Balancing Cancer Immunotherapy Efficacy and Toxicity
Douglas B Johnson1, Baruch D Jakubovic2, Vincent Sibaud3
1Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn.
Summary
Immune checkpoint inhibitor therapies offer durable cancer responses but can cause autoimmune toxicities. Management may involve corticosteroids, immunosuppression, and careful consideration of immunotherapy rechallenge due to potential flares.
Area of Science:
- Oncology
- Immunology
- Allergy
Background:
- Immune checkpoint inhibitors (ICIs) targeting PD-1/PD-L1 have revolutionized cancer treatment.
- ICI therapies induce durable antitumor responses across various cancer types.
- Therapeutic toxicities are primarily autoimmune and can affect multiple organ systems.
Purpose of the Study:
- To review toxicities associated with immune checkpoint inhibitor therapies.
- To focus on clinical issues relevant to allergists/immunologists.
- To discuss the safety of immunotherapy rechallenge.
Main Methods:
- Review of existing literature on ICI toxicities.
- Focus on specific toxicities like interstitial nephritis and skin toxicity.
- Analysis of data regarding immunotherapy rechallenge risks.
Main Results:
- ICI toxicities are autoimmune, involving T-cell activation and autoantibodies.
- Hypersensitivity reactions are also possible.
- Most toxicities respond to corticosteroids, but some require second-line immunosuppression.
Conclusions:
- ICI therapies are effective but carry significant autoimmune risks.
- Allergists/immunologists play a role in managing ICI-related toxicities.
- Rechallenge with ICIs carries risks of toxicity flares and requires careful assessment.
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