Critical Care Management of Toxicities Associated With Targeted Agents and Immunotherapies for Cancer

Conclusions: The complexity of toxicities associated with modern targeted and immunotherapeutic agents for cancer require a multidisciplinary approach among ICU staff, oncologists, and organ specialists and adoption of standardized treatment protocols to ensure the best possible patient outcomes.
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Feature Articles Source Type: research

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Abstract In this manuscript, we describe a patient with an exceptional response of brain metastases from lung cancer to short course nivolumab while on high-dose steroids. This case shows that immunotherapy can cause delayed and enduring responses even in patients with poor predictive parameters for treatment success, such as low programmed death ligand-1 (PDL1) expression and long-term treatment with high-dose corticosteroids. Secondly, it underscores the importance of follow up after the administration of immunotherapy, even in cases with a deemed poor prognosis and few received cycles of immunotherapy. PMI...
Source: The Netherlands Journal of Medicine - Category: General Medicine Authors: Tags: Neth J Med Source Type: research
Conclusion: The prevalence of IRAE in our sample is similar to the reported in literature. Pts with higher BMI are more likely to experience IRAE. One potential explanation is pharmacokinetic changes induced by overweight.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Lung cancer Source Type: research
ConclusionsThe persistent complete response after third-line treatment for relapsed chemotherapy-resistant cervical cancer presented in this case highlights the potential of immunotherapy for patients with advanced cervical cancer impressively.To our knowledge, this is the first report of an isolated immune-related vulvitis under nivolumab. This adverse event might be underdiagnosed and mistreated, however, it is of importance due to its impact on quality of life, sexual wellbeing and compliance of patients. Successful IRAE management may enable prolonged immune checkpoint inhibitor therapy. In the future, routine molecula...
Source: Journal for Immunotherapy of Cancer - Category: Cancer & Oncology Source Type: research
ConclusionsSurvival of our HGG pts treated into ieCTs compared favorably with a matched CC. Inclusion of HGGs pts into ieCTs should be encouraged. Clinical selection factors predicting which pts may benefit most still lack.Legal entity responsible for the studyThe authors.FundingHas not received any funding.DisclosureM. Simonelli: Advisory / Consultancy: AbbVie. A. Santoro: Advisory / Consultancy: BRISTOL-MYERS-SQUIBB; Advisory / Consultancy: SERVIER; Advisory / Consultancy: GILEAD; Advisory / Consultancy: EISAI; Advisory / Consultancy: BAYER; Advisory / Consultancy: MERCK SHARP&DOHME; Speaker Bureau / Expert testimony...
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
Fatal outcome of atezolizumab in a patient with immune-mediated pneumonitis, thrombocytopenia, and cardiac dysfunction: A case report
. Int J Clin Pharmacol Ther. 2019 Sep 06;: Authors: Li J, Deng X, Wang B, Li W Abstract The anti-programmed cell death-ligand 1 (PD-L1) antibody atezolizumab is a promising agent for various cancers. Although immune-related adverse events (irAEs) induced by atezolizumab are rare, they can be severe. Clinical experience in irAE management is presently insufficient. Herein, we present a case of a patient with non-small cell lung cancer (NSCLC) who developed life-thr...
Source: International Journal of Clinical Pharmacology and Therapeutics - Category: Drugs & Pharmacology Tags: Int J Clin Pharmacol Ther Source Type: research
We report a case of our experience and review the current literature of MG exacerbated or occurring during immunotherapy to describe characteristics of this AE, warn the oncologist about this toxicity, and summarize the treatments conducted. Thirty-four cases of MG were reported, mostly with anti-programmed cell death protein 1 checkpoint inhibitor, and with melanoma. Onset was quick after the first or second infusion. Treatment comprised corticosteroids, prostigmine, and more or less plasmapheresis or immunoglobulins. Prognosis is poor, as 13 patients died after MG. MG is a rare immune-related AE that must be rapidly evok...
Source: Journal of Immunotherapy - Category: Allergy & Immunology Tags: Clincal Studies Source Type: research
CONCLUSION We observe several immune cell subpopulations that are dysregulated in CIP, which may represent possible targets that could lead to therapeutics for this morbid immune-related adverse event.FUNDING NIH, Department of Defense, and the Bloomberg~Kimmel Institute for Cancer Immunotherapy.
Source: Journal of Clinical Investigation - Category: Biomedical Science Authors: Source Type: research
Here, we report a case of myasthenia gravis and myopathy in a patient treated with nivolumab. A 76 ‐year‐old man who had been treated with four doses of nivolumab because of non‐small cell lung cancer (NSCLC) presented with proximal‐dominant muscle weakness and fluctuating ptosis and diplopia. Serologic studies revealed increased levels of muscle enzymes including creatine phosphokinase ( 2934 U/L), and acetylcholine receptor antibody was positive (1.31 nmol/L). Following electrodiagnostic study, he was diagnosed with myasthenia gravis and active stage of myopathy. After discontinuation of nivolumab, he was treated...
Source: Thoracic Cancer - Category: Cancer & Oncology Authors: Tags: CASE REPORT Source Type: research
Abstract CD3 bispecific constructs show promising therapeutic potential as anti-tumor antibodies, but it has concurrently been difficult to manage cytokine release syndrome (CRS) in clinical use. Currently, the most effective measure for reducing CRS is considered a combination of intra-patient/animal dose escalation and corticosteroid premedication. To examine how effectively an intra-animal ascending dose regimen without premedication would mitigate CRS, we compared plasma cytokine levels in two groups of cynomolgus monkeys; one group was given a single dose, and the other a three-fold daily ascending dose of a ...
Source: Toxicology and Applied Pharmacology - Category: Toxicology Authors: Tags: Toxicol Appl Pharmacol Source Type: research
ConclusionsSevere CPI ‐related GEC typically manifests within 3 months of immunotherapy exposure. Rates of second‐line immunosuppression and readmission for recrudescence were high. CTCAE grade did not capture the degree of severity in our cohort. Second‐line immunosuppression was not associated with poorer oncolo gic outcomes; however, early corticosteroid exposure was associated with decreased PFS. Further investigation is warranted.
Source: Cancer Medicine - Category: Cancer & Oncology Authors: Tags: ORIGINAL RESEARCH Source Type: research
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