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KMID : 1011320190110010015
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Journal of Pharmacoepidemiology and Risk Management
2019 Volume.11 No. 1 p.15 ~ p.20
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Adverse Events of Immune Checkpoint Inhibitors
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Jang Seung-Ho
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Abstract
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The overall prognosis of cancer patients has substantially improved since the use of immune checkpoint inhibitors has
been actively used in clinical practice. Adverse events of Immune checkpoint inhibitors are basically related with activated
T-lymphocytes, autoantibodies, and cytokines secretion. The adverse events induced by CTLA-4 inhibitors are
more frequent and severe compared with those by PD-1/PD-L1 inhibitors except interstitial pneumonitis and thyroiditis,
and especially when two drugs are combined, the frequency and severity of the adverse events tend to increase. It
should be noted that although timing of adverse events is different according to the affected organs, they may appear at
any time, even after drug discontinuation. Offending agents can be maintained in case of mild adverse events, but
should be postponed in moderate cases, and discontinued in cases of severe adverse events. Adequate steroid therapy is
necessary depending on the severity, and consultation to the specialists is mandatory. The offending agents can be cautiously resumed after the disappearance of the adverse events, but if they were severe, resuming should be considered very carefully and contraindicated in cases of fatal events, especially fatal pneumonitis, myocarditis, and nervous system toxicity. Medical staffs may have a desire to use steroids due to the various types and various degrees of adverse events occurring during the use of immune checkpoint inhibitors. However, unnecessary steroid administration should be avoided because steroids are closely related with poor survival outcomes in the cancer patients treated with immune checkpoint inhibitors.
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KEYWORD
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Immune checkpoint, Cancer, Adverse drug event
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