Immunotherapy: A Case Series
Tuong Vi C Do1, Mythili Kanthi Gudipati2, Subramanya Shyam Ganti3
1Internal Medicine, West Anaheim Medical Center, Anaheim, USA.
Cureus
|December 22, 2021
Summary
Immunotherapy, including CTLA-4 and PD-1 inhibitors, can cause side effects like pneumonitis and thyroiditis. Steroid treatment often resolves these complications, but flares can occur when resuming immunotherapy.
Area of Science:
- Oncology
- Immunology
- Pharmacology
Background:
- Immunotherapy, particularly cytotoxic T lymphocyte antigen 4 (CTLA-4) and programmed cell death 1 (PD-1) inhibitors, is increasingly used for advanced cancers.
- Commonly treated cancers include melanoma, non-small cell lung carcinoma, and renal cell carcinoma.
Observation:
- A case series of four patients treated with pembrolizumab or nivolumab experienced immune-related adverse events.
- Observed side effects included pneumonitis, transaminitis, thyroiditis, nephritis, and hypophysitis.
Findings:
- Three of four patients showed symptom resolution with steroid treatment; one was lost to follow-up.
- One patient experienced a relapse of side effects upon resuming immunotherapy and discontinued treatment.
- Another patient continued immunotherapy successfully with daily steroids, while a third discontinued due to a flare after missing steroid doses.
Implications:
- Steroids are effective in managing immunotherapy-induced side effects.
- Further research is needed on the risks of side effect flares when resuming immunotherapy, with or without concurrent steroid use.
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