Immunotherapy in Cancer: Review of Adverse Events with Immune Checkpoints Inhibitors

Abstract

Over the past few years, remarkable results have been achieved with the availability of Immune-checkpoint inhibitors, including anti-cytotoxic T lymphocyte antigen 4 (CTLA-4), anti-programmed cell death 1 (PD-1) and anti-programmed cell death 1 ligand 1 (PD-L1) antibodies. These therapies have the potential to induce durable responses in multiple solid and hematologic malignancies and thus have reshaped treatment algorithms for numerous tumor types and revolutionized the field of oncology. Immunotherapy, although targeting cancer cells, by the profile of its unique mechanism of action with activation of the immune system can also affect various tissues and organ systems, often leading to immune-related adverse events. With the increasing use of immune-therapeutic agents, clinicians will increasingly be confronted with common but also rare immune-related adverse events which are often distinctly different from the classical chemotherapy-related toxicities. In this review, we provide an overview of potential adverse effects associated with different classes of immunotherapeutic agents organized by organ systems, including pathophysiology, epidemiology and kinetics, screening, surveillance strategies, diagnosis, and management.