Oncologic therapy related adverse events: Difference between revisions

Revision as of 21:53, 4 March 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.

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
- Aplastic anemia
- Pancytopenia
Cardiac effects
- Congestive heart failure
- Arrhythmias
Allergic reactions
Pulmonary
Endocrine
- Thyroiditis
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:
- 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)

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

Management

Disposition

External Links

References

Authors:

@@ Line 1: / Line 1: @@
 ==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.
 ==Clinical Features==
@@ Line 9: / Line 9: @@
 *[[Biologic immunomodulators|Monoclonal Antibodies]] against PD-1 checkpoints
 *Small-molecule inhibitors
+*Monoclonal antibodies against cell surface antigens
 *Antibody-drug conjugates
 *Immunotoxins
@@ Line 16: / Line 17: @@
 {{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 and Large B-cell lymphoma
+*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)===
+===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===
 ==Management==