Oncologic therapy related adverse events: Difference between revisions
 
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==Background==
==Background==
Many of the oncologic therapies currently employed involved immune system checkpoint inhibition which allow for improvement of T-cell activation towards cancer cells. This boost to the immune system can occur by many mechanisms that encompass the list of "novel" oncologic agents" described below.
Many of the oncologic therapies currently employed involved immune system checkpoint inhibition which allow for improvement of T-cell activation towards cancer cells. This boost to the immune system can occur by many mechanisms that encompass the list of "novel" oncologic agents" described below.<ref>Shah, M., Rajha, E., DiNardo, C., Muckey, E., Wierda, W. G., & Yeung, S. C. J. (2020). Adverse Events of Novel Therapies for Hematologic Malignancies: What Emergency Physicians Should Know. Annals of Emergency Medicine, 75(2), 264–286. https://doi.org/10.1016/j.annemergmed.2019.07.015</ref>


==Clinical Features==
==Clinical Features==
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**Acute lymphoblastic leukemia
**Acute lymphoblastic leukemia
**Large B-cell lymphoma
**Large B-cell lymphoma
**Adverse events include:
*Adverse events include:
**[[Cytokine release syndrome]]
**[[Cytokine release syndrome]]
**[[Pancytopenia]]
**[[Pancytopenia]]
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**Dyspnea
**Dyspnea
**Diarrhea
**Diarrhea
**Arrhythmias
*(Arrhythmias
**Myocardial infarctions
*(Myocardial infarctions
**Pericardial effusions
*(Pericardial effusions


===Nivolumab (OPDIVO)===
===Nivolumab (OPDIVO)===
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==Small molecule inhibitors==
==Small molecule inhibitors==
===Enasidenib (IDHIFA)===
===Enasidenib (IDHIFA)===
*[[Jaundice|Indirect hyperbilirubinemia]]
*Adverse Events:
*[[Differentiation syndrome]]
**[[Jaundice|Indirect hyperbilirubinemia]]
**[[Differentiation syndrome]]




===Ivosidenib (Tibsovo)===
===Ivosidenib (Tibsovo)===
*Adverse events
*Adverse events
*[[QT prolongation]]  
**[[QT prolongation]]  
*[[Leukocytosis]]
**[[Leukocytosis]]
*[[Differentiation syndrome]]
**[[Differentiation syndrome]]


===Midostaurin (Rydapt)===
===Midostaurin (Rydapt)===
*[[Adverse Events]]
*Adverse Events:
**[[Febrile neutropenia]]
**[[Febrile neutropenia]]
**[[Mucositis]]
**[[Mucositis]]
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===Bosutinib (Bosulif)===
===Bosutinib (Bosulif)===
*Adverse Events:
**Myelosuppression
**[[Diarrhea]]
**[[Pancreatitis]]
**[[Hepatotoxicity]]
**[[Cardiac arrest]]
**[[Arrythmia]]
**[[ACS]]
===Ibrutinib (Imbruvica)===
===Ibrutinib (Imbruvica)===
*Adverse Events:
**[[Cytopenia|Cytopenias]]
**[[Hypertension]]
===Acalabrutinib (Calquence)===
===Acalabrutinib (Calquence)===
*Adverse Events:
**[[Headache]]
**[[Diarrhea]]
**[[Myalgia]]
**[[Neutropenia]]
**[[Anemia]]
**[[Pneumonia]]
**[[ACS]]
===Duvelisib (Copiktra)===
===Duvelisib (Copiktra)===
*Adverse Events:
**[[Nausea]]
**[[Diarrhea]]
**[[Pyrexia]]
**[[Cytopenia]]
===Copanlisib (Aliqopa)===
===Copanlisib (Aliqopa)===
*Adverse Events:
**[[Hyperglycemia]]
**[[Hypertension]]
**[[Sepsis]]
**[[Neutropenia]]
**[[Pneumonitis]]
===Panobinostat lactate (Farydak)===
===Panobinostat lactate (Farydak)===
*Adverse Events:
**[[Cytopenia]]
**[[Diarrhea]]
**[[Peripheral neuropathy]]
===Ixazomib citrate (Ninlaro)===
===Ixazomib citrate (Ninlaro)===
*Adverse Events:
**[[Cytopenias]]
**[[Vomiting]]
**[[Diarrhea]]
**[[Constipation]]
**[[Neuropathy]]
**[[Peripheral edema]]
**[[Back pain]]
===Venetoclax (Venclexta)===
===Venetoclax (Venclexta)===
*Adverse Events:
**[[Tumor lysis syndrome]]
**Bone marrow suppression
**[[Autoimmune hemolytic anemia]]


