Critical Care Management of Toxicities Associated With Targeted Agents and Immunotherapies for Cancer
- 1 January 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 48 (1), 10-21
- https://doi.org/10.1097/ccm.0000000000004087
Abstract
Objectives: To describe the most common serious adverse effects and organ toxicities associated with emerging therapies for cancer that may necessitate admission to the ICU. Data Sources and Study Selection: PubMed and Medline search of relevant articles in English on the management of adverse effects of immunotherapy for cancer. Data Extraction and Data Synthesis: Targeted therapies including tyrosine kinase inhibitors, monoclonal antibodies, checkpoint inhibitors, and immune effector cell therapy have improved the outcome and quality of life of patients with cancer. However, severe and life-threatening side effects can occur. These toxicities include infusion or hypersensitivity reactions, cytokine release syndrome, pulmonary, cardiac, renal, hepatic, and neurologic toxicities, hemophagocytic lymphohistiocytosis, opportunistic infections, and endocrinopathies. Cytokine release syndrome is the most common serious toxicity after administration of monoclonal antibodies and immune effector cell therapies. Most of the adverse events from immunotherapy results from an exaggerated T-cell response directed against normal tissue, resulting in the generation of high levels of proinflammatory cytokines. Toxicities from targeted therapies are usually secondary to “on target toxicities.” Management is largely supportive and may include discontinuation of the specific agent, corticosteroids, and other immune suppressing agents for severe (grade 3 or 4) immune-related adverse events like neurotoxicity and pneumonitis. Conclusions: The complexity of toxicities associated with modern targeted and immunotherapeutic agents for cancer require a multidisciplinary approach among ICU staff, oncologists, and organ specialists and adoption of standardized treatment protocols to ensure the best possible patient outcomes.Keywords
This publication has 121 references indexed in Scilit:
- Adverse events to monoclonal antibodies used for cancer therapy: Focus on hypersensitivity responsesOncoImmunology, 2013
- B-cell depletion and remissions of malignancy along with cytokine-associated toxicity in a clinical trial of anti-CD19 chimeric-antigen-receptor–transduced T cellsBlood, 2012
- The Emerging Toxicity Profiles of Anti–CTLA-4 Antibodies Across Clinical IndicationsSeminars in Oncology, 2010
- The safety and side effects of monoclonal antibodiesNature Reviews Drug Discovery, 2010
- Rituximab (B‐cell depleting antibody) associated lung injury (RALI): A pediatric case and systematic review of the literaturePediatric Pulmonology, 2009
- Anti-CTLA-4 (CD 152) monoclonal antibody-induced autoimmune interstitial nephritis.Clinical Kidney Journal, 2009
- Hepatitis B Virus Reactivation in Lymphoma Patients With Prior Resolved Hepatitis B Undergoing Anticancer Therapy With or Without RituximabJournal of Clinical Oncology, 2009
- Fatal Toxic Epidermal Necrolysis Associated With Cetuximab in a Patient With Colon CancerJournal of Clinical Oncology, 2008
- VEGF Inhibition and Renal Thrombotic MicroangiopathyThe New England Journal of Medicine, 2008
- Treatment of hemophagocytic lymphohistiocytosis with HLH-94 immunochemotherapy and bone marrow transplantationBlood, 2002