This page includes immunotherapy and immuno-oncology guidance for health professionals caring for people on these treatments. It includes guidance on managing immune-related adverse events. 

Immune checkpoint inhibitors

Immune checkpoints are responsible for “switching off” the T-cell. Inhibition of these checkpoints allows for overexpression of the immune system. This immune system over-activation may result in side effects in healthy body tissues, which is how toxicities can arise; however, the precise mechanism is unknown. These side effects are referred to as immune-related adverse events (irAEs). 

The overall incidence of grade 3 or 4 irAEs is higher with CTLA-4 blockers, compared to PD-1 and PDL-1 inhibitors, which are better tolerated. The combination of PD-1 inhibitor with a CTLA-4 inhibitor was associated more adverse reactions, especially grade 3 or 4 irAEs. However when managed correctly, promptly and with close monitoring, most irAEs are reversible.

Grading of irAEs should follow the Common Terminology Criteria for Adverse Events (CTCAE) guidelines.

Guidance on how to manage irAEs can be found in this section. 

Acute management guidelines for immune-related adverse events

Can patients have the flu vaccine whilst on immunotherapy?

There is no evidence to suggest that the flu vaccine is associated with any issues when on immunotherapy therefore we are currently recommending that people should have their flu vaccine as normal.

If the patient is over 65 there is a new booster to the vaccine. There is no evidence about this and possible interactions with immunotherapies so having this booster therapy is not recommended.

If the pneumococcal vaccine is recommended by a patient's GP practice they can also receive this.

Patient should avoid live vaccines as it is unclear whether there is an increased risk with these vaccines at present. (Note: the nasal flu vaccine is live.)

Can I have dental treatment done whilst receiving immunotherapy?