Starting Immunotherapy: What to Expect

If you’ve been diagnosed with metastatic melanoma, that means the cancer has spread from your skin to other areas of your body. Your doctor may recommend immunotherapy. This treatment doesn’t kill cancer cells directly. Instead, it helps your own immune system to better fight the disease.

How Does Treatment Work?

The most common type of immunotherapy for metastatic melanoma is what’s known as a checkpoint inhibitor. These drugs take the brakes off your body’s immune system to allow T-cells, which recognize and destroy cancer, to do their job.

Like traditional chemotherapy, you get immunotherapy with an IV into a vein in a doctor’s office, clinic, or outpatient unit in a hospital. That means you won’t have to spend the night in the hospital.

How often and how long you’ll get immunotherapy depend on:

  • What type of cancer you have and how advanced it is
  • What type of treatment you get
  • How your body reacts to the therapy

Generally, you’ll go in every 2-3 weeks for an IV infusion. The drugs are given in cycles. That means you’ll get treatment for a while, then have some time off to let your body rest, respond to the treatment, and create new healthy cells.

How Will You Feel?

No two people respond the same way. What happens to you depends on your health before you started, how advanced your cancer is, and the type and dosage of treatment you’re getting.

What About Side Effects?

When your immune system is on high alert, it may start to attack other body parts like your skin. If it does, you could get an itchy rash. If it affects your intestines, you might get diarrhea. These are two of the most common side effects of immunotherapy for metastatic melanoma.

The severity of side effects varies. Some people have mild to moderate symptoms, while others can have major problems. One popular treatment -- a mix of two checkpoint inhibitors:ipilimumab (Yervoy) and nivolumab (Opdivo) -- often causes severe fatigue and loss of appetite. This can seriously affect your quality of life.


Some treatments cause side effects so subtle that you barely know you’re having them. For example, the organs that make up your endocrine system, like the thyroid and pituitary, could get inflamed. Your doctor may not even know it’s happening unless she does a blood test.

Unlike chemotherapy, where side effects usually show up right away, immunotherapy doesn’t cause a reaction until you have a few doses under your belt. The timing varies, but it’s usually within the first 3 months but after the first 3 weeks of therapy.

The good news: Most side effects go away when you’re done. But even during treatment, there are ways to manage them. Let your doctor know so she can help.

Tell her how the symptoms are affecting your daily life. Don’t feel like you’re complaining. You aren’t. You’re sharing vital information she needs to do her job well and to improve your quality of life.

WebMD Medical Reference Reviewed by Stephanie S. Gardner, MD on December 12, 2018



American Cancer Society: “If You Have Melanoma Skin Cancer,” “Immunotherapy for melanoma skin cancer.”

Rodabe Amaria, MD, assistant professor, melanoma medical oncology, University of Texas MD Anderson Cancer Center.

National Cancer Institute: “Immunotherapy.”

Melanoma International Foundation: “Melanoma Treatment: Stage IV.”

MD Anderson: “Side Effects Video Transcript.”

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