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Immune checkpoint inhibitors: An emergency medicine focused review
Michael J Yoo1, Brit Long1, William J Brady2
1Attending Physician, Department of Emergency Medicine, Brooke Army Medical Center, TX, United States of America.
Introduction:
Several novel cancer therapies have been developed, many of which focused on immune system modulation. These include immune checkpoint inhibitors, modulators, T-cell therapy, monoclonal antibodies, cytokines, oncolytic viruses, and vaccines. Although many of these therapies are well tolerated, significant adverse reactions can occur as a result of these novel drugs.
Objective:
This narrative review discusses complications associated with immune based cancer therapies, specifically immune checkpoint inhibitors, for emergency clinicians.
Discussion:
Novel cancer therapies including immune checkpoint inhibitors can improve the care of patients with malignancy. However, these therapies have a number of potential complications, known as immune-related adverse events (irAEs). Complications can involve the neurologic, cardiac, pulmonary, dermatologic, renal, gastrointestinal, hepatic, and hematologic systems. IrAEs most commonly occur in the first several months following treatment initiation. These complications can be graded based on severity of clinical and laboratory findings. While most of these irAEs are mild, patients may present with critical illness. Treatment commonly includes immune checkpoint inhibitor discontinuation, steroids, and evaluation for other immunosuppressant medications.
Conclusions:
Knowledge of this novel cancer therapy class and its potential complications can improve the care of patients on immune checkpoint inhibitors in the emergency department setting.
Insights
Novel cancer therapies, such as immune checkpoint inhibitors, can cause immune-related adverse events (irAEs). Emergency clinicians should be aware of these potential complications affecting multiple organ systems for improved patient care.
Area of Science:
- Oncology
- Immunology
- Emergency Medicine
Background:
- Novel cancer therapies increasingly modulate the immune system.
- Immune checkpoint inhibitors are a key class of these novel therapies.
- While effective, these treatments can lead to significant adverse reactions.
Purpose of the Study:
- To review complications associated with immune-based cancer therapies.
- Specifically focus on immune checkpoint inhibitors for emergency clinicians.
- Enhance emergency department preparedness for irAEs.
Main Methods:
- Narrative review of immune-based cancer therapies.
- Focus on immune checkpoint inhibitors and their adverse events.
- Discussion of potential complications across organ systems.
Main Results:
- Immune-related adverse events (irAEs) can affect neurologic, cardiac, pulmonary, dermatologic, renal, gastrointestinal, hepatic, and hematologic systems.
- irAEs commonly manifest within months of treatment initiation.
- Severity ranges from mild to critical illness, requiring specific management.
Conclusions:
- Understanding immune checkpoint inhibitors and their irAEs is crucial for emergency clinicians.
- Prompt recognition and management of irAEs can improve patient outcomes.
- Knowledge facilitates better care for patients receiving these novel cancer treatments.
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