Immune Therapy Overview
Immune therapy includes a wide variety of treatments for cancer. Immune checkpoint inhibitors are currently the most commonly used. This includes treatments in several families of drugs:
- Anti-PD-1 (programmed death-1): Nivolumab (Opdivo), pembrolizumab (Keytruda), and cemiplimab (Libtayo)
- Anti-PD-L1 (programmed death ligand-1): Atezolizumab (Tecentriq), durvalumab (Imfinzi), and avelumab (Bavencio)
- Anti-CTLA-4 (cytotoxic T lymphocyte antigen-4): Ipilimumab (Yervoy)
These treatments have been approved in over 15 different cancers and aim to remove important “brakes” on the immune (defense) system, causing the immune system to target and attack the cancer. Immune checkpoint inhibitors work very differently from chemotherapy. They work to induce immune “memory,” and thus may produce long-term responses in some patients.
We have little ability to predict which patients will respond prior to starting treatment, though extensive research is ongoing in this area.
Immune therapy causes side effects as “collateral damage” of sorts by causing the immune system to target the body’s organs. This can cause inflammation that may affect any organ system. Prompt treatment with steroids and other therapies is usually very effective at reversing this inflammation. Occasionally, this inflammation can become life-threatening, thus communicating with your physician is critical.
The most common manifestations of this include:
- Colitis (inflammation of the colon): Diarrhea is the most common symptom but also may include abdominal pain and blood in the stool.
- Pneumonitis (inflammation of the lungs): Dry cough and/or shortness of breath are the most common symptom, much less often fever and cough with sputum.
- Rash (inflammation of the skin): This may present in a variety of ways (bumps, plaques, etc.), with or without itching.
- Hypothyroid (low thyroid following inflammation of the thyroid): Fatigue is the most common symptom but may also include weight gain, swelling, hair or skin changes.
- Arthritis (inflammation of the joints): This may present with pain in any joint, most commonly in joints that already had arthritis before starting treatment.
Less common manifestations include:
- Hepatitis (inflammation of the liver): This is usually diagnosed in bloodwork without symptoms, but symptoms may include fatigue, abdominal pain, nausea, or jaundice.
- Myocarditis (inflammation of the heart): May present with chest pain, shortness of breath, severe fatigue, or electrical rhythm disturbances (e.g., heart racing, lightheadedness).
- Neurologic symptoms (inflammation of the brain or nerves): May present with confusion, weakness, or difficulty moving, talking, or swallowing.
- Myositis (inflammation of the muscles): May present as weakness, muscle pain, or difficulty breathing.
- Uveitis (inflammation of the eye): May present with blurred vision or eye pain.
- Hypoadrenal (low adrenal function): May present with lightheadedness or extreme fatigue
- Hypophysitis (pituitary inflammation): May present with headaches or extreme fatigue.
- Hematologic toxicities (resulting in low red blood cell or low platelet counts): his may present with extreme fatigue, jaundice, excess bruising, or easy bleeding
- Diabetes (resulting from inflammation of the pancreas): May present with fatigue, lightheadedness, excess urination, or confusion.
Fighting these inflammatory side-effects requires bringing together physicians and health care providers from different specialties to most effectively treat patients. This is a major goal of V-POINT. At the same time, our program is working to connect clinicians and scientist who will further the research and determine how to make the treatment more effective while lessening the side-effects.