Immune checkpoint inhibitors can inflame almost any organ, and the commonest serious problems — pneumonitis and colitis — often begin with symptoms that look ordinary: a new cough or breathlessness, or loose stools. These can arise weeks to months into treatment and even after it has stopped.
Early recognition changes the course. Patients and clinicians outside oncology should know to report and act on these symptoms promptly, because treatment with corticosteroids is most effective when started early, and delays can turn a manageable toxicity into a life-threatening one.
- Ask patients on immunotherapy about new cough, breathlessness, diarrhoea, rash and fatigue at every contact.
- Give patients a card stating they are on a checkpoint inhibitor, for emergency departments and other doctors.
- Check thyroid function, cortisol and glucose when a patient on immunotherapy feels unwell without explanation.
- Toxicities can begin after treatment has stopped; keep asking during follow-up.
- Contact the treating oncology team early when an immune-related adverse event is suspected.
Why it matters
Symptom monitoring works partly because it catches toxicities like these sooner.
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