Immunotherapy

Key Points

• Immunotherapy enhances the immune system’s ability to detect and destroy cancer cells.
• Checkpoint inhibitors (PD-1, PD-L1, CTLA-4 inhibitors) are the most common class used in solid tumors.
• Immune-related adverse events (irAEs) affect multiple organ systems and require prompt recognition.
• Nursing assessment focuses on early irAE detection: colitis, pneumonitis, hepatitis, endocrinopathies.

Mechanism

Immunotherapy agents remove suppression signals that cancer cells use to evade immune detection. Checkpoint inhibitors block inhibitory receptors (PD-1/PD-L1, CTLA-4), restoring T-cell cytotoxic activity. CAR-T cell therapy genetically modifies patient T-cells to target specific tumor antigens.

Nursing Assessment

NCLEX Focus

Immune-related adverse events can affect any organ system. Early reporting is essential.

• Assess for irAEs: diarrhea/colitis, cough/dyspnea, jaundice, rash, fatigue, endocrine changes.
• Monitor vitals, laboratory values, and organ function at each infusion and between cycles.
• Assess for cytokine release syndrome (CRS): fever, hypotension, tachycardia after CAR-T therapy.

Nursing Interventions

• Administer corticosteroids as prescribed for immune-related adverse events.
• Hold immunotherapy and escalate immediately for grade 3-4 irAEs.
• Educate patient to report any new symptom promptly between treatment cycles.
• Coordinate multidisciplinary management for multi-system irAE presentations.

Related Concepts

• targeted-therapy - Molecular-targeted agents often used alongside immunotherapy in oncology.
• antineoplastic-agents - Broader pharmacologic context for cancer treatment.

Self-Check

1. What symptoms indicate a potentially severe immune-related adverse event?
2. How does checkpoint inhibitor mechanism differ from traditional chemotherapy?