Diagnosis and Management of Rare Immune-Related Adverse Events

被引:20
作者
Schoenfeld, Sara R. [1 ]
Aronow, Mary E. [5 ]
Leaf, Rebecca Karp [2 ]
Dougan, Michael [3 ]
Reynolds, Kerry L. [4 ]
机构
[1] Harvard Med Sch, Massachusetts Gen Hosp, Div Rheumatol Allergy & Immunol, Dept Med, Boston, MA 02115 USA
[2] Harvard Med Sch, Massachusetts Gen Hosp, Div Hematol, Dept Med, Boston, MA 02115 USA
[3] Harvard Med Sch, Massachusetts Gen Hosp, Div Gastroenterol, Dept Med, Boston, MA 02115 USA
[4] Harvard Med Sch, Massachusetts Gen Hosp, Div Oncol, Dept Med, Boston, MA 02115 USA
[5] Harvard Med Sch, Massachusetts Eye & Ear, Retina Serv, Boston, MA 02115 USA
关键词
GIANT-CELL ARTERITIS; CHECKPOINT INHIBITORS; BIOPSY FINDINGS; OPEN-LABEL; NIVOLUMAB; IPILIMUMAB; MELANOMA; THERAPY; PEMBROLIZUMAB; CHEMOTHERAPY;
D O I
10.1634/theoncologist.2019-0083
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Oncologic treatment is being revolutionized by a burgeoning number of immune checkpoint inhibitors (ICPis). To date, seven ICPis have received Food and Drug Administration approval, targeting cytotoxic T-lymphocyte antigen, programmed cell death, or programmed cell death ligand. Adverse events associated with checkpoint inhibition have been described in the literature. Guidelines exist for the most common of these, but as the use of ICPis becomes more common, the number of patients presenting with rare events will increase. This article reviews the diagnosis and management of rare ocular, hematological, luminal gastrointestinal, and rheumatological toxicities arising from ICPi treatment. Key Points As the use of immune checkpoint inhibitors (ICPis) becomes more common, the number of rare immune-related adverse events (irAEs) will increase. A high level of suspicion is required to identify and treat these toxicities. Although it can be difficult to definitively attribute rare irAEs to ICPis, a temporal and mechanistic relationship and the absence of other etiologies should make the treating physician suspicious for a rare irAE. Certain rare irAEs, such as celiac disease, do not require treatment with glucocorticoids. Thus, differentiating this irAE from other gastrointestinal irAEs has important implications for treatment.
引用
收藏
页码:6 / 14
页数:9
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