A multidisciplinary approach to toxicity management of modern immune checkpoint inhibitors in cancer therapy.
Immune-related Adverse Events (irAEs) are the most significant toxicities associated with the use of checkpoint inhibitors, and result from disinhibition of the host's immune homeostasis. The adverse effects experienced from immunotherapy are significantly different from those of chemotherapy and, to a lesser extent, targeted therapy. Early recognition and diagnosis of these toxicities is often challenging, but is critically important because of the potentially life-threatening nature and associated morbidity. Gastrointestinal, dermatologic, endocrine, and liver toxicities are the most commonly observed. Less commonly, the eyes, pancreas, kidneys, lungs, bone marrow, or nervous system may be affected. Although most irAEs may resolve with supportive care or discontinuation of drug, in severe cases, they may require hospitalization and immune suppressants, such as steroids, and/or may even cause death. The management of immune-related side effects requires a multidisciplinary approach.
Division of aMedical Oncology bPulmonary and Critical Care Medicine cEndocrinology dGastroenterology and Hepatology eDermatology fHematology, Mayo Clinic, Rochester, Minnesota gDuke University School of Medicine hDivision of Advance Oncologic and GI Surgery, Duke University, Durham, North Carolina, USA.
Lisa
L
Kottschade
Adam
A
Brys
Tobias
T
Peikert
Mabel
M
Ryder
Laura
L
Raffals
Jerry
J
Brewer
Paul
P
Mosca
Svetomir
S
Markovic
D059447:Cell Cycle Checkpoints / Q000276:immunology*; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D008545:Melanoma / Q000276:immunology* / Q000473:pathology; D012878:Skin Neoplasms / Q000276:immunology* / Q000473:pathology