Lecture Notes
Immuno-oncology: Harnessing the immune system to treat cancer

Are you on the alert for the side effects of immunotherapy in your patients? Prof Phil Clingan gave an eye-opening talk about new immune therapies for cancer at the October medical update.

Immunotherapy is revolutionising cancer treatment and can be much better tolerated than traditional chemotherapy, but it has a large range of possible side effects and some effects are still emerging. Illawarra Shoalhaven is now the 5th largest center for immunotherapy trials in the world. As a result, we need to be prepared for patients presenting with side effects and complications of these treatments.

Immune therapy is quite different to chemotherapy. For example, Pseudoprogression is also a new entity with immunotherapy, where the tumours may look bigger during initial treatment (due to T cell infiltration). This is not a failure of treatment as these tumours then can show dramatic improvement later in the treatment course. For this reason, we don’t judge treatment failure based on tumor size any more.

Common side effects of immunotherapy include:

  • Hypothyroidism – this is routinely monitored for during treatment now. It can occur early or very late in treatment.
  • Pneumonitis
  • Colitis – this can present as diarrhoea and can be life threatening.
  • Hypophysitis
  • Many other side effects are possible…

In general, if a patient presents unwell while on immunotherapy, assume the cause is the immunotherapy until proven otherwise. Corticosteroids are the mainstay of treating these adverse reactions, but early oncologist involvement is essential if you have any concerns.

Live vaccines are contraindicated while on these immune therapies.

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