Severe immune related adverse events induced by immune checkpoint inhibitors: implications for the intensivist
Keywords:immune related adverse events, immune check point inhibitor, cancer, intensive care, multidisciplinary team
Immune checkpoint inhibitors (ICI) have revolutionized the treatment of multiple cancers, even in advanced stages. With the increasing number of patients treated by ICI, related toxicities named immune related adverse events (irAE) have emerged. Understanding their mechanisms and implementing accurate recommendations is key for improving patients care. A variety of these irAE toxicities are eventually fatal and outbalance the very significant improvement in cancer response even in patients with metastatic cancers. Critical care physicians are now facing this issue with patients on ICI affected by life-threatening irAE in patients potentially controlled for their cancer. This work synthesizes the spectrum of severe irAE which may lead to intensive care unit hospitalization with their current recommended management in order to assist the treating physician in his diagnostic and therapeutic work-up.
The overlap of various irAE affecting several organs concurrently requires multidisciplinary care involving oncologists, organ specialists and critical care physicians. The implementation of multidisciplinary team dedicated to these specific toxicities allows for the development of a common expertise, the implementation of emergency care algorithms and research protocols dedicated to the understanding and management of these toxicities in order to improve patient’s morbidity and mortality.