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.
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:
- 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:
Small molecule inhibitors
Enasidenib (IDHIFA)
Ivosidenib (Tibsovo)
- Adverse events
- QT prolongation
- Leukocytosis
- Differentiation syndrome
Midostaurin (Rydapt)
Nilotinib (Tasigna)
- Adverse events
- QT prolongation
- Sudden death
- Myelosuppression
- Arterial thrombosis
- Pancreatitis
- Hepatotoxicity