How Immunotherapy Affects Your Body
- Immunotherapy causes different side effects than chemotherapy because it revs up the immune system instead of attacking the cancer cells directly.
- Side effects depend on which part of the body immunotherapy affects, including the lungs, GI tract, skin, or heart.
- Steroid treatment can calm the overactive immune response and stop side effects.
“Chemotherapy is hard. A lot of patients lose their hair. They get extremely tired and weak,” Dr. Jay Shah, associate professor at Stanford University and a cancer surgeon at the Stanford Cancer Center, tells SurvivorNet.Read More
While immunotherapy avoids many of the typical chemotherapy side effects, like nausea and hair loss, it can cause a few symptoms of its own. Watching for these side effects and reporting them to your doctor can help you manage them quickly.
Immunotherapy Drugs to Treat Bladder Cancer
Checkpoint inhibitors are a type of immunotherapy drug that doctors use to treat bladder cancer. Often doctors prescribe them to people who can’t take the chemotherapy drug cisplatin.
Checkpoints like PD-1 and PD-L1 are proteins on the surface of some cells, including cancer cells. They prevent the immune system from attacking those cells.
Immunotherapy drugs turn off the checkpoints. “The immune system is then able to wake up again and target the cancer,” Dr. Arjun Balar, assistant professor of medicine and director of the Genitourinary Cancer Program at the NYU Perlmutter Cancer Center, tells SurvivorNet.
The specific immunotherapy drugs used in bladder cancer treatment are called PD-1 and PD-L1 inhibitors.
- Atezolizumab (brand name: Tecentriq) and avelumab (brand name: Bavencio) target PD-L1.
- Nivolumab (brand name: Opdivo) and pembrolizumab (brand name: Keytruda) target PD-1.
By blocking PD-1 and PD-L1, checkpoint inhibitors free the immune system to go after the cancer. “What these drugs do is reinvigorate the immune system, or unleash the immune system against cancer,” Dr. Balar says.
How Side Effects Differ
“With chemotherapy, the side effects that patients experience are a direct result of the chemotherapy drugs attacking normal and healthy cells,” Dr. Balar says.
The most common side effects people have from this treatment are:
- Hair loss
- Nausea and vomiting
- Mouth sores
- Low blood cell counts
Immunotherapy for Bladder Cancer Side Effects
Immunotherapy doesn’t cause these side effects because it activates the immune system instead of going after the cancer cells directly. “Then the immune system is attacking the cancer,” Dr. Balar explains.
Immunotherapy Side Effects
Immunotherapy basically takes the brakes off the immune system. That can sometimes cause an autoimmune reaction. Autoimmune means that your immune system attacks your body’s own organs and tissues by mistake.
The types of side effects that you have depend on which part of your body your immune system targets:
- Intestines: diarrhea, belly pain
- Lungs: shortness of breath, cough
- Hormone-producing glands: headaches, fatigue, weight loss, weakness, belly pain, nausea and vomiting
- Joints and muscles: pain, weakness
- Lungs: shortness of breath, cough
- Skin: rash, itchy skin, blisters
- Heart: low blood pressure, abnormal heartbeat
Some people have an allergic-like reaction to the infusion. Infusion reactions cause side effects like these:
- Trouble breathing
“Anywhere between 15 and 20% of our patients will develop a moderate to severe side effect from immunotherapy,” Dr. Balar says. “The good news is that the majority of these side effects are very much treatable.”
Managing Side Effects
Chemotherapy side effects are common, but they usually go away once the drugs are out of your system. Immunotherapy is less likely to cause side effects. But when it does, those side effects can be severe and require prompt treatment to manage.
Major cancer centers are experienced at spotting and treating immunotherapy side effects, Dr. Shah says. Still, it’s important to watch out for side effects and report them to your doctor right away.
If you do have side effects, your doctor might stop your immunotherapy treatment. One way to “calm the immune system back down” is with steroids, adds Dr. Balar. Steroids suppress your immune system so that it no longer attacks your own tissues. “Then usually the side effects go away within a couple of days.”