Immune-Related Adverse Events Associated With Immune Checkpoint Inhibitor Therapy.
Animals
Autoimmune Diseases
/ chemically induced
Autoimmunity
/ drug effects
Humans
Immune Checkpoint Inhibitors
/ adverse effects
Immunity, Innate
/ drug effects
Immunosuppressive Agents
/ therapeutic use
Natural Killer T-Cells
/ drug effects
Prognosis
Risk Assessment
Risk Factors
Self Tolerance
/ drug effects
Journal
Anesthesia and analgesia
ISSN: 1526-7598
Titre abrégé: Anesth Analg
Pays: United States
ID NLM: 1310650
Informations de publication
Date de publication:
01 02 2021
01 02 2021
Historique:
pubmed:
4
10
2020
medline:
17
2
2021
entrez:
3
10
2020
Statut:
ppublish
Résumé
As part of immune surveillance, killer T lymphocytes search for cancer cells and destroy them. Some cancer cells, however, develop escape mechanisms to evade detection and destruction. One of these mechanisms is the expression of cell surface proteins which allow the cancer cell to bind to proteins on T cells called checkpoints to switch off and effectively evade T-cell-mediated destruction. Immune checkpoint inhibitors (ICIs) are antibodies that block the binding of cancer cell proteins to T-cell checkpoints, preventing the T-cell response from being turned off by cancer cells and enabling killer T cells to attack. In other words, ICIs restore innate antitumor immunity, as opposed to traditional chemotherapies that directly kill cancer cells. Given their relatively excellent risk-benefit ratio when compared to other forms of cancer treatment modalities, ICIs are now becoming ubiquitous and have revolutionized the treatment of many types of cancer. Indeed, the prognosis of some patients is so much improved that the threshold for admission for intensive care should be adjusted accordingly. Nevertheless, by modulating immune checkpoint activity, ICIs can disrupt the intricate homeostasis between inhibition and stimulation of immune response, leading to decreased immune self-tolerance and, ultimately, autoimmune complications. These immune-related adverse events (IRAEs) may virtually affect all body systems. Multiple IRAEs are common and may range from mild to life-threatening. Management requires a multidisciplinary approach and consists mainly of immunosuppression, cessation or postponement of ICI treatment, and supportive therapy, which may require surgical intervention and/or intensive care. We herein review the current literature surrounding IRAEs of interest to anesthesiologists and intensivists. With proper care, fatality (0.3%-1.3%) is rare.
Identifiants
pubmed: 33009134
pii: 00000539-202102000-00014
doi: 10.1213/ANE.0000000000005029
doi:
Substances chimiques
Immune Checkpoint Inhibitors
0
Immunosuppressive Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
374-383Informations de copyright
Copyright © 2020 International Anesthesia Research Society.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
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