Head and Neck Cancer: Manage Immunotherapy Side Effects

Immunotherapy drugs for metastatic squamous cell carcinoma of the head and neck (HNSCC) can fight your cancer, but they also can change how you feel. You can find ways to ease most of these side effects and feel better during your treatment. Talk to your doctor about the options you have and try some tips on your own, too.

The exact side effects you’ll have will vary depending on the immunotherapy drug you take -- cetuximab (Erbitux), nivolumab (Opdivo), or pembrolizumab (Keytruda). Here are some of the common ones and what you can do about them.

Fatigue

Feeling very tired and run down is one of the most common side effects of these drugs. It makes sense -- your body is going through a lot right now. So give yourself plenty of time to rest. You may also get some relief from what you eat and how much you move:

  • Drink plenty of water and other fluids, but limit caffeine and alcohol.
  • Ask your doctor or a dietitian about foods that can give you more energy. Those high in protein and calories are usually good bets.
  • Add a few minutes of light exercise to your day, such as walking. Moving will give you more energy and help you feel better.

Stomach Problems

When you’re getting immunotherapy, it’s common to lose your appetite, feel nauseous, vomit, or have diarrhea. Ask your doctor if any medicines would help you deal with these issues. She may be able to recommend over-the-counter or prescription medications, especially for nausea, vomiting, or diarrhea. (Before you decide to try any medicine on your own, ask your doc if it’s OK.)

You can also:

  • Eat smaller meals more often throughout the day, instead of the typical three larger ones.
  • Get the right kinds of foods. If your appetite is poor, eat foods that are higher in calories, such as peanut butter, cheese, ice cream, and pudding. Or try adding meal replacement shakes or drinks to your diet. You can also add protein powder to soup, smoothies, or milkshakes. If you have diarrhea, foods with a lot of potassium and sodium may help.
  • If you don’t feel hungry, exercise will help you work up an appetite. Take a short walk or do other light exercise during the day.
  • Plan to eat more when your appetite is strongest. If that’s in the morning for you, make breakfast your big meal of the day. Or plan to eat more after you get some physical activity.
  • If you have diarrhea, make sure you get enough water and other fluids to drink. If you don’t, you could get dehydrated.
  • To ease nausea and vomiting, stick to clear soups and bland foods like saltines, toast, pretzels, and potatoes. Avoid foods with strong odors and those that are spicy, fatty, fried, or have a lot of caffeine.

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Skin Reactions

Dry, itchy skin that looks like a rash is another common reaction to some of the immunotherapy drugs for HNSCC. Use soaps, lotions, and other products that are gentle on skin, and avoid those that have added scents or alcohols. Bathe with lukewarm (not hot) water, and apply lotion right afterward.

If your skin hurts or gets suddenly red or itchy, let your doctor know right away. These could be signs of a serious skin problem or allergic reaction.

Serious Side Effects

Because immunotherapy drugs use your body’s own defenses to fight cancer, sometimes your immune system can almost go into overdrive. In serious cases, it may start to work against specific parts of your body, including the lungs, brain, liver, kidneys, and intestines.

The problem is rare, but it can cause serious side effects such as trouble breathing, hepatitis, pancreatitis, and thyroid problems. Usually, doctors can control these problems by giving you medicines such as corticosteroids and antihistamines.

It’s crucial to let your doctor know how you’re feeling and if you notice any unusual symptoms or changes. She can make sure you’re safe during treatment and help you feel as good as possible.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on March 31, 2019

Sources

SOURCES:

National Cancer Institute: “Skin and Nail Changes,” “Appetite Loss,” “Diarrhea,” “Nausea and Vomiting,” “Fatigue.”

Dana-Farber Cancer Institute: “What are the side effects of immunotherapy?”

The University of Arizona Cancer Center: “Tips for Before and During Treatment.”

Medscape: “How to Treat Side Effects of New Cancer Immunotherapies.”

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