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Chief of Hematology/Oncology and Medical Director at Memorial Cancer Institute, and Clinical Associate Professor of Medicine at Florida International University

Chief of Hematology/Oncology
Medical Director of Memorial Cancer Institute

Lung Cancer Video Library - Spanish Language: Video #27 Potential Side Effects of Immune Checkpoint Inhibitors and Basic Management Approaches
Fri, 02/03/2017 - 12:51
Luis Raez, MD FACP FCCP, Faculty, Board Member

Posibles efectos secundarios de los inhibidores de puntos de control inmunológicos y los enfoques básicos de manejo

Possible side effects of the immunological checkpoint inhibitors and the basic management approach


 Dr. Luis Raez, MD FACP FCCP,

Chief of Hematology/Oncology and Medical Director, Memorial Cancer Institute,

Clinical Associate Professor of Medicine, Florida International University



La inmunoterapia, en general, no es muy tóxica. Muchas veces cuando los pacientes hablan con nosotros, se asustan porque uno le da la lista de todos los efectos secundarios que potencialmente puede tener, pero en general, en base a los estudios clínicos y a la realidad, la inmunoterapia es mucho menos tóxica. La incidencia de efectos secundarios graves es menor y los pacientes la toleran mucho mejor.

La inmunoterapia da efectos secundarios clásicos, como todos los causados por agentes contra el cancer, como fatiga (muy común) o sarpullido en piel. Los que son particulares son interesantes, como hipertiroidismo o mayormente hipotiroidismo, que muchas veces es asintomático por lo que muchas veces no vamos a esperar que un paciente venga con exceso de peso o somnolencia, por lo que tenemos que estar constanmente checándole la sangre para que descubramos el hipotiroidismo y actuar antes de que el paciente lo haga clínico. Aún no hay un consenso, pero muchos de nosotros cada 6 semanas checamos el TSH como un tamizaje para ver si el paciente está desarrollando hipotiroidismo o no.

Los efectos secundarios graves que todos le tienen miedo como la neumonitis o la colitis son muy poco comunes, pero aun así tenemos que estar despiertos y en alerta. Si el paciente experimenta alguno de esos, inmediatamente se tiene que poner al paciente en esteroides para combatir estos efectos secundarios y después descontinuar el medicamento.



Immunotherapy, in general, is not very toxic. Many times when the patients talk with us, they are scared because we give them the list of the possible side effects of the therapy based on clinical trials. In reality, immunotherapy is less toxic. The severe side effects incidence is lower and patients overall tolerate it better.

Immunotherapy has classic side effects like in any other cancer agent like fatigue or a skin rash. The ones that are particularly interesting like hyperthyroidism or hypothyroidism which are mainly asymptomatic, are interesting because we are not expecting a patient with weight gain or somnolence, so we have to be constantly checking their blood to discover any possible hypothyroidism and treat it before it’s clinical. There isn’t a consensus yet, but most of us check every six weeks the TSH to see if the patient is developing hypothyroidism or not.

The severe side effects that everyone is afraid of are pneumonitis or colitis, even though they are uncommon, we have to be in alert for any possible sign. If the patient has one of them, we will have to give him immediately steroids to fight those side effects and then continue with the treatment.

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