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These Signs May Mean Immunotherapy Is Working


Immunotherapies have helped countless people battle cancer. For mesothelioma patients, these drugs offer better survival and quality of life. They may come with a few side effects, but not every reaction is a bad sign. In fact, some immunotherapy side effects may suggest good survival outcomes.

Experts say a shrinking or stable tumor can show immunotherapy is working. For some cancers, side effects may also mean tumors are responding to treatment. Reactions linked to immunotherapy success include:

  • Any immune-related side effects
  • Various skin reactions
  • Vitiligo rash

You need not worry if you do not experience these side effects. These reactions do not happen in every person whose cancer responds to immunotherapy. The important thing is for you to discuss any health changes with your oncologist. This information allows doctors to continue to optimize your treatment plan.

Note: Even side effects tied to treatment success can become serious or even life-threatening. This is especially true with immune checkpoint inhibitors, which are a common mesothelioma treatment. Patients should quickly report any side effects to healthcare providers. This can help the care team manage reactions swiftly and effectively.

1: Immune-Related Side Effects

Immune checkpoint inhibitors (ICIs) are the most commonly used immunotherapy drugs. Doctors use them to treat a number of different cancers. ICIs help the immune system identify and attack cancer cells.

Many trials have reported on the survival benefits and side effects of ICIs. So researchers have been able to study the link between the two. Across multiple studies of different cancers, patients who had immune-related side effects survived longer than those who didn’t.

Some patients have side effects because of the way the immune system reacts to ICIs. These reactions are sometimes called immune-related adverse events (irAEs). They happen when immune cells mistakenly attack healthy tissues and can look like an autoimmune disorder. Patients receiving ICIs have reported many irAEs, including:

  • Diarrhea
  • Intestinal inflammation (colitis)
  • Itchy skin
  • Lung inflammation (pneumonitis)
  • Pneumonia
  • Skin irritation (dermatitis)
  • Thyroid inflammation (thyroiditis)
  • Vitiligo (rash with loss of skin pigment)

As of December 2023, no studies had reported this relationship for mesothelioma. But several have found it in lung cancer patients treated with the same drugs used to treat pleural mesothelioma.

Studies Linking Immune-Related Side Effects to Better Survival With ICI Treatment

Lung Cancer Study

A 2023 study analyzed 54 prior studies of non-small cell lung cancer patients. Study participants received various ICIs, alone or in combination. Researchers compared survival for patients who did or did not experience immune-related side effects. Patients who had immune-related reactions had a 42% lower risk of dying.

Malignant Melanoma (Skin Cancer) Study

A small study looked at skin cancer patients treated at a single cancer center. They all received Opdivo® (nivolumab). Researchers compared survival for patients who did or did not experience immune-related side effects. Patients who had immune-related reactions were about 70% more likely to be alive at the end of the study.

These studies shed a more hopeful light on the immune-related side effects of ICIs. But patients should not assume these reactions always indicate treatment success. Only experienced health professionals can make this determination.

2: Skin Reactions

Itchy skin and rashes are among the most common treatment side effects of ICIs. Research indicates these reactions may mean treatment is working well. In ICI studies, skin-related side effects were linked to better survival in several types of cancer, including:

  • Bladder cancer
  • Lung cancer
  • Skin cancer

As of December 2023, this relationship had not been reported in mesothelioma research. But additional analysis of clinical trial data could change that in the future.

Studies Linking Skin-Related Side Effects to Better Survival With ICI Treatment

Lung Cancer Study

A recent study looked at non-small cell lung cancer patients at a single cancer center. They all received Opdivo or a similar ICI. Researchers compared survival for patients who did or did not experience skin-related side effects. Patients who had skin-related reactions lived nearly 50% longer than those who did not.

Bladder Cancer Study

A small study looked at bladder cancer patients treated with ICIs. Most had received some other form of treatment before ICIs. Researchers compared survival for patients who did or did not experience skin-related side effects. Patients who had skin-related reactions lived more than 3 times as long as those who did not.

Vitiligo Rash Linked to Skin Cancer Prognosis

Vitiligo is a condition in which patches of skin lose color (pigment), turning milky white. Several studies have looked at the relationship between this reaction and skin cancer prognosis. For patients treated with ICIs, vitiligo may mean treatment is working well. In fact, one study found skin cancer patients who developed vitiligo had a 75% lower risk of death than those without it.

What Does This Mean for Mesothelioma Patients?

Many studies support the link between side effects and ICI efficacy. But that doesn’t mean these reactions are necessary for ICIs to work, according to current research. For now, this link simply means immunotherapy side effects should not inspire despair. Patients have reason to hope these reactions may simply be a sign that treatment is working.

Regardless of any link between side effects and prognosis, patients should quickly report all reactions to their care teams. This can help doctors intervene before things become too serious. And the worst immunotherapy side effects can become life-threatening. So patients and their loved ones should prioritize getting reactions treated as swiftly as possible.