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.<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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*[[Biologic immunomodulators|Monoclonal Antibodies]] against PD-1 checkpoints
*[[Biologic immunomodulators|Monoclonal Antibodies]] against PD-1 checkpoints
*Small-molecule inhibitors
*Small-molecule inhibitors
*Monoclonal antibodies against cell surface antigens
*Antibody-drug conjugates
*Antibody-drug conjugates
*Immunotoxins
*Immunotoxins
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{{oncologic therapy adverse events}}
{{oncologic therapy adverse events}}


==Evaluation==


==CAR-T cells medications==
===Tisagenlecleucel (Kymriah)===
*Indications:
**Acute lymphoblastic leukemia
**Large B-cell lymphoma
*Adverse events include:
**[[Cytokine release syndrome]]
**[[Hypogammaglobulinemia]]
**[[Pancytopenia]]
**[[Altered mental status]]
===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:
**[[Graft-vs-host disease]]
**[[Portal vein thrombosis]]
==Small molecule inhibitors==
===Enasidenib (IDHIFA)===
*Adverse Events:
**[[Jaundice|Indirect hyperbilirubinemia]]
**[[Differentiation syndrome]]
===Ivosidenib (Tibsovo)===
*Adverse events
**[[QT prolongation]]
**[[Leukocytosis]]
**[[Differentiation syndrome]]
===Midostaurin (Rydapt)===
*Adverse Events:
**[[Febrile neutropenia]]
**[[Mucositis]]
**[[Nausea and vomiting]]
**[[Headache]]
**[[Petechiae]]
*[[Epistaxis]]
**[[URI]]
===Nilotinib (Tasigna)===
*Adverse events
**[[QT prolongation]]
**Sudden death
**Myelosuppression
**[[Arterial thrombosis]]
**[[Pancreatitis]]
**[[Hepatotoxicity]]
===Bosutinib (Bosulif)===
*Adverse Events:
**Myelosuppression
**[[Diarrhea]]
**[[Pancreatitis]]
**[[Hepatotoxicity]]
**[[Cardiac arrest]]
**[[Arrythmia]]
**[[ACS]]
===Ibrutinib (Imbruvica)===
*Adverse Events:
**[[Cytopenia|Cytopenias]]
**[[Hypertension]]
===Acalabrutinib (Calquence)===
*Adverse Events:
**[[Headache]]
**[[Diarrhea]]
**[[Myalgia]]
**[[Neutropenia]]
**[[Anemia]]
**[[Pneumonia]]
**[[ACS]]
===Duvelisib (Copiktra)===
*Adverse Events:
**[[Nausea]]
**[[Diarrhea]]
**[[Pyrexia]]
**[[Cytopenia]]
===Copanlisib (Aliqopa)===
*Adverse Events:
**[[Hyperglycemia]]
**[[Hypertension]]
**[[Sepsis]]
**[[Neutropenia]]
**[[Pneumonitis]]


==Management==


===Panobinostat lactate (Farydak)===
*Adverse Events:
**[[Cytopenia]]
**[[Diarrhea]]
**[[Peripheral neuropathy]]
===Ixazomib citrate (Ninlaro)===
*Adverse Events:
**[[Cytopenias]]
**[[Vomiting]]
**[[Diarrhea]]
**[[Constipation]]
**[[Neuropathy]]
**[[Peripheral edema]]
**[[Back pain]]
===Venetoclax (Venclexta)===
*Adverse Events:
**[[Tumor lysis syndrome]]
**Bone marrow suppression
**[[Autoimmune hemolytic anemia]]
==Monoclonal antibodies against cell surface antigens==
===Ofatumumab (Arzerra)===
*Adverse Events:
**Reactivation of [[Hepatitis B]] virus infection
**[[Progressive multifocal leukoencephalopathy]]
**[[Tumor lysis syndrome]]
**[[Infusion reaction]]
**[[Cytopenias]]
===Obinutuzumab (Gazyva)===
*Adverse Events:
**[[Neutropenic Fever]]
**[[Thrombocytopenia]]
**[[Infusion Reactions]]
===Daratumumab (Darzalex)===
*Adverse Events:
**[[Cytopenia]]
**[[Diarrhea]]
**[[Pneumonia]]
===Elotuzumab (Empliciti)===
*Adverse Events:
**[[Pyrexia]]
**[[Anemia]]
**[[Pneumonia]]
**[[Pulmonary embolism]]
**[[Acute renal failure]]
**[[Hepatotoxicity]]
===Empliciti (Poteligeo)===
*Adverse Events:
**[[GVHD]]
**[[Rash]]
==Antibody-drug conjugates==
===Inotuzumab ozogamicin (Besponsa)===
*Adverse Events:
**[[Sinusoid occlusion syndrome]]
**Infusion reactions
**[[Thrombocytopenia]]
**[[Neutropenia]]
**[[QT prolongation]]
===Gemtuzumab ozogamicin (Mylotarg)===
*Adverse Events:
**[[Thrombocytopenia]]
**Abnormal [[LFTs]]
**Veno-oclusions
===Brentuximab vedotin (Adcetris)===
*Adverse Events:
**[[Progressive multifocal leukoencephalopathy]]
**[[Peripheral neuropathy]]
**[[Bone marrow suppression]]
==Immunotoxin==
===Moxetumomab pasudotox-tdfk (Lumoxiti)===
*Adverse Events:
**[[Hemolytic uremic syndrome]]
**[[Capillary leak syndrome]]
==Bispecific T-cell engager (Blincyto)==
===Blinatumomab===
*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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