Minimizing immunotherapy's potentially harmful side effects (Prophylactic tocilizumab reduced bad immune response from 72% to 13%)

Medical Xpress / University of Miami Leonard M. Miller School of Medicine / Blood Cancer Discovery ^ | Jan. 4, 2024 | C. Ola Landgren, M.D. et al

[ConservativeMind]

Recent advances in treating multiple myeloma and other blood malignancies are providing improved outcomes—and hope—to patients worldwide.

But treatment breakthroughs such as the immunotherapy drug teclistamab can lead to potentially lethal side effects, including cytokine release syndrome (CRS).

These potential side effects have necessitated giving immunotherapy drugs in the hospital setting.

Now, new research indicates that providing prophylactic treatment before immunotherapy can significantly reduce the rate of CRS in multiple myeloma patients.

The study could eliminate the need to administer teclistamab and other immunotherapies in hospitals.

In a key clinical study, teclistamab produced an overall response rate of 63% in multiple myeloma patients whose tumors had failed to respond to multiple previous therapies or had become resistant to them.

"These immunotherapy drugs work by revving the immune system's response against the tumor," Landgren explained. "But the process can lead to an overactive immune response, the hallmark of CRS."

Physicians often treat CRS with drugs that counteract the cytokine release that causes T cells to go into overdrive. Tocilizumab, for example, has been used for years to treat CRS from immunotherapies.

Landgren and colleagues were inspired to conduct their research after reviewing preliminary data from a 2022 study on multiple myeloma patients treated prophylactically with tocilizumab. That study showed the approach eased CRS in patients receiving a different bispecific T-cell engager than teclistamab.

In their study, which included 31 multiple myeloma patients, Landgren and collaborators reported that only 13% developed CRS after prophylactic treatment with tocilizumab. The results were in contrast to the 72% observed in an earlier study treating patients for CRS as symptoms arose. Additionally, patients in this newer study had less severe CRS and lower rates of its recurrence.

"Prophylactic treatment with tocilizumab is now standard of care at Sylvester for multiple myeloma patients," said Andrew Kowalski, PharmD.

[ConservativeMind]

Only 13% had an overactive immune system issue when prophylactically treated with tocilizumab, with their immunotherapy, versus 72% without it (normal treatment).

They found no issues with immunotherapy efficacy, when adding the tocilizumab.

[ConservativeMind]

The “Take Charge Of Your Health” Ping List
This high volume ping list is for health articles and studies which describe something you or your doctor, when informed, may be able to immediately implement for your benefit.

Email me to get on either the “Common/Top Issues” (20 - 25% fewer pings) or “Everything” list.

[DIRTYSECRET]

U talking’ bout rubbers?

[ransomnote]

https://www.mayoclinic.org/drugs-supplements/tocilizumab-intravenous-route-subcutaneous-route/side-effects/drg-20073821?p=1

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

 

More common

1. Black, tarry stools
2. bloody or cloudy urine
3. blurred vision
4. body aches or pain
5. chest pain or tightness
6. chills
7. cough with or without mucus
8. diarrhea
9. difficult, burning, or painful urination
10. difficulty breathing
11. difficulty swallowing
12. dizziness
13. ear congestion
14. fast heartbeat
15. feeling of warmth
16. fever
17. frequent urge to urinate
18. headache
19. hives, itching, skin rash
20. loss of appetite
21. loss of consciousness
22. loss of voice
23. lower back or side pain
24. nausea
25. nervousness
26. pain or tenderness around the eyes and cheekbones
27. painful blisters on the trunk of the body
28. pale skin
29. pounding in the ears
30. puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
31. redness of the face, neck, arms, and occasionally, upper chest
32. slow or fast heartbeat
33. sneezing
34. sore throat
35. stomach pain
36. stuffy or runny nose
37. sudden sweating
38. ulcers, sores, or white spots in the mouth
39. unusual bleeding or bruising
40. unusual tiredness or weakness

Less common

1. Accumulation of pus
2. anxiety
3. bladder pain
4. burning feeling in the chest or stomach
5. confusion
6. dark urine
7. decrease in height
8. decreased urine
9. difficulty moving
10. dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
11. dry mouth
12. fast, irregular, pounding, or racing heartbeat or pulse
13. feeling hot
14. general feeling of discomfort or illness
15. heartburn
16. increased thirst
17. indigestion
18. itching, pain, redness, swelling, tenderness, or warmth on the skin at the injection site
19. joint pain
20. light-colored stools
21. loss of appetite
22. mood changes
23. muscle ache, pain, cramp, or stiffness
24. numbness or tingling in the hands, feet, or lips
25. pain in the back, ribs, arms, legs, groin, or genitals
26. severe stomach pain
27. sharp back pain just below the ribs
28. shivering
29. stomach upset
30. sweating
31. swollen joints
32. swollen, painful, or tender lymph glands in the face, neck, armpit, or groin
33. swollen, red, or tender area of infection
34. tenderness in the stomach area
35. trouble with sleeping
36. unexplained runny nose or sneezing
37. vomiting
38. yellow eyes and skin

