Immunotherapy of solid tumors: how safely treat the patients.

Immunotherapy with immune checkpoint inhibitors (ICIs) was shown to improve survival of patients with solid tumors like: melanoma, renal carcinoma, non-small cell lung cancer, cutaneous carcinomas or head and neck carcinoma. However, a special type of ICIs toxicity is observed, namely non-infectious inflammation of different organs connected with autoimmunity known as immune related adverse events (irAEs). This non-infectious inflammation may affect different organs and systems as endocrine organs, the gastrointestinal tract, heart, skin and the nervous system. The lungs are also often involved and this condition is referred to as checkpoint inhibitor pneumonitis (CIP). ICIs toxicity is graded from 1 to 5 depending on the clinical course, the 5 grade being a fatal complication. Corticosteroids are the treatment of choice, generally with good efficacy. In some difficult cases, escalation of immunosuppression is required. The knowledge on irAEs should be promoted among clinicians of all specialties, nurses, patients and their families. The aim of this review is to present the wide spectrum of irAEs: clinical signs and symptoms, differential diagnosis, diagnostic procedures and treatment. The data are supported by our own clinical observations.

Polish archives of internal medicine. 2020 Apr 24 [Epub ahead of print]

Joanna Domagała-Kulawik, Przemysław Leszek, Witold Owczarek, Tomasz Rawa, Maria Stelmachowska-Banaś, Piotr Rutkowski