Immunotherapy has changed the way nurses manage cancer treatment.
Instead of attacking cancer cells directly like chemotherapy, immunotherapy boosts the body’s own immune system to fight cancer.

For NCLEX and real-world practice, every registered nurse must understand how these medications work, their side effects, and the essential nursing interventions.

This simplified guide is perfect for RN students, oncology nurses, and anyone using nursing bundles to prepare for the NCLEX exam.

What Is Immunotherapy? (Simple Definition)

Immunotherapy is a cancer treatment that uses medications to help the immune system recognize and destroy cancer cells.

Unlike chemo, immunotherapy is targeted, with fewer systemic effects—but it can still cause serious immune-related complications.

How It Works

• Activates T-cells
• Helps immune cells identify cancer
• Removes “checkpoints” that stop the immune system
• Boosts immune attack on tumors

Types of Immunotherapy Medications (NCLEX Must-Know)

Below are the major classes you must know for the NCLEX and nursing clinical practice.

1. Checkpoint Inhibitors (Most Important for NCLEX)

These medications block proteins that stop the immune system from attacking cancer.

Examples

• Nivolumab (Opdivo)
• Pembrolizumab (Keytruda)
• Ipilimumab (Yervoy)
• Atezolizumab
• Durvalumab

Used For

Melanoma, lung cancer, kidney cancer, colorectal cancer, Hodgkin lymphoma.

Nursing Priority

Watch for immune-related adverse events (irAEs):

• Pneumonitis
• Colitis
• Hepatitis
• Thyroid dysfunction
• Severe skin reactions

These are NCLEX favorites.

2. CAR T-Cell Therapy

A cutting-edge treatment where the patient’s own immune cells are modified to attack cancer.

Examples

• Tisagenlecleucel (Kymriah)
• Axicabtagene ciloleucel (Yescarta)

Nursing Priority

Monitor for:

• Cytokine Release Syndrome (CRS)
  Symptoms: high fever, low BP, confusion
• Neurotoxicity

This requires an experienced RN nurse due to life-threatening reactions.

3. Monoclonal Antibodies (mAbs)

Target specific proteins on cancer cells.

Examples

• Rituximab
• Trastuzumab
• Bevacizumab

Nursing Priority

Infusion reactions:

• Chills
• Fever
• Low BP
• Bronchospasm

Monitor vitals closely during infusion.

4. Cancer Vaccines

Boost the immune system against cancer antigens.

Examples

• Sipuleucel-T (for prostate cancer)

Nursing Priority

Monitor for injection site reactions and flu-like symptoms.

5. Immune System Modulators

Boost immune responses.

Examples

• Interleukins
• Interferons

Nursing Priority

High risk for flu-like symptoms, fatigue, and mood changes.

Common Side Effects of Immunotherapy (RN Nursing Guide)

Immunotherapy can cause immune system overactivation, leading to inflammation anywhere in the body.

NCLEX Must-Know Side Effects

• Fatigue
• Rash / itching
• Diarrhea (colitis)
• Cough or shortness of breath (pneumonitis)
• Jaundice (hepatitis)
• Thyroid issues (hypo/hyperthyroidism)
• Joint pain
• Infusion reactions

For NCLEX:
If the patient has new fever, cough, abdominal pain, or diarrhea → notify provider immediately.

Nursing Responsibilities (NCLEX Priorities)

1. Assess for New or Worsening Symptoms

Immunotherapy reactions can appear weeks or months later.

Red-Flag Symptoms

• Persistent cough
• Shortness of breath
• Severe diarrhea
• Yellowing of skin
• Chest pain
• Severe headache
• Vision changes

2. Monitor Lab Values

Including:

• Liver enzymes (ALT, AST)
• Thyroid hormones
• Complete blood count
• Kidney function

3. Pre-Infusion Duties

The registered nurse should:

• Verify medication and dosage
• Check allergies
• Review baseline vitals
• Educate the patient
• Use central line or IV access safely

4. Manage Infusion Reactions

Stop infusion if patient develops:

• Hives
• Trouble breathing
• Low blood pressure
• Fever and chills

Follow hospital protocol—usually includes antihistamines, steroids, or slowing infusion rate.

Patient Teaching (For NCLEX and Clinical Care)

Teach Patients to Report Immediately

• Diarrhea
• Shortness of breath
• Rash
• Fever
• Changes in weight
• Extreme fatigue

Why?

These can indicate immune system attacks on organs.

Teach About Self-Care

• Hydrate well
• Use gentle skin care products
• Monitor temperature daily
• Avoid live vaccines
• Practice infection prevention

Teach Families

Immunotherapy doesn’t work like chemo—side effects can appear late, even after treatment ends.

Family members should watch for personality changes, confusion, or breathing problems.

NCLEX Quick Review Box

• Immunotherapy activates the immune system
• Watch for immune-related adverse events (irAEs)
• Notify provider for diarrhea, cough, fever, rash
• Monitor liver enzymes, thyroid levels, and respiratory status
• CAR T-cell therapy can cause CRS and neurotoxicity
• Infusion reactions common with monoclonal antibodies

FAQ