Acetaminophen, bad for immunotherapy, so what are the options?

In response to the study by Bessede, et al in regards to acetaminophen significantly reducing the response to immunotherapy, many have asked what they can take. First, I must mention that acetaminophen is not an anti-inflammatory, so it is not a great option for pain. If the patient can take a Non-Steroidal Anti-Inflammatory (NSAID), such as aspirin, ibuprofen, naproxen, or celecoxib. These medications can help with pain and have anti-cancer properties that can improve the response to immunotherapy. Hopefully, you have read this in my book.
The other issue is patients with more serious pain need narcotic pain medications. Many of these, such as Norco, contains a combination of acetaminophen and hydrocodone. Patients must be extremely careful because I run into cases where they take acetaminophen and don’t even realize it. Even knowing about the acetaminophen study, some patients believe that taking just one or two Tylenol is not harmful. However, look closely at the study, and as little as one or two Tylenol may completely negate the effects of immunotherapy. I also have patients whose doctor says it is safe to take acetaminophen. Please know that doctors are human and have not read or know every study. Before this study, none of us knew the potential problems. However, it is important to get this information out to educate patients and doctors alike. Please discuss this with your doctor, but ensure they have seen the study. Doctors who have reached out to me have been surprised about this study.

In addition, just an FYI. Though we know many things that can help the response to immunotherapy, one study looking back at patients who had better response rates saw two things in common, they took aspirin and anti-histamines.

Reference: Pár A. (1998). A paracetamol (acetaminophen) toxicitásáról [Toxicity of paracetamol (acetaminophen)]. Orvosi hetilap, 139(4), 171–174. Bessede, A., Marabelle, A., Guégan, J. P., Danlos, F. X., Cousin, S., Peyraud, F., Chaput, N., Spalato, M., Roubaud, G., Cabart, M., Khettab, M., Chaibi, A., Rey, C., Nafia, I., Mahon, F. X., Soria, J. C., & Italiano, A. (2022). Impact of acetaminophen on the efficacy of immunotherapy in cancer patients. Annals of oncology : official journal of the European Society for Medical Oncology, 33(9), 909–915.

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