Oncologic therapy related adverse events: Difference between revisions
Ostermayer (talk | contribs) |
|||
(27 intermediate revisions by one other user not shown) | |||
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.<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== | ||
Line 9: | Line 9: | ||
*[[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 | ||
Line 16: | Line 17: | ||
{{oncologic therapy adverse events}} | {{oncologic therapy adverse events}} | ||
==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]] | |||
===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
- 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:
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)
- Adverse Events:
Ivosidenib (Tibsovo)
- Adverse events
Midostaurin (Rydapt)
- Adverse Events:
- Epistaxis
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:
Acalabrutinib (Calquence)
Duvelisib (Copiktra)
Copanlisib (Aliqopa)
- Adverse Events:
Panobinostat lactate (Farydak)
- Adverse Events:
Ixazomib citrate (Ninlaro)
- Adverse Events:
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:
Daratumumab (Darzalex)
Elotuzumab (Empliciti)
- Adverse Events:
Empliciti (Poteligeo)
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:
Immunotoxin
Moxetumomab pasudotox-tdfk (Lumoxiti)
- Adverse Events:
Bispecific T-cell engager (Blincyto)
Blinatumomab
- Adverse Events:
Disposition
- Most of these patients should be admitted and coordination should occur with hematology/oncology
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