Systemic adverse effects and toxicities associated with immunotherapy: A review

Abstract

Immunotherapy is rapidly evolving secondary to the advent of newer immunotherapeutic agents and increasing approval of the current agents by the United States Food and Drug Administration to treat a wide spectrum of cancers. Immunotherapeutic agents have gained immense popularity due to their tumor-specific action. Immunotherapy is slowly transforming into a separate therapeutic entity, and the fifth pillar of management for cancers alongside surgery, radiotherapy, chemotherapy, and targeted therapy. However, like any therapeutic entity it has its own adverse effects. With the increasing use of immuno-therapeutic agents, it is vital for physicians to acquaint themselves with these adverse effects. The aim of this review is to investigate the common systemic adverse effects and toxicities associated with the use of different classes of immunotherapeutic agents. We provide an overview of potential adverse effects and toxicities associated with different classes of immunotherapeutic agents organized by organ systems, as well as an extensive discussion of the current recommendations for treatment and clinical trial data. As we continue to see increasing usage of these agents in clinical practice, it is vital for physicians to familiarize themselves with these effects.

Role of Immunotherapy in the Treatment of Cancer: A Systematic Review

“…Pembrolizumab, which is one of the approved cancer drugs, was used in the treatment of advanced non-small cell lung cancer (NSCLC) alongside chemotherapy, as a combination treatment [ 47 ]. Other approved uses of pembrolizumab includes the treatment of head and neck squamous cell carcinoma, gastrointestinal cancer, Hodgkin’s lymphoma, melanoma, and bladder cancer, as an alternative source of treatment when the disease has progressed after standard treatment or where standard treatment is not appropriate enough to be carried out [ 48 ].…”

Immune Phenomena in Myeloid Neoplasms: An “Egg or Chicken” Question

“…On the other hand, imatinib has been associated with the occurrence of aplastic anemia, and nilotinib and dasatinib implicated in the development of immune-mediated liver injury, SLE, panniculitis, and neurologic demyelinating disease. The harmful effects of potent immunomodulation are even more marked with aggressive therapies such as BM transplantation, where several autoimmune complications are thought to be the consequence of the "immunological storm" elicited by the battle against tumor cells (58)(59)(60). The complexity of the immunological perturbation following allogenic BM transplantation is maximally reflected in the well known graft-versus-host-disease, which resembles progressive systemic sclerosis and vasculitis of the skin, gastrointestinal tract, liver, lungs, and kidneys.…”

Cannabinoid drugs against chemotherapy-induced adverse effects: focus on nausea/vomiting, peripheral neuropathy and chemofog in animal models

“…Although targeted therapy and immunotherapy (with a different and generally milder profile of side effects), are increasingly being applied, conventional standard-of-care (cytotoxic) chemotherapy is still used in everyday practice, also in combination with these newer treatments. Thus, chemotherapy-induced adverse effects (CIAE) deserve continuous attention (Magee et al , 2020; Kichloo et al , 2021; Yip and Papa, 2021).…”