irAE

my report about irAE oncology immunotherapy and cellular therapy

reference

Oral immune-related adverse events associated with PD-1 inhibitor therapy: A case series - PubMed PD-1/PD-L and autoimmunity: A growing relationship - ScienceDirect Severe Oral Mucositis: A Rare Adverse Event of Pembrolizumab - PubMed Oral mucositis—case series of a rare adverse effect associated with immunotherapy | SpringerLink

overview

• ICIs can cause inflammation of any tissue (lungs, liver, colon, joints, skin, etc.)
• Common immune-related adverse events (IRAEs) above; ↑ incidence w/ combinations.
• Rare: myocarditis (can be fulminant), myositis, myelitis, uveitis, diabetes
• Workup: CT chest for dyspnea; colonoscopy and infectious workup for colitis; TSH, FT4, a.m. cortisol, glucose. Trend comprehensive metabolic panel and TSH while on ICI.
• IRAEs graded 1 (mild) to 4 (severe) (NCCN Guideline v4.2021)

management

• Most IRAEs reversible with steroids
• Mild symptoms (grade 1): supportive care, can often continue Rx; moderate symptoms (grade 2): hold ICI, consider steroids; severe symptoms (grades 3–4): often requires admission to hospital, hold ICI, IV steroids, targeted *herapies (eg, enteracept)
• Endocrinopathies (hypophysitis, hypothyroid) are not reversible, Rx hormone replacement
• Managing IRAEs with steroids likely does not reduce ICI efficacy (J Clin Oncol 2019;37:1927)
• If ICI is restarted, Pts at increased risk for recurrent IRAE