Immunotherapy is a type of cancer treatment that uses the body’s immune system to fight cancer. In recent years, there has been a lot of progress in the field of immunotherapy, particularly in the treatment of non-small cell lung cancer (NSCLC) with activating mutations in the epidermal growth factor receptor (EGFR). One type of immunotherapy used in this setting is immune checkpoint inhibitors, such as nivolumab and pembrolizumab. While these drugs can be effective in treating cancer, they can also cause side effects, including those related to the nervous, respiratory, gastrointestinal, endocrine, and dermatologic systems.
Nervous System Side Effects:
The most common nervous system side effects of immunotherapy drugs are fatigue, headache, dizziness, and confusion. These symptoms are usually mild and can be managed with rest and/or pain medication. However, in some cases, immunotherapy can cause more serious nervous system side effects, such as encephalitis, meningitis, or Guillain-Barré syndrome (GBS). Encephalitis and meningitis are inflammation of the brain and the membranes surrounding it, respectively. Symptoms may include fever, headache, confusion, and seizures. GBS is a rare neurological disorder that causes muscle weakness and paralysis. Symptoms may include tingling, numbness, or pain in the limbs, as well as difficulty breathing and swallowing.
Respiratory System Side Effects:
Immunotherapy drugs can cause several respiratory system side effects, including cough, shortness of breath, chest pain, and wheezing. These symptoms may be mild or severe and may require treatment with oxygen therapy, steroids, or bronchodilators. In some cases, immunotherapy can lead to more serious respiratory side effects, such as pneumonitis or acute respiratory distress syndrome (ARDS). Pneumonitis is inflammation of the lung tissue and can cause fever, cough, and shortness of breath. ARDS is a life-threatening condition that causes fluid to accumulate in the lungs, making it difficult to breathe.
Gastrointestinal System Side Effects:
Immunotherapy drugs can cause several gastrointestinal system side effects, including nausea, vomiting, diarrhea, abdominal pain, and loss of appetite. These symptoms may be mild or severe and may require treatment with anti-nausea medication, anti-diarrheal medication, or hydration therapy. In some cases, immunotherapy can lead to more serious gastrointestinal side effects, such as colitis or hepatitis. Colitis is inflammation of the colon and can cause diarrhea, abdominal pain, and fever. Hepatitis is inflammation of the liver and can cause fatigue, jaundice, and abdominal pain.
Endocrine System Side Effects:
Immunotherapy drugs can cause several endocrine system side effects, including hypothyroidism, hyperthyroidism, adrenal insufficiency, and diabetes mellitus. Hypothyroidism is a condition in which the thyroid gland does not produce enough thyroid hormone, causing fatigue, weight gain, and depression. Hyperthyroidism is a condition in which the thyroid gland produces too much thyroid hormone, causing weight loss, anxiety, and tremors. Adrenal insufficiency is a condition in which the adrenal glands do not produce enough steroid hormones, causing fatigue, muscle weakness, and low blood pressure. Diabetes mellitus is a condition in which the body does not produce enough insulin or is resistant to its effects, causing high blood sugar levels.
Dermatologic System Side Effects:
Immunotherapy drugs can cause several dermatologic system side effects, including rash, pruritus, and vitiligo. Rash and pruritus are common side effects that can be managed with topical or systemic medications. Vitiligo is a condition in which the skin loses pigment, causing white patches to appear on the skin.
Other Side Effects:
Immunotherapy drugs can cause several other side effects, including anemia, thrombocytopenia, and neutropenia. Anemia is a condition in which the body does not produce enough red blood cells, causing fatigue and weakness. Thrombocytopenia is a condition in which the body does not produce enough platelets, causing bleeding or bruising. Neutropenia is a condition in which the body does not produce enough white blood cells, causing an increased risk of infection.
In conclusion, immunotherapy drugs can be effective in treating cancer, particularly NSCLC with activating mutations in the EGFR. However, they can also cause side effects, including those related to the nervous, respiratory, gastrointestinal, endocrine, and dermatologic systems. It is important for patients receiving immunotherapy to be aware of these potential side effects and to report any symptoms to their healthcare provider. Healthcare providers should monitor patients closely for side effects and provide appropriate treatment when necessary.
