Dataset Information

Diagnosis and management of immune-related adverse effects of immune checkpoint therapy in the emergency department.

ABSTRACT: Rapid advances in cancer immunotherapy using immune checkpoint inhibitors have led to significantly improved survival. Rapid identification of the toxicity syndromes associated with these therapeutic agents is very important for emergency physicians because the population of patients diagnosed with cancer is increasing and cancer therapies including immune checkpoint inhibitors have become the first-line treatment for more and more types of cancer. The emergency medicine literature lags behind rapid advances in oncology, and oncology guidelines for rapid recognition and management of these emerging toxicity syndromes are not familiar to emergency physicians. In this review article, we discuss the clinical presentation and management of immune-related adverse effects during the critical first hours of emergency care. We also suggest a workflow for the recognition and treatment of emergencies arising from serious immune-related adverse effects, including but not limited to colitis, adrenal crisis, myocarditis, pneumonitis, myasthenic crisis, diabetic ketoacidosis, bullous pemphigus, and hemophagocytic lymphohistiocytosis. Rapid advances in cancer therapy are bringing new diagnostic and therapeutic challenges to emergency providers, and therefore it is crucial to raise awareness and provide guidelines for the management of new treatment-related toxicities.

SUBMITTER: Yeung SJ

PROVIDER: S-EPMC7771833 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Diagnosis and management of immune-related adverse effects of immune checkpoint therapy in the emergency department.

Yeung Sai-Ching Jim SJ Qdaisat Aiham A Chaftari Patrick P Lipe Demis D Merlin Jeffrey J Rajha Eva E Wechsler Adriana A Sandoval Marcelo M Viets Jayne J Al-Breiki Aisha A Shah Mohsin M Pandey Ramesh R Kamal Mona M Khattab Osama O Toale Katy K Wattana Monica M Elsayem Ahmed A Gaeta Susan S Brock Patricia P Reyes-Gibby Cielito C Alagappan Kumar K

Journal of the American College of Emergency Physicians open 20200830 6

Rapid advances in cancer immunotherapy using immune checkpoint inhibitors have led to significantly improved survival. Rapid identification of the toxicity syndromes associated with these therapeutic agents is very important for emergency physicians because the population of patients diagnosed with cancer is increasing and cancer therapies including immune checkpoint inhibitors have become the first-line treatment for more and more types of cancer. The emergency medicine literature lags behind r ...[more]

PMID: 33392573

Similar Datasets

Project description:BackgroundCancer immunotherapy via immune-checkpoint inhibition (ICI) by antibodies against cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and cell death protein 1 (PD-1) have significantly improved the outcome of metastasized melanoma and of a rapidly increasing number of other cancer types. The anti-tumor effect is often accompanied by immune-related adverse events (irAE). Hematological irAE, specifically neutropenia, are rarely observed. However, neutropenia is associated with high morbidity and mortality due to infection complications. Thus, early detection and treatment is crucial.MethodsWe present the clinical course of two patients with severe neutropenia after ICI therapy and demonstrate the difficulty of the diagnosis when a comedication of metamizole, a well-known analgesic drug used to treat cancer pain, is present. Further, we provide a comprehensive descriptive and statistical analysis of published data on diagnostics, treatment and infection complication in patients with at least grade 4 neutropenia by a systematic database search.ResultsFinally, 34 patients were analyzed, including the two case reports from our cohort. The median onset of neutropenia was 10.5?weeks after first ICI administration (interquartile range: 6?weeks). In 76% (N =?26), a normalization of the neutrophil count was achieved after a median duration of neutropenia of 13?days. In a subsample of 22 patients with detailed data, the infection rate was 13%, proven by positive blood culture in 3 cases, but 68% (N =?15) presented with fever >?38?°C. Treatment regime differed relevantly, but mainly included G-CSF and intravenous corticosteroids. Death was reported in 14 patients (41%), 3 of whom (9%) were associated with hematological irAE but only two directly associated with neutropenia.ConclusionWith an increasing number of cancer patients eligible to ICI therapy, the incidence of severe hematological toxicities may rise substantially over the next years. Clinicians working in the field of cancer immune therapies should be aware of neutropenia as irAE to provide immediate treatment.

Dataset Information

Diagnosis and management of immune-related adverse effects of immune checkpoint therapy in the emergency department.

Publications

Diagnosis and management of immune-related adverse effects of immune checkpoint therapy in the emergency department.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets