1. Diagnosis and management of immune-related adverse effects of immune checkpoint therapy in the emergency department
- Author
-
Ramesh Kumar Pandey, Susan Gaeta, Ahmed Elsayem, Mona Kamal, Aisha Al-Breiki, Jayne Viets, Monica K. Wattana, Marcelo Sandoval, Patrick Chaftari, Cielito C. Reyes-Gibby, Katy M. Toale, Jeffrey Merlin, Patricia A Brock, Sai Ching J. Yeung, Eva Rajha, Mohsin Shah, Demis N. Lipe, Kumar Alagappan, Osama K. Khattab, Aiham Qdaisat, and Adriana H. Wechsler
- Subjects
education.field_of_study ,Hemophagocytic lymphohistiocytosis ,medicine.medical_specialty ,cancer immunotherapy ,emergency department ,business.industry ,Population ,Cancer ,Adrenal crisis ,Review Article ,Emergency department ,The Practice of Emergency Medicine ,medicine.disease ,adverse events ,Immune checkpoint ,Review article ,immune checkpoint inhibitors ,Medicine ,medicine.symptom ,business ,education ,Adverse effect ,Intensive care medicine ,immune‐mediated - Abstract
Rapid advances in cancer immunotherapy using immune checkpoint inhibitors have led to significantly improved survival. Rapid identification of the toxicity syndromes associated with these therapeutic agents is very important for emergency physicians because the population of patients diagnosed with cancer is increasing and cancer therapies including immune checkpoint inhibitors have become the first‐line treatment for more and more types of cancer. The emergency medicine literature lags behind rapid advances in oncology, and oncology guidelines for rapid recognition and management of these emerging toxicity syndromes are not familiar to emergency physicians. In this review article, we discuss the clinical presentation and management of immune‐related adverse effects during the critical first hours of emergency care. We also suggest a workflow for the recognition and treatment of emergencies arising from serious immune‐related adverse effects, including but not limited to colitis, adrenal crisis, myocarditis, pneumonitis, myasthenic crisis, diabetic ketoacidosis, bullous pemphigus, and hemophagocytic lymphohistiocytosis. Rapid advances in cancer therapy are bringing new diagnostic and therapeutic challenges to emergency providers, and therefore it is crucial to raise awareness and provide guidelines for the management of new treatment‐related toxicities.
- Published
- 2020