Oncologic therapy related adverse events

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