What Are the Side Effects of Immunotherapy for Mesothelioma?
Immunotherapy works by activating your immune system to attack cancer cells. In some cases, this treatment can also cause an inflammatory response, leading to uncomfortable side effects.
Common side effects of mesothelioma immunotherapy include:
- Changes in taste
- Digestive issues
- Fatigue
- Flu-like symptoms
- Joint pain
- Loss of appetite
- Mouth soreness or irritation
- Skin rash
About 20% of cancer patients report side effects from immunotherapy treatment, according to the Cleveland Clinic. Some studies suggest that side effects from immune checkpoint inhibitors can indicate that the treatment is working.
“Even though these side effects are frustrating, there is a hidden benefit: It shows that your immune system was successfully activated by the immunotherapy.”
– Dr. David Faleck, Gastroenterologist
Below you will find detailed information on each common immunotherapy side effect, why it may occur, and how it’s usually managed. The goal is to help you feel prepared, supported, and confident as you receive immunotherapy treatment.
Download our Free Mesothelioma Immunotherapy Guide to learn what to expect during treatment and how to handle common side effects safely.
Changes in Taste and Appetite Loss
Taste changes are a frequent complaint during immunotherapy. Some patients notice a bitter or metallic taste, while others say food tastes bland or strange. These changes often make eating less enjoyable, which may lead to appetite loss.
Taste changes may happen because immunotherapy influences the cells in the mouth and digestive tract. Sometimes the medications affect nerves that help you taste and smell food. Choosing simple meals, experimenting with different textures, or adding mild seasonings can make food more appealing.
You can also:
- Add protein-rich foods like yogurt, nuts, eggs, or peanut butter to boost calories
- Eat smaller, more frequent meals
- Incorporate herbs, spices, or sauces to make meals more flavorful
- Try smoothies or protein shakes when solid foods are hard to tolerate
If taste changes continue or start limiting how much you can eat, let your doctor or dietitian know so they can help you find alternatives that keep your energy and strength up during treatment.
Digestive Problems
Digestive issues such as constipation, diarrhea, stomach cramps, nausea, or loose stools are common side effects of immunotherapy. These symptoms can range from mild to severe and may come and go throughout the treatment cycle. Many patients find that certain foods irritate their stomach more easily during treatment.
Digestive issues happen when the immune system causes inflammation in the lining of the intestines or stomach. This can speed up digestion or make the digestive tract more sensitive.
Tips that may help include:
- Avoiding spicy, greasy, fried, or highly acidic foods
- Drinking plenty of fluids such as water, electrolyte drinks, or clear broths
- Eating smaller, more frequent meals instead of large ones
- Following the BRAT diet
- Keeping a food diary to identify triggers
- Limiting caffeine and alcohol, which can worsen diarrhea
Contact your doctor if symptoms last longer than two days, become severe, or if you notice signs of dehydration. Your medical team can check for inflammation and recommend medications or dietary adjustments to help soothe the digestive tract.
Fatigue
Fatigue is one of the most common side effects of immunotherapy. Many patients describe it as a deep, ongoing tiredness that doesn’t go away even after resting. You may feel less motivated to be active or find it harder to complete tasks that used to be simple. This type of tiredness often starts early in treatment and can continue throughout your IV infusions.
About 1 in 3 people who receive immune checkpoint inhibitors like pembrolizumab (Keytruda®) experience fatigue, according to a report published in Frontiers in Oncology.
Here are some tips that may help:
- Ask loved ones to help with chores or errands when your energy is low
- Stay hydrated by drinking water regularly throughout the day
- Take short, 15-20 minute naps instead of long ones
- Try gentle exercise, such as a brief walk, to keep your energy more stable
Fatigue happens because the immune system is working harder than usual. When immunotherapy activates your immune system, your body burns more energy, which can lead to exhaustion.
