The author reports on several cases of life-threatening reactions to immunotherapy. We administer these drugs daily at the cancer center, so the article sparked my interest.
For those who are not already familiar, immunotherapy works by using the patient’s own immune system to target the tumor. Some cancer tumors have the ability to mask themselves so they become undetectable by the circulating white blood cells, which are part of the immune system. By blocking this interaction of the tumor and white blood cell with immunotherapy drugs, the white blood cells stay active and are able to see and target the tumor.
Immunotherapy has been an energizing discovery for the world of oncology. Efficacy against multiple types of cancer has been shown, and the side effect profile is completely different than that of conventional chemotherapy. That means they are able to be given to patients who might not be able to receive traditional chemotherapy. Immunotherapies give oncologists another viable option for fighting cancer and extending life.
As with any medication, these drugs may cause side effects, and some patients may experience adverse reactions. An enhanced immune system increases the chance that other organs may be affected by “autoimmune” reactions, where one’s own immune system attacks healthy organ cells. At El Camino Hospital Cancer Center, lab work and a visit with the physician or nurse practitioner is required before each dose. Patients are educated about side effects they should look for and are encouraged to promptly report any new symptoms. Side effects can range from Grade 1 (very mild) to Grade 4 (severe), and the earlier the symptoms are reported and addressed, the more likely they are to be easily and effectively treated.
The author of the New York Times article makes some valid points. For clinicians unfamiliar with these newer cancer therapies (e.g. at smaller clinics or in emergency departments), the side effects can be unexpected, differing from those of traditional cancer treatment. It is important that patients receive thorough education about their treatment and possible side effects, as patients are their own best advocates. An open line of communication to their oncology team makes reporting side effects quick and simple.
For those that may have found the article concerning, there are some details to be aware of. The patients highlighted in the article were receiving a combination of two separate immunotherapy drugs. Treatment with more than one immunotherapy drug at a time has been associated with an increased risk of adverse reactions. The author also reports that there were recently five deaths associated with immunotherapy; however, those patients were being treated with a new drug in a clinical trial setting, NOT with any therapies currently available.
They say there’s no such thing as bad publicity. I think articles like this one, though a bit misleading, can provide an opportunity for patients and providers to talk about the risks and benefits of treatment. The author did ask each of those interviewed whether or not they felt that the risk of side effects associated with immunotherapy was worth the benefits. The answers were a unanimous yes. It is a good reminder to stay informed and notify your care team as soon as possible if you notice a new or worsening side effect. Cancer treatment is ever evolving, and immunotherapy is an exciting new weapon we have in the war against cancer.
Jessica Miles, RN, MS, OCN
Oncology Program Coordinator
El Camino Hospital Cancer Center