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Immunotherapy with immune checkpoint inhibitors is a promising treatment for various types of cancer. These medicines work by activating the immune system to attack cancer cells. In some patients, this may lead to long-term control of metastatic cancer, even after the treatment has stopped. As a result, more and more patients receive these drugs. However, checkpoint inhibitors can also cause the immune system to attack healthy parts of the body. These side effects (also called toxicities) can be severe and may require treatment with drugs like prednisone that suppress the immune system.

In his dissertation “Balancing efficacy and toxicity of immune checkpoint inhibitors”, Rik Verheijden describes research on factors linked to these side effects, and whether treating them with immunosuppression affects patient’s survival.
The researchers discovered that patients who were more physically active before starting with checkpoint inhibitors generally experienced fewer severe side effects and lived longer. They also found that the balance of the bacteria in the gut (the microbiome) was associated with these severe toxicities.
For a long time, treatment of sided effects was not considered to impair efficacy of checkpoint inhibitors. However, the researchers observed that treatment of these toxicities with a higher dose of prednisone or the use of other immunosuppressive drugs might actually reduce survival. Severe side effects often cannot go untreated. Therefore, the researchers recommend carefully weighing how much immunosuppression is needed for each patient individually.