Flu-Like Symptoms
Flu-like symptoms such as chills, mild fever, and headaches are another potential side effect of immunotherapy. These symptoms often appear within the first day or two after treatment and usually fade on their own. Although these side effects can be uncomfortable, they’re usually a sign that your immune system has been activated and the medication is working.
These symptoms happen because immunotherapy encourages your immune system to work harder. The same process that helps your body fight cancer can also trigger temporary inflammation.
Many patients find it helpful to:
- Dress in layers
- Keep a blanket nearby
- Sip warm tea or broth
- Use a cool washcloth
Fever may signal infection or a serious complication. If your temperature rises above 101 degrees Fahrenheit or if you have severe chills, confusion, or trouble breathing, contact your doctor or care team immediately.
“Dress in layers and bring a blanket to your infusion sessions. Some patients may experience hot flashes or chills due to their immune response.”
Joint and Muscle Pain
Joint and muscle pain can feel similar to arthritis or general soreness. Patients often notice stiffness in their knees, shoulders, or hands. These symptoms may affect your ability to walk, stretch, or perform daily tasks, especially in the morning. These aches happen when immunotherapy causes inflammation in the muscles or joints.
Patients with joint pain may benefit from:
- Gentle stretching
- Light walking
- Taking warm baths
- Using heating pads
Talk with your doctor about where the pain occurs and how it affects your movement. They may recommend anti-inflammatory medications or physical therapy to help you stay active and comfortable.
Download our Free Immunotherapy Guide to get more details on what to expect during and after treatment.
Mouth Soreness
Mouth soreness can appear as sensitivity, dryness, or small sores inside the mouth. These symptoms can make it uncomfortable to eat, drink, or brush your teeth. Many patients find that hot, spicy, or crunchy foods become difficult to tolerate during treatment.
This side effect occurs because immunotherapy can irritate the lining of the mouth. Rinsing with mild saltwater solutions and avoiding harsh mouthwashes can help protect the inside of your mouth.
Here are some tips to manage mouth soreness:
- Ask your doctor about prescription mouth rinses or oral cryotherapy (ice chips)
- Avoid salty, sour, or spicy foods
- Brush with a soft toothbrush and use gentle oral-care products
- Rinse with alcohol-free mouthwash such as Biotene® every 4-6 hours
- Use lip balm and consider a humidifier at night to reduce dryness
If mouth soreness keeps you from eating or drinking enough, let your care team know so they can adjust your treatment plan. They may also provide special mouth rinses or medications to help soothe inflammation and prevent infection.
Skin Rash and Irritation
Skin changes like rashes, redness, itching, or peeling are common during immunotherapy and usually show up in the first few weeks. These reactions happen because the immune system is more active and can accidentally irritate healthy skin. Most rashes are more annoying than painful, but they can get worse without early care.
Here are some things that may help:
- Apply cool compresses to ease itching and redness
- Avoid hot showers and harsh soaps that can worsen irritation
- Protect your skin from sun exposure with SPF and clothing
- Use gentle, fragrance-free moisturizers to keep the skin hydrated
- Wear loose, soft clothing to reduce friction
Most skin reactions improve with simple care and quick attention. Keep an eye on any changes and let your doctor know if your skin irritation gets worse.
How Long Do Immunotherapy Side Effects Last?
Most mild side effects appear during the first few treatment cycles and usually fade within a few weeks. Some immune-related problems, such as thyroid or adrenal inflammation, can take longer to improve. These issues may need ongoing medication or regular checkups.
The CheckMate 743 clinical trial was a large international study that compared Opdivo and Yervoy with standard chemotherapy for mesothelioma. The trial found that side effects improved with medical care, and the patients who got immunotherapy didn’t report any new symptoms after 3 years of follow-up.
Your doctor will continue to monitor your bloodwork and recovery during and after treatment to manage any lasting side effects and protect your long-term health.
7 Tips for Managing Mesothelioma Immunotherapy Side Effects
Each patient treated with immunotherapy may have a different experience, but there are some consistent side effects.
