Checkpoint Inhibitors: What Generalists Need to Know
Apr 15, 2024
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Drs. Reaford Blackburn Jr. and Brian C. Westbrook discuss immune-related adverse events from checkpoint inhibitors, highlighting the mechanisms of action, management of adverse events, patient response variations, and the importance of early recognition by healthcare providers.
Checkpoint inhibitors enhance the immune response against cancer by suppressing immune checkpoints like CTLA4 and PD1.
Immune-related adverse events from checkpoint inhibitors, such as colitis and myocarditis, require prompt recognition and management.
Deep dives
Understanding Checkpoint Inhibitors in Oncology
Checkpoint inhibitors target immune checkpoints, allowing the immune system to attack cancer cells that evade detection. These inhibitors, such as CTLA4 and PD1, aim to enhance the immune response against cancer. The adaptation of cancer cells to over-express these proteins can hinder the immune system's recognition of cancer as a threat. By suppressing these checkpoints, checkpoint inhibitors help unleash the immune system against cancer, albeit with the potential for adverse effects on normal cells.
Complications of Checkpoint Inhibitors and Management
Checkpoint inhibitors, while beneficial in fighting cancer, can lead to immune-related adverse events affecting various organs. Common complications include colitis, hypophysitis, and myocarditis, with severity ranging from mild to life-threatening. Prompt recognition and treatment with steroids form the cornerstone of managing these adverse events. Patients often respond well to treatment, but severe cases may necessitate additional therapies like biologics or immune-modulating agents.
Recommendations for Physicians Handling Checkpoint Inhibitor Complications
Physicians must remain vigilant for immune-related adverse events in patients on checkpoint inhibitors. Early recognition based on presenting symptoms and close collaboration with oncology colleagues are crucial. Referring to resources outlining common adverse reactions and appropriate diagnostic tests can aid in effectively managing these complications. Monitoring for adverse events, especially within the initial treatment period, ensures timely intervention to mitigate potential risks associated with checkpoint inhibitors.