Immune Related Adverse Events of Checkpoint Inhibitors
Mar 26, 2024
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Dr. Laura Cappelli discusses Immune Related Adverse Events (IRAEs) of checkpoint inhibitors. She explains their development, common occurrences, risk factors, and the importance of a multidisciplinary approach. Topics include monitoring strategies, treatment approaches, collaboration between rheumatology and oncology, and using corticosteroids as primary therapy.
Immune checkpoint inhibitors can lead to immune-related adverse events like inflammatory arthritis, demanding careful monitoring and treatment.
Multidisciplinary approach with oncologists and rheumatologists is essential for managing immune-related adverse events effectively.
Deep dives
Understanding Cancer Immunotherapy and Immune-Related Adverse Events
Cancer immunotherapy has transformed oncology by enhancing outcomes in previously challenging cancers. These treatments unleash the immune system to combat cancer, leading to immune-related adverse events (IRAEs) that can mimic rheumatic diseases. Dr. Laura Capelli highlights the complexity of IRAEs, including their occurrence, common types like inflammatory arthritis and methods for monitoring and treating them using D-Mards and Biologics.
Impact of Immune Checkpoint Inhibitors on Cancer Treatment and IRAEs
The introduction of immune checkpoint inhibitors, such as Ipilimumab and drugs targeting PD-1/PD-L1, has revolutionized cancer therapy. These drugs work by unleashing the immune system to combat cancer, leading to IRAEs like inflammatory arthritis. Combination therapies significantly increase IRAE occurrence, emphasizing the importance of monitoring and early intervention.
Management of IRAEs and Multidisciplinary Care Approach
Effectively managing IRAEs requires a multidisciplinary approach involving oncologists, rheumatologists, and other specialists. Education of patients on IRAEs and prompt reporting of new symptoms are crucial. Initial treatment involves corticosteroids, with considerations for NSAIDs, intraarticular steroids, D-Mards, and Biologics based on symptom severity and impact on cancer treatment.
Challenges and Future Directions in Treating IRAEs
Persistent IRAEs post-immunotherapy cessation are common, necessitating long-term management strategies. Better understanding pre-existing joint conditions' influence on IRAE risk and exploring optimal immunosuppressive treatments for IRAEs are areas in need of further research. Addressing safety concerns of immunosuppressive therapies in IRAE management remains a critical focus for future studies.
When a patient is diagnosed with cancer, treatments that force the immune system into overdrive are given in hopes that it will recognize the cancer and destroy it. Unfortunately, this can mean that various Immune Related Adverse Events (IRAEs) can occur. In rheumatology, our treatments are meant to tame an overactive immune system, creating a unique dilemma. Joining us today is Dr. Laura Cappelli, MD, MHS. Dr. Cappelli explains what these IRAEs really are, how they commonly occur, what risk factors exist in their development, the importance of a multidisciplinary approach to treatment and much, much more.
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