“These medicines don't just cut the brakes on T
cells—which are a type of immune cell—that recognize cancers,” says Wolchok. “They’re doing it to all
the immune cells in the body that have these brakes on
them.” Immune cells that would normally exist in the
blood in small numbers get “more frequent and more
activated,” he explains. Some of these cells will hopefully kill cancer cells; others might attack healthy tissue.
Professional organizations have recently released
guidelines for recognizing and treating checkpoint
inhibitor side effects, meant to help doctors, nurses and
pharmacists who may not have much experience with
patients treated with immunotherapy. The Society
for Immunotherapy of Cancer guidelines came out in
November 2017, and the American Society of Clinical
Oncology (ASCO) and the National Comprehensive
Cancer Network collaborated as each developed guidelines that were released in February 2018.
Patients also play a vital role in spotting side
effects while they are still manageable. “The patient
is the first line of defense,” says Julie Brahmer, a
medical oncologist specializing in lung cancer and
immunotherapy research at the Bloomberg-Kimmel
Institute for Cancer Immunotherapy at the Johns
Hopkins Kimmel Cancer Center in Baltimore, who
helped lead development of the ASCO guidelines.
“It’s very important that they let us know if they
have side effects. It’s our job to try to read through
the symptoms to figure out ‘Is this immune-related,
cancer-related or something completely different?’”
Clinicians routinely monitor the blood of patients
on checkpoint inhibitors, keeping tabs on the health
of some organs such as the liver and thyroid. But they
can’t test for every problem that might arise.
“One of the most common and potentially fatal
side effects is colitis, or inflammation of the intestines,” says Wolchok. Doctors will not be aware of
colitis if patients do not talk about their symptoms.
“At the very beginning of treatment, I sit down with
my patients and say, ‘ You know what? We have to
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Chemotherapy regimen consisted of: Perjeta, Taxotere,
Carboplatin & Herceptin (every 3 weeks x 6 cycles),
followed by Herceptin every 3 weeks for 1 year.
The ability to maintain my natural eyebrows
during my treatment made a signi;cant
psychological di;erence when dealing with
my other losses. With a wig, eyeliner and the
preservation of my own eyebrows, others
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” — Lynn
Patient retained her eyebrows despite
full body hair loss elsewhere