. That will allow your health care team to help y'all feel better equally quickly as possible.

Questions to enquire the health care team

These questions may be helpful to ask members of your health care team if immunotherapy is recommended every bit a part of your treatment plan. This list is provided as suggestions. You lot do not need to ask all of these questions. Focus on the ones that are nearly important to you in learning nigh your cancer treatment.

  • What side effects tin can I expect from the type of immunotherapy you are recommending for me? When will they likely begin?

  • How can these side effects be managed?

  • Who should I tell when a side effect appears or gets worse?

  • Are in that location specific side furnishings I should tell the wellness care team well-nigh right away?

  • What are the potential long-term furnishings of this type of immunotherapy?

  • Could this treatment affect my fertility? Should I talk with a fertility specialist before treatment begins?

  • Could this treatment affect my sex life? Exercise I need to have steps to prevent conception during and after my treatment?

The information in this article is based on ASCO recommendations on managing side effects related to handling with allowed checkpoint inhibitors and CAR T-cell therapy . Annotation that these links accept yous to a different ASCO website.

Related Resource

What You lot Need to Know About Immunotherapy Side Effects

What It'south Like Taking Immunotherapy to Treat Cancer

How Does CAR-T Cell Therapy Piece of work to Treat Cancer

Tumor-Doubter Treatment for Cancer: An Expert Perspective

ASCO Answers Fact Canvas: Understanding Immunotherapy (PDF)

More Data

National Cancer Institute: Immunotherapy to Care for Cancer

National Comprehensive Cancer Network: Agreement Immunotherapy Side Effects (PDF)

ASCO answers; Side Effects of Immunotherapy

Download ASCO'southward free 1-page (front and dorsum) fact sheet on Side Furnishings of Immunotherapy. This printable PDF provides an overview of side effects which may ascend from immunotherapy, and how they are treated. The dorsum side includes a symptom tracker for yous to fill out with your wellness care squad. Order printed copies of this fact sheet from the ASCO Shop.