Side Effects of New Immunotherapies

Immunotherapy has revolutionized the treatment of many diseases, including breast cancer. It has significantly improved patient outcomes and is generally easier to tolerate than traditional chemotherapy. However, like any other treatment, immunotherapy can cause side effects that patients need to be aware of.

What Side Effects Can Occur?

Immunotherapy can trigger various changes in the body that may affect:

• Blood Composition: сhanges in the number of white blood cells, platelets, and other blood cells can increase vulnerability to infections and bleeding.
• Gastrointestinal Tract: patients may experience diarrhea, nausea, loss of appetite, and even intestinal inflammation.
• Skin: rash, itching, and other skin reactions are commonly observed.
• Lungs: inflammatory processes in the lungs can lead to coughing and shortness of breath.
• Nervous System: neurological and psychiatric disorders, including headaches, confusion, and depression, may also occur during treatment.

Classification of Side Effects Severity

The severity of side effects is classified according to the CTCAE (Common Terminology Criteria for Adverse Events), which helps doctors assess and manage adverse events:

• Grade 1: Mild side effects, such as minor skin rashes or slight malaise. These symptoms do not require special treatment and do not interfere with daily life.
• Grade 2: Moderate side effects, such as more pronounced skin reactions or digestive issues, which may affect daily activities. These symptoms are often treated on an outpatient basis.
• Grade 3: Severe side effects, such as significant organ dysfunction or severe weakness, requiring hospitalization and intensive treatment.
• Grade 4: Life-threatening conditions, such as severe lung inflammation or serious heart damage. In these cases, therapy must be immediately stopped, and intensive treatment should be administered.
• Grade 5: In very rare cases, side effects can be so severe that they lead to death.

Specialized Side Effect Boards: A Necessity of the Times

It is currently impossible to predict with certainty which patients will experience side effects and how they can be prevented. However, with the increasing use of checkpoint inhibitors, it is becoming increasingly important to develop strategies for effectively managing side effects.

For example, at the Center for Integrated Oncology at the University Hospital of Cologne, a special side effect board (iTox-Board) was established three years ago. This board, which meets every two weeks, brings together doctors from various specialties to improve the management of immunotherapy side effects. Their goal is to quickly diagnose emerging symptoms and initiate timely supportive therapy.

The Importance of Informing Patients

Before starting checkpoint inhibitor therapy, it is important for patients to be fully informed about possible side effects. The doctor conducts a thorough physical examination, orders laboratory tests, ECG, ultrasound, and, if necessary, other imaging methods to check organ functions and identify patients at increased risk of side effects.

During therapy, patients require regular monitoring, including laboratory tests such as blood tests, kidney function markers, liver function markers, thyroid levels, blood glucose levels, and pancreatic enzymes. If abnormalities are detected, additional tests are ordered to confirm the diagnosis.

Supportive Treatment

When side effects occur, their severity determines the course of further treatment:

• Grade 1: Regular monitoring is usually sufficient, and therapy can continue unless the side effects affect critical organs such as the heart or nervous system.
• Grade 2: Temporary cessation of therapy may be necessary. Treatment is resumed after symptoms reduce to Grade 1 level, and low-dose corticosteroid therapy may be prescribed.
• Grade 3 and above: Checkpoint inhibitor therapy must be discontinued. High doses of corticosteroids are administered concurrently. Cancer treatment can only resume after corticosteroids are discontinued and the patient’s condition stabilizes.

The Future of Managing Side Effects

As checkpoint inhibitors become more significant in oncology, managing side effects is becoming an increasingly important task. The high severity of complications caused by therapy presents a serious challenge for both diagnosis and treatment. In Germany, there is still a lack of local and regional boards and scientific data on the side effects of immunotherapy, as well as corresponding treatment strategies.

Therefore, continuous improvement of medical knowledge and practice in the field of immunotherapy and side effects is crucial for the successful treatment of patients and improving their quality of life.