As Chuck Peal lay in hospital, doctors scrambled to figure out what was wrong with him. He appeared to be dying, and doctors thought he was having a heart attack. His blood pressure plummeted, and his blood sugar spiked to ten times the normal levels. His body was essentially attacking itself. In reality, this was all a result of treatment aimed at saving his life (1).
Immunotherapy
Mr. Peal had been dealing with melanoma that had spread to his lungs in June 2015 when he resorted to immunotherapy. The therapy which is designed to take the breaks off the immune system often has severe and irreversible side effects. In the case of Mr. Peal, it lead to acute-onset diabetes, but he’s not alone (1).
Nivolumab and ipilimumab
Using a combination of drugs, most commonly nivolumab, and ipilimumab, doctors have had a wide array of success treating otherwise fatal conditions. It’s just that the side effects are severe, require hospitalization, or are life-threatening (2).
Turning off the brakes
The effectiveness of immunotherapy drugs and the side effects are bound by the same principles. The drugs work by reversing a trick that cancer plays on the immune system. The cancer cells send signals to the immune system cells that cause them to stand down. In short, cancer is turning on the immune system’s brake. But the immunotherapy drug turns the break-off, sometimes shrinking tumors in mere days (3).
Side effects
However, what Mr. Peal experienced was extreme. When he started taking nivolumab and ipilimumab, he was told he might feel drowsy or nauseated and that he might get a rash. But what he went through almost cost him his life.
For Mr. Peal, it started with a rash from his knees to his waist. He visited the doctor and was prescribed a steroid. Later, he experienced fever, nausea and was dying of thirst. He was also throwing up everything. He was given two anti-nausea drugs, and by the following day he simply couldn’t move and was taken to the hospital. While there (24 days) his pancreas failed, his bowels became inflamed, and his kidneys became dysfunctional all while having a fever of a 103 (1).
Tradeoffs
But the tradeoff seems to be worth it as scans have shown that immunotherapy has eliminated two of Mr. Peal’s cancer lesions and shrunk two others. It seems patients can handle the trade-offs, even though things like their pancreas won’t ever recover, diabetes is far more handleable than melanoma (1).
Unprepared for side effects
The biggest hurdle for people taking immunotherapy drugs is that when they experience side effects, doctors and nurses are often caught off guard. For one thing, the side effects are different for everyone who takes these drugs, even though there are growing numbers of people like Mr. Peal who are now diabetic thanks to the treatment, symptoms often present as something mild like flu-like symptoms. Additionally, the drugs are new and many of the side effects have not yet been seen by doctors. Further, symptoms seem to appear at random sometimes months after treatment(1).
There hasn’t been enough research into the side effects of these drugs, some doctors calling it a massively understudied area. But the main concern is the anti-tumor effects, the consequences, no matter how severe they may appear, seem to be worth it for many.
(1) The New York Times. Immune System, Unleashed by Cancer Therapies, Can Attack Organs http://www.nytimes.com/2016/12/03/health/immunotherapy-cancer.html?_r=1 Published: December 3, 2016. Accessed: December 15, 2016.
(2) NCBI. Efficacy and safety of ipilimumab monotherapy in patients with pretreated advanced melanoma: a multicenter single-arm phase II study https://www.ncbi.nlm.nih.gov/pubmed/20147741 Published: August 21, 2010. Accessed: December 15, 2016.
(3) Cancer.net. Understanding Immunotherapy http://www.cancer.net/navigating-cancer-care/how-cancer-treated/immunotherapy-and-vaccines/understanding-immunotherapy Published: May 2016. Accessed: December 15, 2016.
Youtube. Immunotherapy: Boosting the immune system to fight cancer https://www.youtube.com/watch?v=-NNjDjXSJt0 Published: March 30, 2012. Accessed: December 15, 2016.
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