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New cancer treatments have perplexing side effects

When Diane Legg began seeing black specks in her right eye, she went to an ophthalmologist near her home in Amesbury, Mass. He said she had a torn retina and needed laser surgery.

Legg’s oncologist was skeptical. He was worried that Legg had eye inflammation, called uveitis, that was caused by an immunotherapy drug she had been on for advanced lung cancer. If so, Legg needed to get a far different treatment — and quickly — to avoid vision problems or blindness.

Yet the eye doctor, sure of his diagnosis, performed the laser surgery. A few days later, when specks appeared in Legg’s left eye, it was clear she had uveitis, not a torn retina. When Legg finally got what she needed, steroid eye drops, the inflammation faded — but the specks remain, two years later. “It’s like I have a dirty lens,” she says. Her problem might have been reduced with correct, prompt treatment.

Legg, 55, is one of a growing number of wary veterans of powerful new medications that are revolutionizing cancer treatment. Her therapy knocked back her cancer, and she’s glad she got it. But the drug also gave her “almost every ‘itis’ you can get,” she said: arthritis-like joint pain, lung inflammation called pneumonitis and liver inflammation that bordered on hepatitis, in addition to the uveitis. She warns patients that highly touted immunotherapy treatments have downsides as well as benefits and to watch for complications, because “not all doctors know all the side effects.”

….A few years ago, Kevan Herold, an immunologist and endocrinologist at Yale University, noticed that some cancer patients were developing Type 1 diabetes, usually diagnosed in childhood. He realized that the patients’ immunotherapy treatments were killing insulin-producing cells in the pancreas.

Are the cancer treatments worth the trade-off? “Absolutely,” Herold said. “If it’s a choice between staying alive and developing diabetes versus not, I’d always pick taking the drug and managing the diabetes.”

Almost always, doctors say, cancer is more dangerous than immunotherapy side effects.

“The last thing you want to do is scare people away from lifesaving treatments,” said Jeffrey Bluestone, an immunologist at the University of California at San Francisco who is president and chief executive of the Parker Institute for Cancer Immunotherapy.

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