Immune Checkpoint Inhibitor Toxicity

Written by Vivian Lei

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Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that block inhibitors of T-cell activation and function. They are increasingly used in different malignancies by removing inhibition of T-cell function. However, this also facilitates autoimmune activity against multiple organs. Autoimmune adverse events are most common during the first 12 weeks of therapy but may occur up to 6 months following treatment discontinuation.

Why does this matter?
More and more cancer patients are taking these agents. This review in JAMA Insights highlights the most common ICI toxicities that a clinician may encounter and what to do about them.

Primary mechanisms of ICIs include:

  • Inhibition of cytotoxic T lymphocyte antigen 4 (CTLA-4; i.e., ipilimumab)

  • Inhibition of programmed death 1 (PD-1; i.e., novolumab, pembrolizumab)

  • Inhibition of programmed death ligand 1 (PD-L1; i.e., atezolizumab, avelumab, durvalumab)

The high gravity beer of chemo drugs - disinhibited, disorderly T-cells
Here is a table of the most common side effects by organ system. High-dose steroid treatment is the main way to shut down the toxic effects.

Click here for a higher resolution  PDF version .

Click here for a higher resolution PDF version.

Source
Immune Checkpoint Inhibitor Toxicity in 2018. JAMA. 2018 Oct 23;320(16):1702-1703. doi: 10.1001/jama.2018.13995.

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Reviewed by Clay Smith

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