New therapeutic perspectives to manage refractory immune checkpoint-related toxicities

Immune checkpoint inhibitors are reshaping the prognosis of many cancer and are progressively becoming the standard of care in the treatment of many tumour types. Immunotherapy is bringing new hope to patients, but also a whole new spectrum of toxicities for healthcare practitioners to manage. Oncol...

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Veröffentlicht in:The lancet oncology Jg. 20; H. 1; S. e54 - e64
Hauptverfasser: Martins, Filipe, Sykiotis, Gerasimos P, Maillard, Michel, Fraga, Montserrat, Ribi, Camillo, Kuntzer, Thierry, Michielin, Olivier, Peters, Solange, Coukos, Georges, Spertini, Francois, Thompson, John A, Obeid, Michel
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England Elsevier Ltd 01.01.2019
Elsevier Limited
Elsevier
Schlagworte:
Algorithms
Antibodies, Monoclonal - adverse effects
Antineoplastic Agents - adverse effects
Apoptosis
Arthritis
Biopsy
Cancer
Cancer therapies
Corticosteroids
Cytokines
Cytotoxicity
Drug dosages
Drug-Related Side Effects and Adverse Reactions - drug therapy
Drug-Related Side Effects and Adverse Reactions - immunology
Drug-Related Side Effects and Adverse Reactions - pathology
Drug-Related Side Effects and Adverse Reactions - physiopathology
Encephalitis
Fatalities
Guillain-Barre syndrome
Hematology, Oncology, and Palliative Medicine
Hepatitis
Humans
Immune checkpoint inhibitors
Immunoglobulins
Immunosuppression
Immunosuppressive agents
Immunosuppressive Agents - adverse effects
Immunosuppressive Agents - therapeutic use
Immunotherapy
Immunotherapy - adverse effects
Inflammation
Inflammatory bowel disease
Life Sciences
Meningitis
Mortality
Neoplasms - therapy
Oncology
Patients
Precision Medicine
Psoriasis
Tumors
ISSN:1470-2045, 1474-5488, 1474-5488
Online-Zugang:Volltext
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Zusammenfassung:Immune checkpoint inhibitors are reshaping the prognosis of many cancer and are progressively becoming the standard of care in the treatment of many tumour types. Immunotherapy is bringing new hope to patients, but also a whole new spectrum of toxicities for healthcare practitioners to manage. Oncologists and specialists involved in the pluridisciplinary management of patients with cancer are increasingly confronted with the therapeutic challenge of treating patients with severe and refractory immune-related adverse events. In this Personal View, we summarise the therapeutic strategies that have been used to manage such toxicities resulting from immune checkpoint inhibitor treatment. On the basis of current knowledge about their pathogenesis, we discuss the use of new biological and non-biological immunosuppressive drugs to treat severe and steroid refractory immune-related adverse events. Depending on the immune infiltrate type that is predominant, we propose a treatment algorithm for personalised management that goes beyond typical corticosteroid use. We propose a so-called shut-off strategy that aims at inhibiting key inflammatory components involved in the pathophysiological processes of immune-related adverse events, and limits potential adverse effects of drug immunosuppression on tumour response. This approach develops on current guidelines and challenges the step-by-step increase approach to drug immunosuppression.
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ISSN:1470-2045
1474-5488
1474-5488
DOI:10.1016/S1470-2045(18)30828-3