Here are 7 quick tips to manage the side effects of immunotherapy for mesothelioma:
- Create a diary of your treatments and side effects
- Take care of your skin
- Eat soft, bland foods
- Use the BRAT diet
- Dress in layers
- Explore alternative therapies
- Balance rest and activity
You can use these tips on their own or alongside guidance from your medical team to help keep yourself more comfortable throughout immunotherapy treatment.
1. Create a Symptom Diary
On the day you start mesothelioma treatment, create a symptom diary and record your experience during and after the session.
Keep track of:
- When you had treatment
- How you felt during and after
- How severe the side effects were
- Timing and frequency of side effects
- Whether the effects faded or worsened
Bring your notes to each appointment. They’ll help your doctor spot patterns and make simple changes to your treatment schedule, diet and nutrition, or medications to ease side effects and keep your energy up.
“A journal or diary will help you, your loved ones, and your doctor manage your symptoms more effectively.”
2. Care for Your Skin
Rashes and dryness are common side effects of immunotherapy for mesothelioma. They can appear on your arms, legs, chest, or face and may itch or peel. Consistent skin care can prevent irritation and reduce discomfort.
Try the following tips to handle skin irritation:
- Use fragrance-free moisturizers after bathing
- Take lukewarm showers instead of hot ones
- Choose loose-fitting, breathable fabrics
- Protect your skin from sun exposure
If your skin reaction becomes painful or widespread, your doctor may prescribe topical steroids or oral antihistamines. These help prevent infection and allow you to continue treatment without any interruptions.
“One of the most common treatments for immunotherapy-related side effects is steroids. You basically cool the immune system back down where it’s been activated a little bit too much in the normal, healthy tissue.”
3. Eat Gentle, Soothing Foods
Mouth soreness, nausea, and taste changes from immunotherapy and chemotherapy can make eating difficult. However, maintaining proper nutrition is vital to your recovery between treatment sessions.
Try soft, bland foods that are easy to swallow, such as:
- Bananas or applesauce
- Oatmeal, mashed potatoes, or scrambled eggs
- Yogurt, smoothies, or ice pops
Avoid spicy, acidic, or crunchy foods that irritate the mouth or stomach. If food still tastes unpleasant, use plastic utensils to reduce metallic flavors. Meeting with an oncology dietitian can help you design meals that support a healthy weight while ensuring you get enough protein.
4. Manage Digestive Upset
Diarrhea and abdominal cramps are common dietary side effects linked to mesothelioma treatment. Simple diet adjustments can help calm your gastrointestinal system.
Follow the BRAT diet — Bananas, Rice, Applesauce, Toast — for a few days until your symptoms improve. In the meantime, drink water, electrolyte beverages, or clear broths frequently to stay hydrated.
If diarrhea lasts more than 2 days or you notice blood in your stool, contact your doctor. They can prescribe anti-diarrheal medication or test for inflammation markers to adjust your treatment.
5. Handle Flu-Like Symptoms
Many patients experience chills, mild fever, or body aches after immunotherapy infusions. These reactions are temporary but can interfere with rest and appetite.
Dress in layers to adapt to temperature changes, and keep warm drinks or soup nearby. If you start experiencing fever symptoms later on, put a cool washcloth on your face and drink plenty of fluids to stay hydrated.
6. Explore Complementary and Alternative Therapies
Alternative therapies such as acupuncture, gentle massage, and meditation may reduce muscle tension and stress. These techniques are safe when performed by trained practitioners who are familiar with cancer patients.
While these options can’t treat your cancer, they can help you feel more relaxed, promote healing, and enhance your overall well-being.
Before starting any complementary approach, discuss it with your doctor to make sure it won’t interfere with your medications or immune function.
7. Balance Rest and Activity
Fatigue is one of the most common side effects of immunotherapy for mesothelioma, and it can last for several days after treatment. Getting enough rest is important, but too much time in bed can actually make you feel weaker.
