Immunotherapy-Related Adverse Events

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Distinct sets of adverse events (AEs) occur in individuals who are treated with immunotherapies, says Madhav Dhodapkar, MD. Many of these AEs resemble autoimmune diseases, such as autoinflammatory rheumatic disease, dermatologic disease, and endocrinopathies. Early detection of these AEs is essential for a positive outcome, notes Dhodapkar, especially in the context of chimeric antigen receptor (CAR) T-cell therapy.

Treatment with immunotherapy, especially CAR T-cell therapy, may result in very high levels of cytokines, causing a clinical condition that presents with shock-like symptoms, explains Dan Douer, MD. These responses may occur very rapidly and need to be managed promptly. The other main toxicities associated with the rapid release of cytokines result in neurologic side effects, adds Douer. These effects are transient and generally reversible.

Clinical trials evaluating immunotherapies have excluded individuals with preexisting autoimmune diseases. The challenge after these medications gain FDA approval and are available in the community, says Ivan Marques Borrello, MD, is knowing how patients with these preexisting conditions will respond to these new agents.