Treat immunotherapy side-effects without wiping out the response
Immune side-effects are usually treated with high-dose steroids, which may also switch off the anti-cancer response. Targeted alternatives may control the side-effect and keep the benefit.
High cumulative corticosteroid exposure for immune-related adverse events is associated with worse cancer outcomes in several cohorts, although confounding by severity is hard to exclude. Targeted alternatives — early infliximab or vedolizumab for colitis, tocilizumab for arthritis and some pneumonitis, topical or organ-directed therapy — could resolve toxicity with less systemic immunosuppression. A randomised comparison has never been done with cancer outcome as an endpoint.
- No one can predict who responds to immunotherapy · Checkpoint drugs cure some patients and do nothing for most. We still cannot tell the two apart before treating.
- Toxicity and quality of life are undervalued · Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.
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