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Common immunotherapy side effects and how to manage them

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 21, 2021.

Immunotherapy has become one of the most common treatments for cancer, and is designed to use your immune system to find and attack cancer cells.

Among the many different immunotherapy drugs, there are three main types of treatments, including:

  • Checkpoint inhibitors
  • Cytokines
  • Cancer vaccines

With any cancer treatment, there is a potential risk of side effects. A key takeaway for any side effect of immunotherapy is to be aware of what to expect and have a management plan of action with your care team.

How long will side effects from immunotherapy last?

Side effects of immunotherapy may occur at any point throughout treatment and be short- or long-term. It’s important to know the signs and have a management plan.

You need immediate attention if you’re experiencing the following severe side effects:

  • Colitis
  • Hepatitis
  • Kidney failure
  • Pancreatitis
  • Neuropathy
  • Myocarditis
  • Severe infections or skin reactions
  • Type 1 diabetes
  • Lung inflammation

What are the side effects of immunotherapy?

Immunotherapy uses drugs and substances to attack cancer and cancerous cells, or to slow its spread to other parts of the body, but it may also attack healthy cells, tissues or organs in the process.

The side effects depend on how healthy you were before treatment, your type of cancer, and the length of treatment and dosage.

Knowing as much as possible about immunotherapy side effects and what to expect may help put you more in control and at ease.

A few main side effects of immunotherapy include:

Fatigue: Immunotherapy can take a toll on your body and be both physically and mentally exhausting. Cancer fatigue feels different from fatigue from your usual day-to-day routine.

Some ways to manage fatigue are:

  • Balance rest and activity. Find a routine where you can relax and also make time for a walk or partake in other outdoor activities.
  • Create a nutrition plan. Drink plenty of clear fluids and consume a balanced diet of protein, carbohydrates, fat, and vitamins and minerals to keep your energy levels up.
  • Connect with a mental health expert. Speaking with a counselor or psychologist may help you manage pain and cope with the stress and difficult thoughts often associated with cancer treatment.

Skin irritation: Immunotherapy often causes a series of skin reactions, including blistering, dryness and redness. In other cases, the skin may become sensitive to sunlight, and your fingertips may crack.

Some ways to manage skin irritation are:

  • Contact a dermatologist. Your cancer care team may recommend speaking with a dermatologist to address more specialized treatments for managing skin problems.
  • Clean appropriately. Use warm water and unscented soap to rinse your skin, then pat it dry with a towel.
  • Moisturize often. Lather the irritated areas of your skin with a cream or a thicker lotion to help add moisture.
  • Ask about over-the-counter or other medicines. Cream or ointment for skin swelling or dryness may help relieve pain and itching and reduce any swelling or redness. In more severe cases, you may be prescribed an antihistamine or steroid.

Fever and chills: After immunotherapy, your temperature may spike to help regulate your body’s processes.

Some ways to manage fever and chills are:

  • Cool down. Run cold water over a cloth and place it on your forehead.
  • Avoid creating more heat. Don’t wrap your body in blankets, as this may increase your temperature.
  • Reach out for professional help if needed. If your chills continue, speak with your doctor. Medications may be prescribed to help.

Nausea and vomiting: During immunotherapy, you may feel queasy or lightheaded.

Some ways to manage nausea and vomiting are:

  • Follow a simple diet. Try to stick to bland foods such as toast or crackers and clear liquids such as water. In some cases, ginger ale may also help.
  • Take a break. Relaxation techniques, hypnosis or acupuncture may help to ease symptoms.
  • Discuss medication options. If the problem persists, certain medicines may help control nausea and help you feel better.

Diarrhea: Immunotherapy may irritate your abdomen or areas around your abdomen, which can lead to diarrhea or loose stools.

Some ways to manage diarrhea are:

  • Stay hydrated. You lose a lot of fluids with diarrhea, so you’ll want to drink plenty of water and electrolytes to replenish your levels and prevent dehydration. Potassium and sodium specifically are important to replenish, and you can get them from drinking sports drinks or broths. If diarrhea continues, your doctor may prescribe medication.
  • Change your meal structure. Aim for six to eight mini meals throughout the day instead of three larger ones. This may help so that your body isn’t working harder to digest larger meals. Try to include foods high in minerals such as potassium and sodium.

High blood pressure: Certain immunotherapy medications may cause high blood pressure.

Some ways to help manage high blood pressure naturally include:

  • Making exercise a part of your regular routine
  • Following a balanced diet
  • Cutting back on sodium
  • Reducing and limiting your alcohol and caffeine intake
  • Stopping smoking

If you’re experiencing high blood pressure, speak with your physician to help find the most appropriate way to manage it. This may include taking medication. It may also help to have a blood pressure monitor at home so you can regularly check your levels.

Headaches: Immunotherapy treatment may cause flu-like symptoms, including headaches, which can feel like a throbbing in your head or behind your eyes.

Some ways to manage headaches are:

  • Try massage. Use your fingers to gently massage your head, neck and around your eyes.
  • Seek cooling relief. Place a cool cloth on your forehead or even take a cold shower.
  • Ask about medication. Ibuprofen, aspirin or acetaminophen may help relieve tension.

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