Molecular targeted therapy-related life-threatening toxicity in patients with malignancies. A systematic review of published cases

Background Molecular targeted therapy increased overall and disease-free survival in a wide range of malignancies. Although generally well tolerated compared to chemotherapy, molecular targeted therapy may be associated with adverse events requiring ICU admission. Informing clinicians about clinical...

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Vydané v:	Intensive care medicine Ročník 45; číslo 7; s. 988 - 997
Hlavní autori:	Assoun, Sandra, Lemiale, Virginie, Azoulay, Elie
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2019 Springer Springer Nature B.V
Predmet:	Adverse events Anesthesiology Angiogenesis Angiogenesis Modulating Agents - adverse effects Antiangiogenic agents Antiangiogenics Antimitotic agents Antineoplastic agents Biomarkers Cancer Cardiovascular Diseases - chemically induced Cardiovascular Diseases - therapy Care and treatment Case reports Chemotherapy Comparative analysis Complications and side effects Critical Care Medicine Drug approval Drug Hypersensitivity - therapy Emergency Medicine Epidermal growth factor receptors ErbB Receptors - antagonists & inhibitors ErbB-2 protein Evidence-based medicine Gastrointestinal Diseases - chemically induced Gastrointestinal Diseases - therapy Health services Humans Hypersensitivity Immune checkpoint inhibitors Immunologic Factors - adverse effects Inhibitors Intensive Intensive care Intensive Care Units Malignancy Medicine Medicine & Public Health Molecular Targeted Therapy - adverse effects Monoclonal antibodies Neoplasms - drug therapy Pain Medicine Patients Pediatrics Pneumology/Respiratory System Receptor, ErbB-2 - antagonists & inhibitors Respiratory Tract Diseases - chemically induced Respiratory Tract Diseases - therapy Review Schedules Severity of Illness Index Side effects Signs and symptoms Systematic review Targeted cancer therapy Toxicity Critical care Molecular targeted therapy Digestive perforation Pneumonitis Malignancies
ISSN:	0342-4642, 1432-1238, 1432-1238
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Popis
Shrnutí:	Background Molecular targeted therapy increased overall and disease-free survival in a wide range of malignancies. Although generally well tolerated compared to chemotherapy, molecular targeted therapy may be associated with adverse events requiring ICU admission. Informing clinicians about clinical features of these toxic events might maintain awareness and favor early recognition, prompt diagnosis and treatment. Methods We performed a systematic review of published case reports of molecular targeted therapy-related life-threatening toxicity that led to ICU admission. The search used the Pubmed database using medical subject heading (Mesh) terms, including all FDA-approved molecular targeted therapy (TT), up to March 2019. No language restriction was applied. All cases reports of patients admitted to the ICU for molecular targeted therapy-related toxicity were included. Non-FDA-approved combinations of treatments or hormonal therapy were not included. Results Two hundred and fifty-three cases were identified. Nearly half of them ( n = 102; 40.3%) were related to anti-angiogenic agents, mostly for gastrointestinal and cardiovascular complications. Other molecules responsible for adverse events were chiefly immune checkpoint inhibitors ( n = 85, 33.6%), EGFR inhibitors ( n = 33; 13.0%), and anti-HER2 ( n = 10; 4.0%). They were associated with adverse events such as respiratory or hypersensitivity events. Management and outcomes associated with these life-threatening complications are reported. Conclusions Based on the vast number of treated patients, only 253 cases of molecular therapy-related severe toxicity are reported in cancer patients. Symptoms and biomarkers that depict these events need to be better identified as to allow appropriate reporting and improving dose and schedule of the treatment adapted to each patient.
Bibliografia:	ObjectType-Article-2 SourceType-Scholarly Journals-1 content type line 14 ObjectType-Feature-3 ObjectType-Evidence Based Healthcare-1 ObjectType-Article-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	0342-4642 1432-1238 1432-1238
DOI:	10.1007/s00134-019-05650-w