Opportunistic autoimmunity secondary to cancer immunotherapy (OASI): An emerging challenge

Area of Science:

• Oncology
• Immunology
• Internal Medicine

Background:

• Cancer immunotherapy with checkpoint inhibitors (targeting PD1/PD-1 ligands or CTLA-4/CD28) has transformed oncology treatment.
• These therapies, initially for metastatic cancers, are now used more broadly, leading to increased immune-related adverse events (irAEs).

Purpose of the Study:

• To review available checkpoint inhibitors and associated irAEs, proposing the term Opportunistic Autoimmunity Secondary to Cancer Immunotherapy (OASI).
• To provide practical recommendations for diagnosing, assessing, and managing OASIs.
• To discuss the need for predictive biomarkers for OASI occurrence.

Main Methods:

• Literature review of checkpoint inhibitors and reported irAEs.
• Synthesis of clinical data on OASI presentation and management.
• Discussion of diagnostic criteria and pre-therapeutic assessments.

Main Results:

• Checkpoint inhibitors, including PD1/PD-1 ligand and CTLA-4/CD28 pathway blockers, are associated with various irAEs.
• OASIs represent a specific category of irAEs requiring tailored management strategies.
• Current literature highlights the need for collaborative care between oncologists and other specialists.

Conclusions:

• Effective management of OASIs is crucial due to the expanding use of cancer immunotherapy.
• Standardized diagnostic and management protocols for OASIs are needed.
• Further research into predictive biomarkers for OASI is essential for personalized immunotherapy.