==Monoclonal antibodies against cell surface antigens==
==Monoclonal antibodies against cell surface antigens==
===Ofatumumab (Arzerra)===
===Ofatumumab (Arzerra)===
*Adverse Events:
**Reactivation of [[Hepatitis B]] virus infection
**[[Progressive multifocal leukoencephalopathy]]
**[[Tumor lysis syndrome]]
**[[Infusion reaction]]
**[[Cytopenias]]
===Obinutuzumab (Gazyva)===
===Obinutuzumab (Gazyva)===
*Adverse Events:
**[[Neutropenic Fever]]
**[[Thrombocytopenia]]
**[[Infusion Reactions]]
===Daratumumab (Darzalex)===
===Daratumumab (Darzalex)===
*Adverse Events:
**[[Cytopenia]]
**[[Diarrhea]]
**[[Pneumonia]]
===Elotuzumab (Empliciti)===
===Elotuzumab (Empliciti)===
*Adverse Events:
**[[Pyrexia]]
**[[Anemia]]
**[[Pneumonia]]
**[[Pulmonary embolism]]
**[[Acute renal failure]]
**[[Hepatotoxicity]]
===Empliciti (Poteligeo)===
===Empliciti (Poteligeo)===
*Adverse Events:
**[[GVHD]]
**[[Rash]]


==Antibody-drug conjugates==
==Antibody-drug conjugates==
===Inotuzumab ozogamicin (Besponsa)===
===Inotuzumab ozogamicin (Besponsa)===
*Adverse Events:
**[[Sinusoid occlusion syndrome]]
**Infusion reactions
**[[Thrombocytopenia]]
**[[Neutropenia]]
**[[QT prolongation]]
===Gemtuzumab ozogamicin (Mylotarg)===
===Gemtuzumab ozogamicin (Mylotarg)===
*Adverse Events:
**[[Thrombocytopenia]]
**Abnormal [[LFTs]]
**Veno-oclusions
===Brentuximab vedotin (Adcetris)===
===Brentuximab vedotin (Adcetris)===
*Adverse Events:
**[[Progressive multifocal leukoencephalopathy]]
**[[Peripheral neuropathy]]
**[[Bone marrow suppression]]


==Immunotoxin==
==Immunotoxin==
===Moxetumomab pasudotox-tdfk (Lumoxiti)===
===Moxetumomab pasudotox-tdfk (Lumoxiti)===
*Adverse Events:
**[[Hemolytic uremic syndrome]]
**[[Capillary leak syndrome]]


==Bispecific T-cell engager (Blincyto)==
==Bispecific T-cell engager (Blincyto)==
===Blinatumomab===
===Blinatumomab===
==Management==
*Adverse Events:
 
**[[Altered mental status]]
**[[Cytokine release syndrome]]


==Disposition==
==Disposition==
 
*Most of these patients should be admitted and coordination should occur with hematology/oncology


==See Also==
==See Also==

Latest revision as of 00:21, 15 December 2020

Background

Many of the oncologic therapies currently employed involved immune system checkpoint inhibition which allow for improvement of T-cell activation towards cancer cells. This boost to the immune system can occur by many mechanisms that encompass the list of "novel" oncologic agents" described below.[1]

Clinical Features

  • Many novel oncologic therapies and Biologic immunomodulators adverse reactions may mimic common ED presentations such as sepsis.

Types of novel oncologic agents

  • Genetically engineered T cells
    • CD19–chimeric antigen receptor (CAR)-T cell therapy
  • Monoclonal Antibodies against PD-1 checkpoints
  • Small-molecule inhibitors
  • Monoclonal antibodies against cell surface antigens
  • Antibody-drug conjugates
  • Immunotoxins
  • Bispecific T-cell engagers

Differential Diagnosis


CAR-T cells medications

Tisagenlecleucel (Kymriah)

Axicabtagene ciloleucel (Yescarta)

PD1 Monoclonal Antibodies

Pembrolizumab (Keytruda)

  • A PD-1 humanized mouse mAb
  • Adverse events include:
    • Infusion reactions
    • Musculoskeletal pain
    • Dyspnea
    • Diarrhea
  • (Arrhythmias
  • (Myocardial infarctions
  • (Pericardial effusions

Nivolumab (OPDIVO)


Small molecule inhibitors

Enasidenib (IDHIFA)


Ivosidenib (Tibsovo)

Midostaurin (Rydapt)

Nilotinib (Tasigna)

Bosutinib (Bosulif)

Ibrutinib (Imbruvica)


Acalabrutinib (Calquence)

Duvelisib (Copiktra)

Copanlisib (Aliqopa)


Panobinostat lactate (Farydak)

Ixazomib citrate (Ninlaro)

Venetoclax (Venclexta)

Monoclonal antibodies against cell surface antigens

Ofatumumab (Arzerra)


Obinutuzumab (Gazyva)


Daratumumab (Darzalex)

Elotuzumab (Empliciti)

Empliciti (Poteligeo)

Antibody-drug conjugates

Inotuzumab ozogamicin (Besponsa)


Gemtuzumab ozogamicin (Mylotarg)

Brentuximab vedotin (Adcetris)

Immunotoxin

Moxetumomab pasudotox-tdfk (Lumoxiti)

Bispecific T-cell engager (Blincyto)

Blinatumomab

Disposition

  • Most of these patients should be admitted and coordination should occur with hematology/oncology

See Also

External Links

References

  1. ↑ Shah, M., Rajha, E., DiNardo, C., Muckey, E., Wierda, W. G., & Yeung, S. C. J. (2020). Adverse Events of Novel Therapies for Hematologic Malignancies: What Emergency Physicians Should Know. Annals of Emergency Medicine, 75(2), 264–286. https://doi.org/10.1016/j.annemergmed.2019.07.015
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