What Are the Side Effects of Immunotherapy?

  • The side effects of immunotherapy can be different from those associated with standard treatments.
  • One study found that fatigue was the most common side effect, along with fever, chills, nausea, and reactions at the site of the infusion.

Medically reviewed by Gordon Freeman, PhD

New drugs that stimulate the patient’s immune system to attack tumors have achieved some dramatic and long-lasting benefits in several forms of cancer. A few drugs are already approved for wide use and many more are in the research pipeline. Because these immunotherapy agents work differently than chemotherapy, the side effects of immunotherapy can be different from those associated with standard treatments.

One of cancer cells’ survival strategies is to hide from immune soldier T-cells and exploit natural “checkpoint” proteins that suppress T-cell activity. Some immunotherapy agents disable these checkpoints, removing the brakes so T-cells can mount a stronger immune attack on cancer cells. In this way, the drugs don’t directly assault the cells; instead, they free the patient’s own defensive forces to destroy cancers.

But it’s a two-edged sword. Freed from checkpoint restraint, the surging immune response can overshoot its target and attack healthy tissues and organs, similar to an autoimmune disorder.

“Immunotherapies are pretty well tolerated – there’s no hair loss or blood cell abnormalities. There are not cell poisons. But they have a different set of potential side effects,” says Dana-Farber’s Gordon Freeman, PhD, whose research has been fundamental to the development of immunotherapies that have emerged in the past several years.

Common and serious side effects

One study found that fatigue was the most common side effect, along with:

  • Fever
  • Chills
  • Nausea
  • Reactions at the site of infusion

Immunotherapy drugs such as ipilimumab, which targets the CTLA-4 checkpoint, and PD1/L1 checkpoint blockers like nivolumab and pembrolizumab are approved for melanoma, lung, and kidney cancer. Patients who receive these therapies need to be monitored for potentially more serious adverse effects such as:

  • Pneumonitis (inflammation of the lungs resulting in cough and difficulty breathing)
  • Colitis (inflammation of the large bowel leading to diarrhea)
  • Hepatitis and pancreatitis
  • Skin rashes
  • Endocrine disorders including thyroid abnormalities and adrenal insufficiency

Fortunately, the vast majority of such reactions can be controlled with immune suppressive drugs such as corticosteroids and antihistamines that tamp down the inflammatory overreaction.

Side effects are best treated when diagnosed early. Patients are always asked to report anything that seems unusual to their care team who can determine if it’s related to their immunotherapy treatment.

6 thoughts on “What Are the Side Effects of Immunotherapy?”

  1. I’d like to hear more about the progress being made against brain cancer, specifically glioblastoma multiforme.

  2. Dear Rachel–

    Thank you for your comment and for reading Insight. We are actually hosting a live webchat on Feb. 26 at 1pm that will cover the latest research for adult brain tumors. You can watch the chat live (or a recording later that day) by visiting http://www.dana-farber.org/braintumorchat.

    More information about brain tumor research and treatment is also available here: http://www.dana-farber.org/Adult-Care/Treatment-and-Support/Treatment-Centers-and-Clinical-Services/Center-for-Neuro-Oncology.aspx

    Thank you again for reading. Wishing you all the best.

  3. I was told over a year ago that immunotherapy is very difficult if not impossible with ER+/PR+/HER2- breast cancer. As a result the immunotherapy research is focused on HER2+ and triple negative. Has there been any advances that have shown promise with HR+/HER2-?

  4. Dear Sharon —

    Thank you for your question and for reading Insight. It is true that initial studies of immunotherapy in ER+/PR+/HER2- breast cancer suggest that the currently available immunotherapy drugs are not likely to be effective in a significant percentage of patients with this type of breast cancer. However, some data from laboratory studies suggest that combining immunotherapy with other types of treatment such as chemotherapy or radiation may improve the effectiveness of immunotherapy in this type of breast cancer. At Dana-Farber, clinical trials of immunotherapy plus chemotherapy in ER+/PR+/HER2- breast cancer are being developed and should be available later this year.

    I hope this is helpful! Wishing you all the best.

    • My brother in law became severely confused as a result of Immuno therapy. He was diagnosed with cancer of the brain and lung cancer. He was determined to be too weak for chemo and radiation therapy but a good candidate for Immuno therapy. After two treatments he became very confused and his treatment were discontinued.
      His doctors were never able to specifically diagnosis this problem nor to treat it except to let the drug run its course. After three weeks his confusion cleared up and he was placed on hospice I’d like to know if this is is unusual . The therapy was working for him

      His brain cancer was eradicated and his lung cancer reduced. His doctors are .afraid to continue the treatment since they can’t manage the confusion I’d like know if there is a solution to this problem.

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