Using Evolving Knowledge to Manage Cancer's Side Effects

Q: I’ve read a number of news reports about serious side effects arising from immunotherapy treatment for cancer. Should I avoid taking immunotherapy?

A: There are some lessons one learns during a decadeslong career in cancer care, chief among them that there is always more to learn. Many new treatments may live up to or even exceed expectations, while others may not turn out quite as successful as they initially appear.

Recent reports in the popular media on the side effects of immunotherapy reinforce those lessons, but, in fact, have a bit of a sensationalist tone. From where I sit, they may be tilting the pendulum a bit too far in the wrong direction.

When it became evident a couple of years ago that immunotherapy was more effective than we had anticipated — offering meaningful treatment with apparently fewer side effects compared with more traditional treatments — there was considerable excitement in the scientific and patient communities. Now we have reports that, sometimes, these drugs cause our immune systems to turn on our own bodies. Serious side effects, such as inflammation of the colon and other glandular organs, are being seen more often as the drugs are used in more patients. What gets lost in the discussion is the fact that these effects were not unanticipated. At a major annual cancer meeting a couple of years ago, when research was reported on the large number of cancers responding to immunotherapy, I thought that, although the side effects in most cases appeared to be modest, nothing is ever as good as it seems. Things can go wrong when you tinker with our bodies’ built-in checks and balances. So it’s no surprise that, as we gained more experience with these treatments, more side effects became apparent.

However, that does not diminish the reality that these drugs represent a genuine advance in treating cancer, and the best hope for some patients. Yes, side effects can occur, but that doesn’t mean that patients should avoid immunotherapy, or that their doctors shouldn’t prescribe it. Instead, we can apply what we have learned by teaching patients, their caregivers and health care providers to anticipate, recognize and treat these side effects, and to balance anticipated benefits versus harms.

It’s not a perfect system, but this evolution highlights the importance of our ongoing quest to gain experience and knowledge, which prepares us do the most possible good, and the least harm, as we embrace novel anticancer strategies.

The need to balance excitement with awareness is a lesson we should never forget.

Len Lichtenfeld, M.D., is deputy chief medical officer of the American Cancer Society.

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