Immune checkpoint inhibition
Immune checkpoint inhibitors (ICI) represent a class of immuno-oncology drugs consisting of monoclonal antibodies occurring against inhibitory receptors or ligands within the immune system including CTLA-4, PD-1, and PD-L1. ICI has transformed oncology in the last decade leading to increased response rates and improved overall survival across several advanced malignancies. ICI is associated with a unique array of toxicities termed immune-related adverse events (IrAEs) which are T-cell-mediated autoimmune toxicities reported in nearly every organ system; most commonly affecting the skin, liver, gastrointestinal tract, and endocrine system. Most IrAEs are manageable with prompt recognition and initiation of appropriate management. General treatment of IrAEs is based on immunosuppression using varying strengths of glucocorticoids. Severe steroid-refractory IrAEs have required nonsteroidal immunosuppressive agents. In this chapter, we describe IrAEs observed with CTLA-4 and PD-1/PDL-1 inhibition by system describing clinical presentation, grading, incidence, time of onset, management, and time to resolution.
