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Review
. 2021 Oct;17(4):411-424.
doi: 10.1007/s13181-021-00833-8. Epub 2021 Apr 7.

A Review of Cancer Immunotherapy Toxicity: Immune Checkpoint Inhibitors

Neeraj Chhabra  1   2 , Joseph Kennedy  3   4
Affiliations
Review

A Review of Cancer Immunotherapy Toxicity: Immune Checkpoint Inhibitors

Neeraj Chhabra et al. J Med Toxicol. 2021 Oct.

Abstract

Cancer immunotherapy, which leverages features of the immune system to target neoplastic cells, has revolutionized the treatment of cancer. The use of these therapies has rapidly expanded in the past two decades. Immune checkpoint inhibitors represent one drug class within immunotherapy with its first agent FDA-approved in 2011. Immune checkpoint inhibitors act by disrupting inhibitory signals from neoplastic cells to immune effector cells, allowing activated T-cells to target these neoplastic cells. Unique adverse effects associated with immune checkpoint inhibitors are termed immune-related adverse effects (irAEs) and are usually immunostimulatory in nature. Almost all organ systems may be affected by irAEs including the dermatologic, gastrointestinal, pulmonary, endocrine, and cardiovascular systems. These effects range from mild to life-threatening, and their onset can be delayed several weeks or months. For mild irAEs, symptomatic care is usually sufficient. For higher grade irAEs, discontinuation of therapy and initiation of immunosuppressive therapy may be necessary. The management of patients with irAEs involves multidisciplinary care coordination with respect to the long-term goals the individual patient. Clinicians must be aware of the unique and sometimes fatal toxicologic profiles associated with immunotherapies to ensure prompt diagnosis and appropriate management.

Keywords: Adverse events; Checkpoint inhibitor; Chemotherapy; Immunotherapy; Toxicity.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Immune checkpoint inhibitor mechanism of action (PD-1) (reproduced with permission from Terese Winslow LLC). PD-1, programmed death receptor 1; PD-L1 programmed death-ligand 1.
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