Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Sep 28:12:9139-9158.
doi: 10.2147/CMAR.S218756. eCollection 2020.

Management of Immune Checkpoint Inhibitor Toxicities

Quentin Durrechou  1 , Charlotte Domblides  1   2 , Baptiste Sionneau  1 , Felix Lefort  1 , Amandine Quivy  1 , Alain Ravaud  1 , Marine Gross-Goupil  1 , Amaury Daste  1
Affiliations
Review

Management of Immune Checkpoint Inhibitor Toxicities

Quentin Durrechou et al. Cancer Manag Res. .

Abstract

Immune checkpoint inhibitors (ICIs) have radically changed the clinical outcome of several cancers with durable responses. CTLA-4 (cytotoxic T lymphocyte antigen-4), PD-1 (programmed cell death protein 1) or PDL-1 (programmed cell death ligand protein 1) represent ICIs that can be used as monotherapy or in combination with other agents. The toxicity p\rofiles of ICIs differ from the side effects of cytotoxic agents and come with new toxicities like immune-related adverse events. Typically, these toxicities occur in all organs. However, the main organs affected are the skin, digestive, hepatic, lungs, rheumatologic, and endocrine. Most of the immune toxicity that occurs is low grade but some more severe toxicities can occur that require a rapid diagnosis and appropriate treatment. The recognition of symptoms by physicians and patient is necessary to resolve them rapidly and adapt treatment to allow the toxicity to resolve.

Keywords: corticosteroids; immune check point inhibitor; immunosuppressive treatments; toxicity.

PubMed Disclaimer

Conflict of interest statement

Felix Lefort reports personal fees from Ipsen, outside the submitted work. A Ravaud has received honoraria for consultancy from Pfizer, Astra Zeneca, MSD, BMS, Roche, and Ipsen; is a member of the GU for Pfizer, Astra Zeneca, MSD, BMS, Roche and Ipsen; and has received transportation and housing for meetings from Pfizer, Astra Zeneca, BMS and Ipsen; and reports grants, personal fees, and non-financial support from Pfizer and Merck GA, and personal fees, non-financial support from BMS, Ipsen, MSD, Astra Zeneca, and Novartis, outside the submitted work. M Gross-Goupil is a member of GU board for Pfizer, Astra Zeneca, MSD, BMS, Roche and Ipsen; has received transportation and housing for meetings from Pfizer, BMS, Janssen, Ipsen, Roche, MSD, Amgen, Astellas; has received honoraria for symposiums from MSD, BMS, Pfizer.; and reports personal fees, non-financial support from BMS, MSD, Astra Zeneca, Roche, and Merck, during the conduct of the study. A Daste has received honoraria for consultancy for Astra-Zeneca, BS, MSD, Roche, and Merck. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

Figure 1
Figure 1
Mechanism of action of both anti CTLA-4 and anti PD-1/PD-L1 agents.
Figure 2
Figure 2
General principles of immunotoxicity management inspired from Menzies et al.33
Figure 3
Figure 3
Mechanism of action of immune modulating medications inspired from Martins et al.35
Figure 4
Figure 4
Organs affected by immune-related adverse events.
See this image and copyright information in PMC

References

    1. Spain L, Diem S, Larkin J. Management of toxicities of immune checkpoint inhibitors. Cancer Treat Rev. 2016;44:51–60. doi:10.1016/j.ctrv.2016.02.001 - DOI - PubMed
    1. Postow MA, Sidlow R, Hellmann MD. Immune-related adverse events associated with immune checkpoint blockade. N Engl J Med. 2018;378(2):158–168. doi:10.1056/NEJMra1703481 - DOI - PubMed
    1. Tian T, Olson S, Whitacre JM, Harding A. The origins of cancer robustness and evolvability. Integr Biol. 2011;3(1):17–30. doi:10.1039/C0IB00046A - DOI - PubMed
    1. Boon T, Cerottini J-C, Van den Eynde B, van der Bruggen P, Van Pel A. Tumor antigens recognized by T lymphocytes. Annu Rev Immunol. 1994;12(1):337–365. doi:10.1146/annurev.iy.12.040194.002005 - DOI - PubMed
    1. Chen DS, Mellman I. Oncology meets immunology: the cancer-immunity cycle. Immunity. 2013;39(1):1–10. doi:10.1016/j.immuni.2013.07.012 - DOI - PubMed