Clinical Pearls

Side Effects of Immunotherapy in Palliative Care

Susan B. LeGrand, MD FACP FAAHPM

The hope of immunotherapy was that it would be less toxic than cytotoxic chemotherapy by binding to specific receptors and using the patient’s own immune system to treat the cancer. As the agents have been used more, we are discovering significant toxicities that are different from the normal chemotherapy side effects. Many agents have been approved for different hematologic and solid tumors. This article will only discuss solid tumor immune checkpoint inhibitor (ICI) therapies because they are the ones most likely to be seen in palliative medicine. The other class of agents that may be seen are the tyrosine kinase inhibitors, with predominantly skin toxicity, edema, nausea, hypothyroidism, vomiting, and diarrhea. Skin toxicity actually may help predict response. For practical reference, drugs ending in “ib” are inhibitors (of various receptors) whereas those ending in “mab” are monoclonal antibodies.