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Toxicity of Immune Checkpoint Inhibitors: Considerations for the Surgeon

Annals of Surgical Oncology volume 27, pages 1533–1545 (2020)Cite this article

Abstract

Background

The use of immunotherapeutic agents, specifically immune checkpoint inhibitors (ICIs) for solid malignancies, is rapidly rising, and many new agents and treatment combinations are in development. However, ICIs have a unique side-effect profile of immune-related adverse events (irAEs) compared with chemotherapeutic agents or targeted therapies.

Methods

In this report the diverse spectrum of irAEs is highlighted using two patients with metastatic melanoma undergoing treatment with ICIs. We supplement these case reports with a brief literature review of the data regarding the safety of surgical intervention in patients taking irAEs.

Results

The report describes the basic approach to the detection and management of irAEs, notes important perioperative considerations, and discusses the safety of surgical intervention for these patients.

Conclusions

Overall, these irAEs represent a diverse group of pathologies with variable timing and sometimes subtle presentation requiring careful monitoring and heightened clinical suspicion for potential toxicity by all providers, including surgeons.

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Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA

    Beth A. Helmink MD, PhD, Christina L. Roland MD, MS, Colleen M. Kiernan MD, MPH & Jennifer A. Wargo MD, MSc

  2. Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA

    Jennifer A. Wargo MD, MSc

Authors
  1. Beth A. Helmink MD, PhD
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  2. Christina L. Roland MD, MS
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  3. Colleen M. Kiernan MD, MPH
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  4. Jennifer A. Wargo MD, MSc
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Corresponding author

Correspondence to Jennifer A. Wargo MD, MSc.

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Disclosures

Beth A. Helmink, MD, PhD, was supported by National Institutes of Health T32 CA 009599 and the MD Anderson Cancer Center support Grant (P30 CA016672). Colleen M. Kiernan, MD, MPH, reports no disclosures. Christina L. Roland, MD, MS, receives research support from Bristol Myers Squibb. Jennifer A. Wargo, MD, MSc, reports compensation for speaker’s bureau and honoraria from Imedex, Dava Oncology, Omniprex, Illumina, Gilead, PeerView, Physician Education Resource, MedImmune, Exelixis, and Bristol-Myers Squibb. She serves as a consultant/advisory board member for Roche/Genentech, Novartis, AstraZeneca, GlaxoSmithKline, Bristol-Myers Squibb, Merck, Biothera Pharmaceuticals, and Microbiome DX; receives research support from GlaxoSmithKline, Roche/Genentech, Bristol-Myers Squibb, and Novartis; and has a U.S. patent application (PCT/US17/53.717) submitted by the University of Texas MD Anderson Cancer Center that covers methods to enhance immune checkpoint blockade responses by modulating the microbiome.

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Helmink, B.A., Roland, C.L., Kiernan, C.M. et al. Toxicity of Immune Checkpoint Inhibitors: Considerations for the Surgeon. Ann Surg Oncol 27, 1533–1545 (2020). https://doi.org/10.1245/s10434-019-08183-0

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  • DOI: https://doi.org/10.1245/s10434-019-08183-0

Keywords

  • Immunotherapy
  • Checkpoint blockade
  • Melanoma
  • Surgery