In general, try to:
- Aim for 7 to 8 hours of sleep each night
- Keep naps during the day to about 1 hour or less
- Stay hydrated with at least 8 glasses of water
- Take short walks if you’re able
Try to move a little each day since staying active can help you regain strength, improve circulation, and feel more awake as your body recovers from treatment.
“When patients understand ways to improve their quality of life, they feel more in control of their cancer journey.”
Be better prepared for your medical appointments — download our Free Questions to Ask Your Doctor Checklist to help you discuss digestive and medication concerns.
What Causes Immunotherapy for Mesothelioma Effects?
Unlike chemotherapy or radiation, which directly target cancer cells, immunotherapy helps your immune system do the attacking.
Checkpoint inhibitors such as nivolumab (Opdivo®) and ipilimumab (Yervoy®) remove the “brakes” that normally keep the body’s immune responses under control. When those brakes are lifted, immune cells can sometimes attack healthy organs and tissues.
This inflammation can appear almost anywhere in the body. The skin, intestines, lungs, liver, and thyroid are some of the most commonly affected areas. Most reactions are mild and temporary.
Your medical team will monitor you throughout treatment, using blood tests and physical exams to catch early signs of inflammation. Always share new symptoms (even minor ones) so your doctor can treat them before they get worse.
If you have sudden fatigue, shortness of breath, severe diarrhea, or yellowing of the skin, call your cancer care team right away. Getting treated quickly can stop these reactions and prevent long-term complications.
Get Support for Mesothelioma Immunotherapy Side Effects
You don’t have to manage treatment side effects on your own. Mesothelioma Hope can connect you with medical experts who can help, including dietitians who specialize in managing immunotherapy side effects.
Our team can also help you:
- Understand your diagnosis and treatment plan
- Find palliative care for symptom relief
- Explore financial assistance and legal options
- Connect with support groups and survivor mentors
Download our Free Immunotherapy Guide or call (866) 608-8933 to speak directly with a Patient Advocate today.
Side Effects of Immunotherapy for Mesothelioma FAQs
What is the downside of immunotherapy?
Immunotherapy can be very effective for some people with mesothelioma, but it can also cause side effects when the immune system becomes too active. This can lead to inflammation in healthy organs such as the lungs, liver, thyroid, or intestines.
Most reactions are mild — like fatigue, rash, or diarrhea — but more serious problems can develop if they’re not treated quickly.
Doctors manage these effects with medications such as corticosteroids or by pausing treatment until symptoms improve. Regular checkups and reporting new changes right away help keep mesothelioma immunotherapy side effects under control.
What are good signs that immunotherapy is working?
Every mesothelioma patient’s response to immunotherapy is different, but some encouraging signs may include reduced pain or breathing problems, improved energy, or scans that show your tumors are shrinking or staying stable.
Some people also notice mild flu-like symptoms or skin changes, which may indicate an active immune system. Your mesothelioma care team will use imaging tests and lab work to confirm whether the immunotherapy drugs are having the desired effect.
What to avoid while on immunotherapy?
While receiving immunotherapy for mesothelioma, it’s best to avoid things that put extra stress on your immune system or interfere with treatment. Try not to drink alcohol in excess, smoke, or take over-the-counter supplements without talking to your doctor first.
Certain herbal products, like echinacea or St. John’s wort, can alter how cancer drugs work. You should also avoid live vaccines and limit exposure to people who are sick, since your immune system may not react normally.
How to fight fatigue from immunotherapy?
Fatigue is one of the most common side effects of immunotherapy for mesothelioma. Try to get 7-8 hours of sleep each night, take short naps if needed, and plan your day so you have time to rest between activities.
Gentle movement, such as walking, stretching, or low-impact yoga, can boost your energy and mood. Eating balanced meals, staying hydrated, and treating pain or anemia also help reduce tiredness.
If fatigue becomes severe, tell your mesothelioma doctor. They can check for thyroid or hormonal issues, or other medical conditions that can sometimes cause long-lasting fatigue during treatment.
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