Immunotherapy Side Effects Guidelines – 2018

Last Updated: November 16, 2020

Immunotherapy is a type of cancer treatment that boosts the body’s natural defenses to fight cancer. One type of immunotherapy is called an immune checkpoint inhibitor. Immune checkpoints are proteins that act as brakes on the immune system. Immune checkpoint inhibitors target these proteins. This video discusses 2018 guidelines from the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) around immunotherapy and its side effects.

More Information 

What You Need to Know About Immunotherapy Side Effects

Side Effects of Immunotherapy

Understanding Immunotherapy

ASCO Answers Fact Sheet: Understanding Immunotherapy (PDF)

Immunotherapy: The 2016 Clinical Cancer Advance of the Year

If you are having trouble watching videos, you may need to download and install the latest version of Adobe Flash Player. To see additional videos, visit and subscribe to Cancer.Net's YouTube channel.


Immunotherapy Side Effects Guidelines

Voice-over: Immunotherapy with immune checkpoint inhibitors has revolutionized treatment for many different types of cancer:

  • Head and Neck Cancer

  • Melanoma

  • Hodgkin Lymphoma

  • Lung Cancer

  • Kidney Cancer

  • Bladder Cancer

Voice-over: By unleashing the body’s immune system to attack cancer, these treatments can send even the most hard-to-treat cancers into lasting remission. But these treatments also come with unique side effects which can affect multiple organs of the body. And because these treatments have entered the clinic fairly recently, many clinicians are not experienced in recognizing and treating these side effects.

This is why the American Society of Clinical Oncology (ASCO) and and National Comprehensive Cancer Network (NCCN) have collaborated on guidelines that offer clinicians much needed recommendations for assessment and management of side effects related to immune checkpoint inhibitors.

The major strength of the guidelines is to identify and manage side effects when they are just beginning, and therefore much more manageable.

Julie R. Brahmer, MD, MSc; Professor of Oncology, Director of the Thoracic Oncology Program, John Hopkins Kimmel Cancer Center; Chair, ASCO Guideline Panel on Management of Immune-related Adverse Events: As immunotherapy starts getting into the community more and more and we’re treating more and more patients with these type of drugs, then trying to figure out how best to manage their side effects would be very important, as well as education of both the patients as well as caregivers and the physician and extended team.

Marc S. Ernstoff, MD; Professor & Katherine Anne Gioia Chair of Medicine, Roswell Park Cancer Center; Chair, SITC Consensus Group on the Management of ICI Toxicities: The widespread use of immunotherapy is moving into standard clinical practice for lung cancer, for melanoma, for bladder cancer, for Hodgkin’s disease. And therefore these agents are beginning to be widely used. They have a very different spectrum of side effects.

Dr. Brahmer: While fatigue is very common on immunotherapy as it is also with chemotherapy, the immunotherapy tends not to have direct side effects on the bone marrow. Patients tend not to lose their hair. So, the mechanism of action of immunotherapy is very important to know because that can help guide you about, 1, how to treat side effects that occur on immunotherapy, but also how to be aware of these type of side effects that can come up.

John A. Thompson, MD; Co-Director, Seattle Cancer Care Alliance, Melanoma Clinic, Fred Hutchinson Cancer Research Center; Chair, NCCN Guidelines Panel on Management of Immune-Related Toxicities: With the immune checkpoint inhibitors, we are removing the brake pedal from the immune system. Those brake systems are there for a reason, that is to prevent our immune system from attacking itself. So, when we remove those safety mechanisms from our immune system, we encounter all kinds of side effects that could be described as autoimmune side effects.

Dr. Ernstoff: Patients are living a lot longer with immunotherapy so they’re now, we’re now facing the chronic toxicities of these drugs and how to manage them. So that’s an important concept that we need to understand and need to approach in a very logical and sequential way.

Dr. Thompson: We’re seeing more and more cases of toxicity that result from these treatments. And so, the guidelines are intended to address how to diagnose, recognize, and treat the side effects of immune checkpoint inhibitor therapy.

Immunotherapy Side Effects Guidelines

ASCO ® American Society of Clinical Oncology

NCCN National Comprehensive Cancer Network ®

Voice-over: It is the goal of the ASCO and NCCN guidelines to improve patient care by making clinicians aware of the side effects of immune checkpoint inhibitors and to guide them on how to best manage them.

To read the guidelines, please visit or

Special Thanks

  • Dr. Mary Wilkinson, Dr. Raymund Cuevo, and the staff at Medical Oncology & Hematology Associates of Northern Virginia

  • Medical Oncology Hematology Consultants, Newark, Delaware

  • Carolyn B. Hendricks, MD, Cancer for Breast Health

  • Dana-Farber Cancer Institute

  • Rockefeller Research Laboratories, Memorial Sloan Kettering Cancer Center

  • Palo Alto Medical Foundation, Sutter Health

  • The Adele R. Decof Comprehensive Cancer Center at The Miriam Hospital. The Miriam Hospital is a teaching hospital of The Warren Alpert Medical School of Brown University.

  • University Hospitals Case Medical Center Seidman Cancer Center

  • University of Michigan Comprehensive Cancer Center

The opinions expressed in the video do not necessarily reflect the views of ASCO or the Conquer Cancer Foundation.

Requests for commercial use of this video should be submitted to

© 2018 American Society of Clinical Oncology®. All rights reserved

Sharing and personal publication of this video indicates your consent to the Terms of Use, viewable at: