title: Acute management of autoimmune toxicity in cancer patients on immunotherapy: Common toxicities and the approach for the emergency physician.
abstract: When a patient receiving anti-cancer treatment presents acutely unwell, an understanding of associated side effects of their therapy is critical. This review will discuss the approach to patients receiving anti-cancer treatment with immunotherapy presenting with autoimmune toxicities in the emergency setting. These toxicities are commonly referred to as immune-related adverse events (irAE). IrAE might consist of, but are not limited to, dermatologic, gastrointestinal (diarrhoea, colitis), hepatic, endocrine (thyroid dysfunction, hypophysitis, adrenal crisis), renal, ocular and pulmonary toxicity. General principles of managing these irAE in the acute setting will be outlined. Steroid therapy is a critical component of the treatment algorithm, being administered at high doses and for prolonged periods to switch off immune over-activation. Prompt intervention might prevent multi-organ failure and fatality, and allow patients to remain on effective anti-cancer therapy.
authors.affiliation: Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
authors.forename: Anna J
authors.initials: AJ
authors.lastname: Lomax
authors.affiliation: Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.|Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: Catriona
authors.initials: C
authors.lastname: McNeil
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use; D015551:Autoimmunity / Q000276:immunology*; D003092:Colitis / Q000209:etiology; D003967:Diarrhea / Q000209:etiology; D064420:Drug-Related Side Effects and Adverse Reactions / Q000628:therapy*; D004635:Emergency Medicine / Q000379:methods*; D006801:Humans; D007167:Immunotherapy / Q000009:adverse effects* / Q000379:methods; D000074324:Ipilimumab; D009369:Neoplasms / Q000188:drug therapy* / Q000276:immunology; D000077594:Nivolumab; D011537:Pruritus / Q000209:etiology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000074324:Ipilimumab; D000077594:Nivolumab; C582435:pembrolizumab
keywords: immune-related adverse event; immunotherapy; ipilimumab; nivolumab; pembrolizumab