Immunomodulators and Their Side Effects


Immunomodulators are drugs that can help the immune system operate by modifying the immune system’s response to a threat in a beneficial way.

They primarily target the pathways involved in the treatment of multiple myeloma and a few other malignancies. They operate in a variety of ways, including directly affecting the immune system by turning down some proteins and increasing others.

The immune system is a complex network of tissues and organs. They work together to help the body fight infections and illnesses. When the immune system recognizes an antigen (a substance that the body perceives as harmful or alien), which can be germs like bacteria and viruses, chemicals or toxins, or cells damaged by cancer or sunburn, antibodies are produced (proteins that work to attack, weaken, and destroy antigens).

Thalidomide, Lenalidomide and Pomalidomide:

Thalidomide (Thalomid), lenalidomide (Revlimid), and pomalidomide (Pomalyst) are immunomodulating drugs (or IMiDs) .

Thalomid treats multiple myeloma and lesions which associates with complications from leprosy; while Revlimid treats multiple myeloma and myelodysplastic syndromes, a group of blood disorders. Pomalyst is a prescription medicine, taken along with the medicine dexamethasone, used to treat adults with multiple myeloma who have previously received at least 2 medicines to treat multiple myeloma, including a proteasome inhibitor and lenalidomide, and whose disease has become worse during treatment or within 60 days of finishing the last treatment. These medications can cause sleepiness, tiredness, constipation, low blood cell counts, and neuropathy (painful nerve damage). There is also an elevated risk of life-threatening blood clots (that start in the leg and can travel to the lungs). These are more common with thalidomide than with the other medications.

If used during pregnancy, these medications can also cause severe birth abnormalities.


Bacillus Calmette-Guerin (BCG) is a germ that does not cause significant illness in humans, but it does infect human tissues and aid in immune system activation. As a result, one can use BCG as a type of cancer immunotherapy. BCG was one of the first immunotherapies to treat cancer, and it is still in use today.

BCG essentially treats bladder cancer in its early stages. It is a liquid that a doctor inserts into the bladder via a catheter. BCG attracts immune cells to the bladder, where they can target bladder cancer cells. Treatment with BCG might result in flu-like symptoms such as fever, chills, and tiredness. It might also give you a burning sensation in your bladder. By injecting BCG directly into the tumors, the doctors can use it to treat certain melanoma skin cancers. Experts also utilize it as a TB vaccination.


Imiquimod is a drug that one can apply to the skin as a cream. It stimulates a local immune response against skin cancer cells. It is prescribed to treat genital warts, Bowen’s disease (squamous cell carcinoma in situ), and, secondary to surgery, for basal cell carcinoma etc. 

The cream is applied anywhere from once a day to twice a week for many months. Some people have severe skin reactions to this drug.

Its side effects include local inflammatory reactions, such as blisters, a burning sensation, skin redness, dry skin, itching, skin breakdown, skin crusting or scabbing, skin drainage, skin flaking or scaling, skin ulceration, sores, swelling, as well as systemic reactions, such as fever, “flu-like” symptoms, headache, and tiredness.

People who have had an organ transplant and are taking immune-suppressing drugs should not use imiquimod.


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