What is hidden from the view. The problem of chronic and delayed toxicity after immunotherapy based on clinical cases and literature review
https://doi.org/10.18027/2224-5057-2024-023
Abstract
The emergence of immunotherapy has revolutionized the treatment approaches of numerous malignancies. Patients that previously faced a prognosis of only a few months left to live can now enjoy extended lifespans for several years. Nevertheless, it is crucial to acknowledge that immunotherapy carries its own spectrum of adverse events. Notably, the issue of immune-related toxicity is progressively gaining prominence with each passing year. A distinctive feature of these immune-related adverse events is their propensity to transition into chronic conditions, with some manifesting long after discontinuation of immunotherapy. Given the current incorporation of adjuvant immunotherapy regimens in clinical guidelines, it becomes imperative to direct heightened attention towards the challenges associated with chronic and delayed toxicity of immunotherapy.
Keywords
immunotherapy,
toxicity,
oncology,
adverse events,
quality of life,
adrenal insufficiency,
thyreoiditis
Supporting agencies: The article was prepared without sponsorship
About the Authors
M. M. Sobolev
Oncology Center No. 1 of the City Clinical Hospital named after S.S. Yudin of the Moscow Department of Health
Russian Federation
Competing Interests:
Russian Federation
Maksim Mikhailovich Sobolev
18A Zagorodnoe Shosse, Moscow 117152
Competing Interests:
The authors declare that there are no possible conflicts of interest
I. A. Pokataev
Oncology Center No. 1 of the City Clinical Hospital named after S.S. Yudin of the Moscow Department of Health
Russian Federation
Competing Interests:
Russian Federation
Ilya Anatolevich Pokataev
18A Zagorodnoe Shosse, Moscow 117152
Competing Interests:
The authors declare that there are no possible conflicts of interest
E. S. Kuzmina
Oncology Center No. 1 of the City Clinical Hospital named after S.S. Yudin of the Moscow Department of Health
Russian Federation
Competing Interests:
Russian Federation
Evgeniya Sergeevna Kuzmina
18A Zagorodnoe Shosse, Moscow 117152
Competing Interests:
The authors declare that there are no possible conflicts of interest
V. N. Galkin
Oncology Center No. 1 of the City Clinical Hospital named after S.S. Yudin of the Moscow Department of Health
Russian Federation
Competing Interests:
Russian Federation
Vsevolod Nikolaevich Galkin
18A Zagorodnoe Shosse, Moscow 117152
Competing Interests:
The authors declare that there are no possible conflicts of interest
References
1. Eggermont А.М.М., Blank C.U., Mandala М., et al. Adjuvant pembrolizumab versus placebo in resected stage III melanoma. N Engl J Med 2018;378(19):1789-1801. https://doi.org/10.1056/NEJMoal802357
2. Felip E., Altorki N., Zhou C., et al. Adjuvant atezolizumab after adjuvant chemotherapy in resected stage IB — IIIA nonsmall-cell lung cancer (iMpowerOlO): arandomised, multicentre, open-label, phase 3 trial. Lancet 2021;398(10308):1344-1357. https://doi.org/10.1016/S0140-6736(21)02098-5
3. Weber J.S., Poretta T., Stwalley B.D., et al. Nivolumab versus placebo as adjuvant therapy for resected stage III melanoma: a propensity weighted indirect treatment comparison and number needed to treat analysis for recurrence-free survival and overall survival. Cancer Immunol Immunother 2023;72(4):945-954. https://doi.org/10.1007/s00262-022-03302-5
4. Patrinely Jr J.R., Young A.C., Quach H., et al. Survivorship in immune therapy: Assessing toxicities, body composition and health-related quality of life among long-term survivors treated with antibodies to programmed death-1 receptor and its ligand. Eur J Cancer 2020;135:211-220. https://doi.Org/10.1016/j.ejca.2020.05.005
5. PatrinelyJrJ.R., Johnson R., Lawless A.R., et al. Chronic Immune-Related Adverse Events Following Adjuvant Anti-PD-1 Therapy for High-risk Resected Melanoma. JAMA Oncol 2021;7(5):744-748. https://doi.org/10.1001/jamaoncol.2021.0051
6. Couey M.A., Bell R.B., Patel A.A., et al. Delayed immune-related events (DIRE) after discontinuation ofimmunotherapy: diagnostichazard ofautoimmunity at a distance. J Immunother Cancer 2019;7(l):165. https://doi.org/10.1186/s40425-019-0645-6
7. Protsenko S.A., Ballyuzek M.F., Vasiliev D.A., et al. Practical recommendations for the management of immune-mediated adverse events. Zlokachestvennie opuholi = Malignant Tumors 2023;13(3s2):212-251 (In Russ.), https://doi.org/10.18027/22245057-2023-13-3s2-2-212-251
8. Johnson D.B., Nebhan C.A., Moslehi J.J., Balko J.M. Immune-checkpoint inhibitors: long-term implications of toxicity. Nat Rev Clin Oncol 2022;19(4):254-267. https://doi.org/10.1038/s41571-022-00600-w
9. Ghisoni E., Wicky A., Bouchaab H., et al. Late-onset and long-lasting immune-related adverse events from immune checkpoint-inhibitors: An overlooked aspect in immunotherapy. Eur J Cancer 2021;149:153-164. https://doi.Org/10.1016/j.ejca.2021.03.010
10. Tong J., Kartolo A., Yeung C., et al. Long-term toxicities of immune checkpoint inhibitor (ICI) in melanoma patients. Curr Oncol 2022;29(10):7953-7963. https://doi.org/10.3390/curroncol29100629
11. Parakh S., Cebon J., Klein O. Delayed autoimmune toxicity occurring several months after cessation of anti-PD-1 therapy. Oncologist 2018;23(7):849-851. https://doi.org/10.1634/theoncologist.2017-0531
12. Owen C.N., Bai X., Quah T., et al. Delayed immune-related adverse events with anti-PD-l-based immunotherapy in melanoma. Ann Oncol 2021;32(7):917—925. https://doi.Org/10.1016/j.annonc.2021.03.204
13. Jacob S., Quandt Z., Melisko M.E., et al. Delayed immune toxicities in patients with breast cancer receiving immune checkpoint inhibitors. J Clin Oncol 2023. № 16_suppl (41). e24091. https://doi.org/10.1200/JCO.2023.41.16_suppl.e2409
14. Chen Y.C., Jaffer M., Zhou L., et al. A brain, a heart, and the courage: balancing benefit and toxicity of immunotherapy in melanoma. Am Soc Clin Oncol Educ Book 2023;43:e390594. https://doi.org/10.1200/EDBK_390594
15. Kotwal A., Perlman J.E., Goldner W.S. Endocrine dysfunction from immune checkpoint inhibitors: pearls and pitfalls in evaluation and management. JCO Oncol Pract 2023;19(7):395-402. https://doi.org/10.1200/OP.23.00023.
Review
For citations:
Sobolev M.M., Pokataev I.A., Kuzmina E.S., Galkin V.N. What is hidden from the view. The problem of chronic and delayed toxicity after immunotherapy based on clinical cases and literature review. Malignant tumours. 2024;14(3):86-91. (In Russ.) https://doi.org/10.18027/2224-5057-2024-023
Views:
178
Email this article 