Review article
Kumar V, et al. Front Pharmacol. 2017.
Abstract
The indications of immune checkpoint inhibitors (ICIs) are set to rise further with the approval of newer agent like atezolimumab for use in patients with advanced stage urothelial carcinoma. More frequent use of ICIs has improved our understanding of their unique side effects, which are known as immune-related adverse events (irAEs). The spectrum of irAEs has expanded beyond more common manifestations such as dermatological, gastrointestinal and endocrine effects to rarer presentations involving nervous, hematopoietic and urinary systems. There are new safety data accumulating on ICIs in patients with previously diagnosed autoimmune conditions. It is challenging for clinicians to continuously update their working knowledge to diagnose and manage these events successfully. If diagnosed timely, the majority of events are completely reversible, and temporary immunosuppression with glucocorticoids, infliximab or other agents is warranted only in the most severe grade illnesses. The same principles of management will possibly apply as newer anti- cytotoxic T lymphocytes-associated antigen 4 (CTLA-4) and programmed cell death protein 1 (PD-1/PD-L1) antibodies are introduced. The current focus of research is for prophylaxis and for biomarkers to predict the onset of these toxicities. In this review we summarize the irAEs of ICIs and emphasize their growing spectrum and their management algorithms, to update oncology practitioners.
https://www.ncbi.nlm.nih.gov/m/pubmed/28228726/
Current Diagnosis and Management of Immune Related Adverse Events (irAEs) Induced by Immune Checkpoint Inhibitor Therapy
Re: Current Diagnosis and Management of Immune Related Adverse Events (irAEs) Induced by Immune Checkpoint Inhibitor The
Despite important clinical benefits, checkpoint inhibition is associated with a unique spectrum of side effects termed immune-related adverse events (irAEs) or, occasionally, adverse events of special interest [1,2]. IrAEs include dermatologic, gastrointestinal, hepatic, endocrine, and other less common inflammatory events. IrAEs are believed to arise from general immunologic enhancement, and temporary immunosuppression with corticosteroids, tumor necrosis factor-alpha antagonists, mycophenolate mofetil, or other agents can be an effective treatment in most cases.
The side effects of the checkpoint-blocking antibodies targeting the PD-1 and PD-L1 receptors and CTLA-4 are reviewed here. The management approach to irAEs is presented based upon clinical experience, since no prospective trials have been conducted to guide the treatment of irAEs. The majority of data are derived from patients with advanced melanoma who were treated with ipilimumab, nivolumab, and pembrolizumab.
The side effects of the checkpoint-blocking antibodies targeting the PD-1 and PD-L1 receptors and CTLA-4 are reviewed here. The management approach to irAEs is presented based upon clinical experience, since no prospective trials have been conducted to guide the treatment of irAEs. The majority of data are derived from patients with advanced melanoma who were treated with ipilimumab, nivolumab, and pembrolizumab.
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