Immune-Related Adverse Events

Immune-related adverse events are side effects caused when immunotherapy drugs, such as nivolumab and ipilimumab, lead the immune system to attack healthy organs as well as the cancer. They can affect the lungs, bowel, liver, skin, thyroid and other glands, range from mild to life-threatening, and can appear months after treatment starts or even after it ends.

Origin

The term came into use as checkpoint inhibitors entered trials and practice in the 2000s and 2010s, beginning with ipilimumab for melanoma, approved in 2011. Oncology societies have since published guidelines for grading and managing these side effects.

Significance in Asbestos Context

Since the approval of nivolumab plus ipilimumab for pleural mesothelioma in 2020, and of pembrolizumab with chemotherapy in 2024, many mesothelioma patients receive checkpoint inhibitors. Common immune-related side effects include rash and itching, diarrhea or colitis, an overactive or underactive thyroid, liver inflammation (hepatitis) and pneumonitis; less often the pituitary or adrenal glands, kidneys, heart or nerves are involved, and a few patients develop type 1 diabetes. Serious events are more common with the two-drug combination than with one drug. Most are treated by pausing immunotherapy and giving steroids, and many resolve, but some, especially gland problems, leave a permanent need for hormone replacement. Early reporting matters: a new cough, diarrhea or extreme fatigue should be called in promptly, not saved for the next visit. For a claim, these side effects are part of the harm the disease and its treatment cause, and records of hospital stays, steroid courses and lasting conditions help show it.

Example Sentence

Eight weeks into nivolumab and ipilimumab, she developed severe diarrhea, which her oncologist treated as an immune-related adverse event with steroids and a pause in treatment.

Related Terms

Immunotherapy, Checkpoint Inhibitors, Nivolumab (Opdivo), Ipilimumab (Yervoy), Dual Checkpoint Inhibitor Therapy, Pneumonitis, Quality of Life, Noneconomic Damages

Notes

• Carry a card or list saying you are on immunotherapy, and show it to any emergency doctor.
• Call the oncology team the same day for new diarrhea, cough, shortness of breath, rash or severe fatigue.
• Keep records of steroid courses, hospital stays and any lasting conditions, such as thyroid replacement.