[A Wolf in Sheep's Clothing - Manifestation and Diversity of Immune-Related Adverse Events in Cancer Immunotherapy].

Abstract

Immunotherapy, particularly immune checkpoint inhibitors, has significantly impacted cancer treatment by enhancing the immune system's ability to identify and attack cancer cells. However, this treatment introduces unique immune-related adverse events (irAEs), which require careful management due to their potential to affect multiple organ systems. IrAEs can manifest during or after treatment, affecting organs such as the gastrointestinal tract, endocrine glands, lungs, and liver, with symptoms ranging from mild to life threatening. While irAEs are distinct from those seen in traditional cancer treatments, their early recognition and appropriate management are crucial. Steroid therapy and other immunosuppressive treatments are often necessary to mitigate these effects. Guidelines from organizations like ESMO and ASCO recommend a structured approach for evaluating and managing irAEs, including staging the severity, ruling out other diagnoses, and adjusting treatment protocols accordingly. Medical doctors need to stay vigilant, as the indications for immune checkpoint inhibitors continue to expand. The potential for delayed onset of irAEs months after treatment cessation increases the importance of maintaining irAEs on the differential diagnosis list for an extended period, even after patients have stopped immune checkpoint inhibitor therapy.