Rare

1. Belching
2. changes in skin color
3. coughing or spitting up blood
4. fainting
5. gaseous stomach pain
6. lightheadedness
7. neck pain
8. night sweats
9. noisy breathing
10. rapid, shallow breathing
11. recurrent fever
12. red, tender, or oozing skin at the wounded area
13. sudden high fever or low-grade fever for months
14. swelling of the foot or leg
15. weight loss

Incidence not known

1. Blistering, peeling, loosening of the skin
2. bloating
3. dilated neck veins
4. pains in the stomach, side, or abdomen, possibly radiating to the back
5. red skin lesions, often with a purple center
6. red, irritated eyes
7. severe stomach pain, cramping, or burning
8. swelling of the face, fingers, feet, or lower legs
9. vomiting of material that looks like coffee grounds, severe and continuous
10. weight gain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

1. Burning, dry, or itching eyes
2. constipation
3. discharge, excessive tearing
4. redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid
5. skin rash, encrusted, scaly and oozing
6. swelling or inflammation of the mouth

Less common

1. Abnormal or decreased touch sensation
2. bleeding or redness and swelling of the gums
3. blemishes on the skin
4. bloody eye
5. chapped, red, or swollen lips
6. earache
7. feeling of constant movement of self or surroundings
8. irritation in the mouth
9. loose teeth
10. persistent breath odor or bad taste in your mouth
11. pimples
12. redness or swelling in the ear
13. scaling, redness, burning, pain, or other signs of inflammation on the lips
14. sensation of spinning
15. sore mouth or tongue
16. white patches in the mouth or on the tongue

Rare

1. Bleeding after passing stool
2. blindness
3. bloody nose
4. burning, numbness, tingling, or painful sensations
5. change in hearing
6. continuing ringing or buzzing or other unexplained noise in the ears
7. coughing or spitting up blood
8. decreased vision or other changes in vision
9. dry mouth
10. ear drainage
11. flushed, dry skin
12. fruit-like breath odor
13. hearing loss
14. increased hunger, thirst, urination
15. itching ears
16. uncomfortable swelling around the anus
17. unexplained weight loss
18. unsteadiness or awkwardness
19. weakness in the arms, hands, legs, or feet

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

[Mears]

TMI

…..

[ConservativeMind]

Believe it or not, despite those issues, it still makes sense to take it, when dealing with cancer.

Do you want to live, or die?

[ransomnote]

In the General/Chat forum, on a thread titled Minimizing immunotherapy's potentially harmful side effects (Prophylactic tocilizumab reduced bad immune response from 72% to 13%), ConservativeMind wrote:

Believe it or not, despite those issues, it still makes sense to take it, when dealing with cancer.

Do you want to live, or die?

Believe it or not, that's a false dichotomy. There are other options and tocilizumab does not necessarily decide between life and death.

I first heard about tocilizumab when the CDC was refusing to provide or permit the use of Ivermectin and HCQ. The Toxic CDC protocol for Covid included Remdesivir and tocilizumab, as did some hospitals.

https://www.cdc.gov/library/covid19/pdf/public_pdfs/2020_10_30_Science-Update_Final-Public_v2.pdf

Remdesivir was a known organ killer. But Ivermectin was denied and Remdesivir was designated THE DRUG OF CHOICE. Some hospitals likewise ruled out HCQ/Ivermectin but ruled in tocilizumab. This did not give me confidence.

For this reason I want people to know what doctors no longer bother to tell patients - the side effects

[FlipWilson]

Friend of mine was being treated with Keytruda. Worked on the cancer but attacked her liver. This article is helpful.

[sauropod]

bkmk

[trebb]

Nailed it...

[gop4lyf]

I take Keytruda. I was taking it every 3 weeks, then my dr. changed it to every 6 weeks, but with a larger dose. Once he did this, I developed itchy rashes all over my torso and groin. Drove me crazy. He put me on Prednisone and that helped a whole lot, and then he moved me back to every 3 weeks. I have about 6 months left then I’m done. at least I don’t have to get chemo.

[FlipWilson]

Yah, Keytruda nuked my friends liver. She had to get off of it. I hope your treatments are working. Prayers.

[gop4lyf]

My dr. keeps a pretty close eye on my liver function. He told me up front that it could be hard on my liver.