Adverse effects of immunotherapy and their management

Immunotherapy is a rapidly evolving and specific cancer treatment. It is based on antibodies against checkpoints of the immune response (CTLA-4, PD-1, PD-L1). These monoclonal antibodies (so-called checkpoint inhibitors) are able to significantly prolong overall survival and long-term disease control in cancer patients. The immunotherapy is associated with new toxicity profiles, so called ir-AEs, that are caused by nonspecific activation of the immune system. Ir-AEs can affect almost any organ. The most common ir-AEs are cutaneous, intestinal, endocrine, pulmonary and musculoskeletal ir-AEs while cardiovascular, haematological, renal, neurological and ophthalmic ir-AEs are less frequent. Effective ir-AEs management depends on timely recognition of ir-AEs and it requires immediate intervention with immune suppression and/or immuno modulation. The ir-AEs management depends on severity of ir-AE, and education of the patients, physicians and nurses about the potential risk of developing ir-AES is important. (author)