Oncologic therapy related adverse events: Difference between revisions
Ostermayer (talk | contribs) |
Ostermayer (talk | contribs) |
||
| Line 1: | Line 1: | ||
==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== | ||
Revision as of 17:34, 6 March 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
- Decreased cellular immunity which an cause reactivation or new
- Neurologic syndromes
- Hematologic side effects
- Cardiac effects
- Allergic reactions
- Pulmonary
- Endocrine
- GI
- Perforations
- Clostridium difficile
- Acute bacterial infections
- Malignancies
- Non-melanoma skin cancers
- Lymphoma
CAR-T cells medications
Tisagenlecleucel (Kymriah)
- Indications:
- Acute lymphoblastic leukemia
- Large B-cell lymphoma
- Adverse events include:
Axicabtagene ciloleucel (Yescarta)
- Indications:
- Acute lymphoblastic leukemia
- Large B-cell lymphoma
- Adverse events include:
- Cytokine release syndrome
- Pancytopenia
- Altered mental status
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)
- A PD-1 human IgG4 mAb
- Adverse events include:
Small molecule inhibitors
Enasidenib (IDHIFA)
Ivosidenib (Tibsovo)
- Adverse events
- QT prolongation
- Leukocytosis
- Differentiation syndrome
Midostaurin (Rydapt)
Nilotinib (Tasigna)
- Adverse events
- QT prolongation
- Sudden death
- Myelosuppression
- Arterial thrombosis
- Pancreatitis
- Hepatotoxicity
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
Management
Disposition
See Also
External Links
References
- ↑ 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