Immune-Related Adverse Events: A Case-Based Approach

Abstract

Immunotherapy has heralded the advent of a new era in oncology. Immune checkpoint inhibitors (ICIs) enhance anti-tumor immunity, thereby reinvigorating a patient's immune system to fight cancer. While therapy with this class of agents has resulted in improved clinical outcomes for patients with multiple tumor types, a broad spectrum of immune-related adverse events (irAEs) may affect any organ system, with variable clinical presentations. Prompt recognition and management of irAEs are associated with improved irAE outcomes, and represents an important new clinical challenge for practicing oncologists. Herein, we provide a comprehensive case-based review of the most common and clinically-important irAEs, focussing on epidemiology, clinical manifestations, and management. We also examine future strategies that may provide meaningful insights into the prevention and management of irAEs.

Keywords: immune checkpoint inhibitors; immune-related adverse events; immune-related toxicities; immunotherapy; management.

Figure 1

Early diagnosis and multidisciplinary management are integral to optimal clinical outcomes. It is crucial that physicians have a detailed knowledge of the wide range of clinical manifestations of irAEs, as well as familiarity with existing algorithms for their grading and management.

Figure 2

Clinical manifestations of irAE. (A) Inflammatory arthritis: US image of knee effusion; (B) myopericarditis: cardiac MRI with late gadolinium enhancement overlying basal left ventricular lateral wall (arrow); (C) bullous pemphigoid; (D) lichenoid dermatitis; (E) encephalitis: brain MRI with hyperenhancement of right hippocampus (arrow); (F) pneumonitis: chest CT with bilateral lower lobe infiltrates; (G) colitis: endoscopic findings of pan-colitis.