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Review
. 2022 Feb;192(1):1-17.
doi: 10.1007/s10549-021-06480-5. Epub 2022 Jan 11.

Immunotherapy toxicity: identification and management

O Gumusay  1 , J Callan  2 , H S Rugo  2
Affiliations
Review

Immunotherapy toxicity: identification and management

O Gumusay et al. Breast Cancer Res Treat. 2022 Feb.

Abstract

The widespread adoption of immunotherapy has revolutionized the treatment of various cancer types, including metastatic triple-negative breast cancer (TNBC), which has long been associated with poor prognostic outcomes. In particular, immune checkpoint inhibitors (ICIs) that target and inhibit programmed cell death-1 (PD-1) and programmed cell death ligand-1 (PD-L1), have shown promising results in the treatment of patients with metastatic TNBC. However, while manipulating the immune system to induce antitumor response, ICIs can also lead to a unique set of immune-related adverse events (IRAEs), which differ from standard chemotherapy toxicities due to their immune-based origin. These toxicities require highly specific management, including guidance from multidisciplinary specialists. The primary treatment strategy against IRAEs is systemic corticosteroid use, but additional treatment approaches may also involve supportive care, additional immunosuppression, and concurrent treatment delay or discontinuation. Given the rising prevalence of ICI therapy, it is essential to educate clinicians on the presentation and management of these potentially life-threatening events so that they are identified early and treated appropriately. Using data from recent clinical trials, this review will focus on known IRAEs, particularly those seen in patients with breast cancer, and will summarize their prevalence, severity, and outcomes. We will discuss optimal strategies for early recognition and management, as well as approaches toward cautious retreatment following resolution of IRAEs.

Keywords: Breast cancer; Immune checkpoint inhibitors; Immune-related adverse events; Immunotherapy; Retreatment; Toxicity.

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Figures

Fig. 1
Fig. 1
Flow diagram for monitoring and management of immune-related thyroid toxicities in patients treated with ICIs. Abs antibodies; FT4 free thyroxine; ICI immune checkpoint inhibitor; TSH thyroid-stimulating hormone
See this image and copyright information in PMC

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