Rare irAEs associated with immune checkpoint inhibitor therapy

Area of Science:

• Oncology
• Immunology
• Clinical Medicine

Background:

• Immune checkpoint inhibitors (ICIs) are effective cancer treatments but can cause immune-related adverse events (irAEs).
• While common irAEs are documented, rare irAEs are less understood, often appearing in case reports.
• These rare irAEs can affect nearly every organ system.

Purpose of the Study:

• To review and highlight rare immune-related adverse events (irAEs) associated with immune checkpoint inhibitors (ICIs).
• To characterize the proposed etiology, phenotype, and treatment of these rare irAEs.
• To emphasize the importance of recognizing rare irAEs for refining cancer treatment strategies.

Main Methods:

• Literature review focusing on case reports and case series of rare irAEs.
• Compilation of information on irAEs across various organ systems.
• Discussion of proposed mechanisms, clinical presentations, and management strategies.

Main Results:

• Rare irAEs can manifest in cardiac, dermatological, endocrine, gastrointestinal, hematological, hepatobiliary, neurological, ocular, pancreatic, renal, and rheumatological systems.
• These events may have delayed onset and are challenging to attribute directly to ICI therapy.
• Understanding these rare events is crucial despite their scarcity.

Conclusions:

• Rare irAEs associated with ICIs affect a wide range of organ systems.
• Early recognition and diagnosis of rare irAEs are critical for optimal patient outcomes.
• Further research is needed to improve the identification and management of these uncommon adverse events.