Immune checkpoint inhibitors most common side effects

WHAT IS IMMUNOTHERAPY?

Immunotherapy is a type of cancer treatment that increases the body’s natural defenses to fight cancer. It improves the immune system’s ability to find and attack cancer cells2 by using substances made either by the body or in a laboratory. This treatment can be used alone or combined with other cancer treatments. There are different kinds of immunotherapies, each working in a different way. Some of them boost the immune system to stop or slow the growth of cancer cells, whereas others destroy cancer cells or stop the cancer from spreading to other parts of the body. The most common immunotherapy types include monoclonal antibodies, tumor-agnostic treatments (such as checkpoint inhibitors), oncolytic viruses, T-cell therapy and cancer vaccines. The tumor-agnostic treatments treat tumors anywhere in the body by focusing on specific genetic changes3. Research is being done to help identify those patients for whom immunotherapy may succeed and those who may have severe side effects4. The type of drug, dose, and treatment schedule depend on many factors, as the type of cancer, size, location, where it has spread, the age, general health, body weight, and how well the patient can cope with side effects3.

WHAT ARE IMMUNE CHECKPOINT INHIBITORS?

Immune checkpoint inhibitors are used to treat many types of cancer, including lung cancer, melanoma, bladder cancer, melanoma, colorectal cancer, kidney cancer 1 and many others. They target the immune checkpoint proteins, which are designed to stop the immune system 4 . For instance, they include PD-1, PD-L1, and CTLA-4 1 . Blocking these proteins activates the immune system in a highly effective way. However, immune checkpoint inhibitors are a new kind of therapy, so the research community is still learning about how it affects people. The over-activation of the immune system can end up attacking healthy and functional parts of the body, causing unpredictable side effects that can be life-threatening if not treated in time 4 . One example of an approved immune checkpoint inhibitor is pembrolizumab, used to treat metastatic tumors that have a specific molecular alteration (microsatellite instability-high) or DNA mismatch repair deficiency. Another example is nivolumab, which has also been approved to treat adults and children with microsatellite instability-high or DNA mismatch repair deficiency in metastatic colorectal cancer that has not been stopped by chemotherapy. Other common immune checkpoint inhibitors are ipilimumab, atezolizumab, avelumab, durvalumab 3 , cemiplimab, and dostarlimab 2

WHY DO IMMUNE CHECKPOINT INHIBITORS CAUSE SIDE EFFECTS?

What are the most common immune checkpoint inhibitors side effects? Any cancer treatment can cause side effects, including immunotherapy 1 , because sometimes the immune system can also attack healthy cells, creating «immune-related adverse events». These side effects can occur at any time during treatment, or sometimes even after stopping immunotherapy, and can range from mild to severe 1 . They will depend on the type of immunotherapy 2 , the type of cancer, its location, general health and other factors, and are different for each person. Therefore, patients should always ask their doctors about the side effects of their personalised treatment 1 .

WHICH ARE THE MOST COMMON SIDE EFFECTS OF IMMUNE CHECKPOINT INHIBITORS?

The most common side effects include gastrointestinal tract problems (diarrhea or colitis as the most frequent, and less commonly, nausea or vomiting) 2 , skin rashes 1 (covering less than 10% of the body) or itching 2 , fatigue, shortness of breath, liver problems 1 , fever, headache, weight loss, difficulty falling or staying asleep, decreased appetite 4 , or problems with the muscles, joints, and bones. Besides, treatment with immune checkpoint inhibitors can cause inflammation of the tissues of the eyes, especially in people who receive a combination of immune checkpoint inhibitors 2 . There are many other possible side effects, including severe ones, but not as frequent as these. Of note, they are common but may not occur in all people or with all types of immunotherapies 4 .


If they occur moderate or severe side effects, the treatment may be paused and the doctor may prescribe corticosteroids or other medications to calm the immune system of the patient. If the side effects are relieved, the doctor may try to start immunotherapy again or adjust the treatment regimen 2

Victoria Menéndez

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REFERENCES

  1. What People With Cancer Should Know About Immune Checkpoint Inhibitor Side Effects. Cancer.Net. 2021;
  2. Schneider BJ, Naidoo J, Santomasso BD, et al. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update. J. Clin. Oncol. 2021;39(36):4073–4126.
  3. Understanding Immunotherapy. Cancer.Net. 2013;
  4. What You Need to Know About Immunotherapy Side Effects. Cancer.Net. 2018.

Immune checkpoint inhibitors most common side effects

Immune checkpoint inhibitors most common side effects

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