Immunotherapy Flashcards
AE’s of checkpoint inhibitors
- autoimmune encephalitis
- peripheral neuropathy
- nephritis/renal failure
- cardiotoxicity (anything but high risk for conduction abnormalities)
- type 1 diabetes (irreversible)
- hypophysitis
- rash
- autoimmmune hepatitis
- hypo/hyperthyroidism
- colitis (diarrhea, abdominal pain, GI bleeding). ***Virtually any organ can be subject to autoimmunity. There all diagnosis of exclusion, must rule out infection too. Lung toxicity can be deadly if not identified early enough.
- Most common – skin rash, pruritus, colon SE’s.
Rash in immune checkpoint inhibitors
highly variable, includes SJS and bullous pemphigoid.
When to hold immunotherapy
most grade 2 toxicities, grade 3 generally
Deaths from immune checkpoint inhibitors?
very rare but have been documented.
correlation of toxicity and outcome
*Toxicity does not correlate to outcome, There is some data that if you develop toxicity, you have a higher survival rate (immune system activation).
Elderly population and immunotherapy
Data suggests they do just as well, despite immune system senescence (but this is for elderly people with high PS).
Can HIV patients be treated?
Yes, but need HIV ID specialist.
Can you treat organ transplant recipient?
Yes, but about 50% have organ rejection
Can you restart immune checkpoint blockade after AE?
Depends on severity of AE, but data is mixed on efficacy (a lot of people seem to remain in CR).
Can you treat patients with autoimmune disease?
You can but chance of flair are higher.
How to manage most SE’s of checkpoint inhibitors
→ steroids for generally at least 4 weeks + hold therapy (a few you can continue)
Management of autoimmune hepatitis as SE from checkpoint inhibitors
mycophenolate, NOT infliximab (hepatotoxic)
steroid taper for managing AE’s
4-6 weeks
Patients on immune checkpoint inhibitors also need
PPI + bactrim
general physiologic effect of immune system activation
immune system activation commonly causes an inflammatory response in normal tissue.
