TY - JOUR
T1 - Diagnosis and management of immune-related adverse effects of immune checkpoint therapy in the emergency department
AU - Yeung, Sai Ching Jim
AU - Qdaisat, Aiham
AU - Chaftari, Patrick
AU - Lipe, Demis
AU - Merlin, Jeffrey
AU - Rajha, Eva
AU - Wechsler, Adriana
AU - Sandoval, Marcelo
AU - Viets, Jayne
AU - Al-Breiki, Aisha
AU - Shah, Mohsin
AU - Pandey, Ramesh
AU - Kamal, Mona
AU - Khattab, Osama
AU - Toale, Katy
AU - Wattana, Monica
AU - Elsayem, Ahmed
AU - Gaeta, Susan
AU - Brock, Patricia
AU - Reyes-Gibby, Cielito
AU - Alagappan, Kumar
N1 - Publisher Copyright:
© 2020 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of the American College of Emergency Physicians.
PY - 2020/12
Y1 - 2020/12
N2 - Rapid advances in cancer immunotherapy using immune checkpoint inhibitors have led to significantly improved survival. Rapid identification of the toxicity syndromes associated with these therapeutic agents is very important for emergency physicians because the population of patients diagnosed with cancer is increasing and cancer therapies including immune checkpoint inhibitors have become the first-line treatment for more and more types of cancer. The emergency medicine literature lags behind rapid advances in oncology, and oncology guidelines for rapid recognition and management of these emerging toxicity syndromes are not familiar to emergency physicians. In this review article, we discuss the clinical presentation and management of immune-related adverse effects during the critical first hours of emergency care. We also suggest a workflow for the recognition and treatment of emergencies arising from serious immune-related adverse effects, including but not limited to colitis, adrenal crisis, myocarditis, pneumonitis, myasthenic crisis, diabetic ketoacidosis, bullous pemphigus, and hemophagocytic lymphohistiocytosis. Rapid advances in cancer therapy are bringing new diagnostic and therapeutic challenges to emergency providers, and therefore it is crucial to raise awareness and provide guidelines for the management of new treatment-related toxicities.
AB - Rapid advances in cancer immunotherapy using immune checkpoint inhibitors have led to significantly improved survival. Rapid identification of the toxicity syndromes associated with these therapeutic agents is very important for emergency physicians because the population of patients diagnosed with cancer is increasing and cancer therapies including immune checkpoint inhibitors have become the first-line treatment for more and more types of cancer. The emergency medicine literature lags behind rapid advances in oncology, and oncology guidelines for rapid recognition and management of these emerging toxicity syndromes are not familiar to emergency physicians. In this review article, we discuss the clinical presentation and management of immune-related adverse effects during the critical first hours of emergency care. We also suggest a workflow for the recognition and treatment of emergencies arising from serious immune-related adverse effects, including but not limited to colitis, adrenal crisis, myocarditis, pneumonitis, myasthenic crisis, diabetic ketoacidosis, bullous pemphigus, and hemophagocytic lymphohistiocytosis. Rapid advances in cancer therapy are bringing new diagnostic and therapeutic challenges to emergency providers, and therefore it is crucial to raise awareness and provide guidelines for the management of new treatment-related toxicities.
KW - adverse events
KW - cancer immunotherapy
KW - emergency department
KW - immune checkpoint inhibitors
KW - immune-mediated
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U2 - 10.1002/emp2.12209
DO - 10.1002/emp2.12209
M3 - Article
C2 - 33392573
AN - SCOPUS:85101431720
SN - 2688-1152
VL - 1
SP - 1637
EP - 1659
JO - JACEP Open
JF - JACEP Open
IS - 6
ER -