A multidisciplinary approach to toxicity management of modern immune checkpoint inhibitors in cancer therapy

Kottschade, Lisa A.; Brys, Adam K.; Peikert, Tobias; Ryder, Mabel; Raffals, Laura E.; Brewer, Jerry D.; Mosca, Paul J.; Markovic, Svetomir

doi:10.1097/cmr.0000000000000273

Cited by 31 publications

(35 citation statements)

References 65 publications

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“…According to recent systematic reviews and meta-analyses, the incidence of TDs depends on the class of ICIs used ( 1 , 21 ). During anti-PD-1 treatment, thyroid involvement of any grade was one of the most common organ-specific irAEs ( 59 ). Different TDs had been observed in approximately 7% of patients receiving ipilimumab, 19% of those receiving PD-1 and PD-L1 inhibitors, and 28% of those receiving combination therapy with ipilimumab and nivolumab ( 21 , 48 ).…”

Section: Immune Checkpoint Inhibitor-induced Thyroid Disordersmentioning

confidence: 99%

Management of endocrine immune-related adverse events of immune checkpoint inhibitors: an updated review

Stelmachowska-Banaś

Czajka-Oraniec

2020

Endocrine Connections

114

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Immune checkpoint inhibitors (ICIs) belong to a new group of anticancer drugs targeting T-cell proteins involved in the activation of immune response toward malignancies. Their introduction into clinical practice was a milestone in modern cancer treatment. However, the significant advantage of ICIs over conventional chemotherapy in terms of therapeutic efficacy is accompanied by new challenges related to specific side effects. ICI-induced immune system activation could lead to the loss of self-tolerance, presenting as autoimmune inflammation and dysfunction of various tissues and organs. Thus, the typical side effects of ICIs include immune-related adverse events (irAEs), among which endocrine irAEs, affecting numerous endocrine glands, have been commonly recognized. This review aimed to outline the current knowledge regarding ICI-induced endocrine disorders from a clinical perspective. We present updated information on the incidence and clinical development of ICI-induced endocrinopathies, including the most frequent thyroiditis and hypophysitis, the rarely observed insulin-dependent diabetes mellitus and primary adrenal insufficiency, and the recently described cases of hypoparathyroidism and lipodystrophy. Practical guidelines for monitoring, diagnosis, and treatment of ICI-related endocrine toxicities are also offered. Rising awareness of endocrine irAEs among oncologists, endocrinologists, and other health professionals caring for patients receiving ICIs could contribute to better safety and efficacy. As immunotherapy becomes widespread and approved for new types of malignancies, increased incidences of endocrine irAEs are expected in the future.

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Section: Immune Checkpoint Inhibitor-induced Thyroid Disordersmentioning

confidence: 99%

Management of endocrine immune-related adverse events of immune checkpoint inhibitors: an updated review

Stelmachowska-Banaś

Czajka-Oraniec

2020

Endocrine Connections

114

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“…Rola endokrynologów pozostaje nadal znacząca, pomimo że onkolodzy mają obecnie coraz większe doświadczenie w stosowaniu immunoterapii i dostęp do dobrze opracowanych algorytmów postępowania w przypadku wystąpienia powikłań [3,4]. Praktyka w interpretacji wyników dodatkowych badań laboratoryjnych i obrazowych zlecanych w celu różnicowania etiologii nadczynności lub niedoczynności gruczołów wydzielania wewnętrznego (takich jak przeciwciała, badania hormonalne, scyntygrafia jodowa lub technetowa tarczycy) [5] oraz możliwość specjalistycznego leczenia bywa często przydatna w prowadzeniu chorego na nowotwór. Niezbędna jest też długotrwała obserwacja pacjentów, gdyż niektóre z zaburzeń endokrynologicznych -choć częściej występują na wczesnym etapie leczenia -mogą się ujawnić nawet rok po zaprzestaniu terapii.…”

Section: Omówienieunclassified

Rozsiew czerniaka u 77-letniej chorej leczonej pierwotnie z powodu lentigo maligna

Gabalewicz

2019

Oncol Clin Pract

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Rozsiew czerniaka u 77-letniej chorej leczonej pierwotnie z powodu lentigo maligna Dissemination of melanoma in a 77-year-old patient initially treated for lentigo maligna STRESZCZENIE Przedstawiono przypadek chorej w podeszłym wieku, u której przed kilkoma laty rozpoznano lentigo maligna, uznawaną za czerniaka in situ. Dwa lata po wycięciu zmiany na skórze pacjentka zauważyła 2-centymetrowe zgrubienie. Usunięto płat powierzchowny lewej ślinianki przyusznej z guzem. W raporcie histopatologicznym opisano przerzut melanoma malignum, a w badaniach obrazowych potwierdzono rozsiew procesu nowotworowego. Pacjentkę zakwalifikowano do leczenia pembrolizumabem. Leczenie trwało od listopada 2016 roku do 18 maja 2018 roku, było dobrze tolerowane. Z powodu progresji choroby zakończono immunoterapię i chorą zakwalifikowano do radioterapii paliatywnej.

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“…Their timing following initial treatment is less consistent but typically occur after 6 to 9 weeks of therapy. While nivolumab and pembrolizumab have a similar side effect profile to ipilimumab, adverse events due to these drugs are generally less common and less severe [78]. Skin-related symptoms occur in up to 37% of patients, and severe colitis has been observed in only 1% to 2% of patients [17].…”

Section: Toxicities Associated With Immune Checkpoint Blockadementioning

confidence: 99%

The Role of Immune Checkpoint Inhibition in the Treatment of Brain Tumors

et al. 2017

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The standard of care for malignant gliomas of the brain has changed very little over the last few decades, and does not offer a cure for these rare, but fatal, tumors. The field of immunotherapy has brought potent new drugs into the oncological armamentarium, and is becoming recognized as a potentially important arm in the treatment of glioblastoma for adults. Immune checkpoints are inhibitory receptors found on immune cells that, when stimulated, cause those immune cells to become quiescent. While this is a natural mechanism to prevent excessive inflammatory damage and autoimmunity in otherwise healthy tissues, cancer cells may utilize this process to grow in the absence of targeted immune destruction. Antibodies derived to block the stimulation of these negative checkpoints, allowing immune cells to remain activated and undergo effector function, are a growing area of immunotherapy. These therapies have seen much success in both the preclinical and clinical arenas for various tumors, particularly melanoma and nonsmall-cell lung cancer. Multiple clinical trials are underway to determine if these drugs have efficacy in glioblastoma. Here, we review the current evidence, from early preclinical data to lessons learned from clinical trials outside of glioblastoma, to assess the potential of immune checkpoint inhibition in the treatment of brain tumors and discuss how this therapy may be implemented with the present standard of care.

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A multidisciplinary approach to toxicity management of modern immune checkpoint inhibitors in cancer therapy

Cited by 31 publications

References 65 publications

Management of endocrine immune-related adverse events of immune checkpoint inhibitors: an updated review

Management of endocrine immune-related adverse events of immune checkpoint inhibitors: an updated review

Rozsiew czerniaka u 77-letniej chorej leczonej pierwotnie z powodu lentigo maligna

The Role of Immune Checkpoint Inhibition in the Treatment of Brain Tumors

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