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New oncologic emergencies: What is there to know about inmunotherapy and its potential side effects?

      Highlights

      • Immunotherapy blocks inhibitory immune checkpoints allowing our immune system to fight against tumor cells.
      • Most frequent irAEs affect skin, gastrointestinal, liver, lung and endocrine systems.
      • Timely intervention with corticosteroids is crucial to limit the severity of irAEs.
      • Corticosteroids are generally indicated together with dose skipping or discontinuation for persistent grade ≥2 irAEs.
      • Severe irAEs, grade 3-4, may require additional immunosuppressive agents and a multidisciplinary approach.

      Abstract

      Over the last decade anticancer treatment has experienced encouraging changes. One of the latest developments is immunotherapy, which is increasingly becoming a mainstay for the treatment of these malignancies. Unlike conventional chemotherapy, immunotherapy enhances anti-tumor immune response by blocking inhibitory immune checkpoints, and allowing our own immune system to fight against the tumor cells, arising as a new and innovative mechanism of action. Therefore, although well tolerated, these drugs have a unique side effect profile and are known to cause immune-related adverse events (irAEs). Adverse effects of immunotherapy are most commonly observed in the skin, gastrointestinal tract, liver, lung and endocrine systems. Less common toxicities may include neurological, haematological, cardiac, ocular or rheumatologic involvement. As far as we know, cancer patients are frequently seen in the Emergency Department due to treatment related toxicities, thus there is an increasing necessity to learn about this particular side effect profile
      given that they entail a different and unique management than that of classic chemotherapy drugs.

      Keywords

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