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Supportive
Immune-related toxicity management
Immunotherapy side effects behave nothing like chemotherapy's, and are missed constantly.
What it is
Checkpoint inhibitors can cause the immune system to attack normal organs, thyroid, bowel, liver, lung, skin, pituitary, occasionally heart. These reactions can appear weeks or months after treatment, including after it stops.
They are highly treatable when recognised early and dangerous when not. The commonest failure is a patient with diarrhoea being sent home with an anti-motility drug when they needed steroids.
When it is used
- Anyone on or recently on a checkpoint inhibitor
- New diarrhoea, rash, breathlessness or fatigue on immunotherapy
- Unexplained symptoms months after immunotherapy ended
- Before an unrelated operation or steroid course
How the decision is made
- Whether a symptom is disease progression, infection or immune toxicity, the treatments are opposite.
- Grade, and therefore whether treatment is paused, stopped or continued with steroids.
- Whether re-challenge is safe once it settles.
Assessed and managed here, with same-day escalation to a partner emergency unit where needed.
Who does what
What we handle, and what happens elsewhere
KPCIRC handles
- A written toxicity card you carry, naming the drug and what to watch for
- Baseline and interval thyroid, liver and glucose monitoring
- Rapid assessment when something new appears
- Steroid protocols and a taper plan
- A re-challenge decision at the board
Performed and billed elsewhere
- Inpatient care where admission is needed
- Endoscopy or imaging to confirm a diagnosis
- Tell any doctor who sees you that you are on or have had immunotherapy, including in an emergency department, and including up to a year after it stopped. Diarrhoea on immunotherapy is not food poisoning until proven otherwise.
Questions to ask your own doctor
Take these with you. They work whether or not you are treated here.
- What symptoms mean I should call you the same day?
- Who do I call, and out of hours?
- Should I be carrying a card?
- How long does this risk last after treatment stops?
Support that goes with it
Where this is used
Cancers this commonly forms part of
Lung & thoracic cancer
Non-small cell and small cell lung cancer, mesothelioma, thymic tumours
Skin cancer & melanoma
Melanoma, basal cell and squamous cell carcinoma
Kidney cancer
Renal cell carcinoma
Bladder cancer
Urothelial carcinoma of the bladder
Liver cancer
Hepatocellular carcinoma, HCC
Oral, head & neck cancer
Mouth, tongue, cheek, gum, throat, voice box and salivary gland cancers
Not sure this is the right option for you?
That is exactly what a second opinion is for. Bring what you have, we will tell you what is missing and what the alternatives actually are, in writing.