title: [Adverse events of immune checkpoint inhibitors].
abstract: After immune checkpoint inhibitor therapy was approved for renal cell carcinoma last year, this new immune therapy has spread to urology. Further approvals (atezolizumab, nivolumab, pembrolizumab) are expected in 2017 for metastatic urothelial carcinoma that has progressed following treatment with platinum-based chemotherapy. With expanding use of immune checkpoint inhibitors, experience in diagnosing and managing immune-mediated adverse events increases. Although of low incidence, grade 3/4 toxicities play a central role. Organs most common for immune-mediated adverse events are skin, liver (hepatitis), kidneys (nephritis), gastrointestinal tract (diarrhea and colitis), lungs (pneumonitis), and endocrine organs (hyper-, hypothyroidism and hypophysitis). Diagnostic workup includes routine laboratory tests (including liver function tests) and may be supplemented with hormone values. In cases of pneumonitis or hypophysitis, imaging (high-resolution CT, MRI) can confirm diagnoses. Immune-mediated toxicities are treated with therapy interruption and administration of corticosteroids (and in individual cases additional immunosuppression). Dose modification is not intended!
authors.affiliation: Urologische Klinik und Poliklinik, Universitätsklinikum Jena, Lessingstraße 1, 07743, Jena, Deutschland. Susan.Foller@med.uni-jena.de.
authors.forename: S
authors.initials: S
authors.lastname: Foller
authors.affiliation: Urologische Klinik und Poliklinik, Universitätsklinikum Jena, Lessingstraße 1, 07743, Jena, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Oppel-Heuchel
authors.affiliation: Urologische Klinik und Poliklinik, Universitätsklinikum Jena, Lessingstraße 1, 07743, Jena, Deutschland.
authors.forename: I
authors.initials: I
authors.lastname: Fetter
authors.affiliation: Urologische Klinik und Poliklinik, Universitätsklinikum Jena, Lessingstraße 1, 07743, Jena, Deutschland.
authors.forename: Y
authors.initials: Y
authors.lastname: Winkler
authors.affiliation: Urologische Klinik und Poliklinik, Universitätsklinikum Jena, Lessingstraße 1, 07743, Jena, Deutschland.
authors.forename: M-O
authors.initials: MO
authors.lastname: Grimm
mesh_terms: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents / Q000009:adverse effects*; D018797:Cell Cycle Proteins / Q000037:antagonists & inhibitors; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000517:prevention & control; D004305:Dose-Response Relationship, Drug; D004700:Endocrine System Diseases / Q000139:chemically induced / Q000517:prevention & control; D019317:Evidence-Based Medicine; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007167:Immunotherapy / Q000009:adverse effects; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control; D011014:Pneumonia / Q000139:chemically induced* / Q000517:prevention & control; D012871:Skin Diseases / Q000139:chemically induced* / Q000517:prevention & control; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000150:complications / Q000188:drug therapy
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D018797:Cell Cycle Proteins; D007166:Immunosuppressive Agents
keywords: Adverse events, immune-mediated; Corticosteroids; Immunotherapy; PD-1 inhibitor; PD-L1 inhibitor