J Korean Med Assoc.  2023 Feb;66(2):116-122. 10.5124/jkma.2023.66.2.116.

Management of the adverse effects of cancer immunotherapy with a focus on the respiratory and nervous systems

• Park SE

• KMID: 2539907
• DOI: http://doi.org/10.5124/jkma.2023.66.2.116

Abstract

Background
The incidence of adverse toxic reactions to immunotherapy using immune checkpoint inhibitors is 2-10% in the respiratory system and 3.9% to 12% in the neurologic system. The severity of adverse effects increases when combined immunotherapeutic agents are administered.
Current Concepts
In cases of high-grade toxicity, it is important to discontinue immunotherapy immediately. In cases of grade 3 to 4 toxicity, immunosuppressive corticosteroid therapy is the first-line treatment. Short-term steroid treatment does not affect anti-tumor efficacy. It is thus necessary to use steroids for an appropriate period then carefully taper the steroid dose to prevent recurrence. If no improvement is achieved within 48-72 hours after the administration of steroids, it is essential to initiate multidisciplinary treatment involving related departments and add immunosuppressive drugs. If the patient is administrated immunotherapy again, it may be necessary to permanently discontinue the immunotherapy depending on the toxicity grade that first occurred.
Discussion and Conclusion
The primary goals for effective management of immunotherapy-related adverse events are early recognition of symptoms and immediate treatment.

Keyword

Antineoplastic agents; Immunotherapy; Immune checkpoint inhibitors; Adverse effects; 항암제; 면역요법; 면역관문억제제; 부작용