As an immunotherapeutic agent (PD-1 inhibitor), the main side effects of tislelizumab stem from an overactivated immune system attacking normal body tissues, known as immune-related adverse events (irAEs). These reactions may affect multiple organ systems with varying severity, making timely detection and management critical.
I. Immune-Related Neurological Side Effects
This category of side effects is relatively uncommon and requires high vigilance:
Peripheral neurotoxicity
May present as numbness, tingling, weakness, or abnormal sensations in the hands and feet. The physician will decide whether to suspend or permanently discontinue the medication based on the severity of symptoms, along with corresponding treatment and monitoring.
Myasthenia gravis
Typical symptoms include ptosis (drooping eyelids), diplopia (double vision), difficulty chewing or swallowing, limb weakness, and even dyspnea. Once diagnosed, medication is usually suspended, and treatment (e.g., cholinesterase inhibitors, corticosteroids) is initiated. Severe cases (affecting respiration) require permanent discontinuation and may need more aggressive interventions such as plasmapheresis or intravenous immunoglobulin (IVIG).
II. Other Immune-Related Adverse Events
Beyond the nervous system, the overactivated immune response may affect other parts of the body:
Commonly affected organs include:
Skin: pruritus, rash;
Gastrointestinal tract: diarrhea, abdominal pain;
Liver: hepatitis, abnormal liver function;
Lung: pneumonitis, cough, dyspnea;
Endocrine glands: thyroid dysfunction, hypophysitis, adrenal insufficiency, type 1 diabetes mellitus;
Eye: e.g., uveitis;
Principles for Identification and Management
Any new or worsening symptoms (e.g., persistent fever, severe fatigue, skin changes, persistent diarrhea/abdominal pain, shortness of breath, visual changes, excessive thirst/polyuria) should be reported to a physician immediately.
Management is generally based on the grade of side effects:
Mild cases: medication may be continued with close monitoring.
Moderate to severe cases: medication is usually suspended, and immunosuppressive agents such as corticosteroids are administered.
Life-threatening or recurrent severe irAEs: permanent discontinuation of treatment is required.
