Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :2637
Small font sizeDefault font sizeIncrease font size
Navigate Here
 »   Next article
 »   Previous article
 »   Table of Contents

Resource Links
 »   Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
 »   Citation Manager
 »   Access Statistics
 »   Reader Comments
 »   Email Alert *
 »   Add to My List *
 * Requires registration (Free)

 Article Access Statistics
    PDF Downloaded117    
    Comments [Add]    

Recommend this journal


Year : 2019  |  Volume : 56  |  Issue : 5  |  Page : 10-22

Adverse effects of immuno-oncology drugs—Awareness, diagnosis, and management: A literature review of immune-mediated adverse events

Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India

Correspondence Address:
Shyam Aggarwal
Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijc.IJC_448_19

Rights and Permissions

Immuno-oncology (IO) approaches such as cytokine therapy, immune-checkpoint blockers (ICBs), cancer vaccines, and cell-based therapies have revolutionized cancer treatment. ICBs provide better response-to-toxicity profile among various IO approaches; however, they can cause dysregulation of host immune system resulting in immune-mediated adverse events (imAEs). The skin and gastrointestinal system are most commonly affected. Although reversible, imAEs may cause life-threatening conditions if untreated. Risk assessment and appropriate patient selection before treatment initiation may prevent most imAEs. Key factors in effectively managing imAEs include baseline clinical evaluation, appropriate diagnostic tests, severity grading, timely decision on discontinuation or reintroduction of ICB treatment, and intervention with immunosuppressive and/or immunomodulatory agents. Patient and healthcare provider awareness is critical for identifying and managing lower grade imAEs. Immediate reporting is important for successfully managing and preventing or worsening of imAEs. Pretreatment sensitization of patients should address barriers to reporting such as fear of ICB discontinuation, ignorance of symptoms, financial constraints, and self-medication. Physicians should rely on clinical presentation and diagnostic work-up (including imaging) to accurately identify, characterize, and differentiate imAEs from metastasis. Treatment-related new symptoms should be dealt with a high level of suspicion. Corticosteroids are initiated if symptoms do not resolve within a week from onset and tapered over a month to avoid rebound of symptoms. ICB therapy should be permanently discontinued in most cases of grade 3-4 imAEs. A multidisciplinary approach involving oncologists, oncosurgeons, primary care physicians, and nurses is necessary in effectively managing imAEs and facilitating better clinical outcomes.


Print this article     Email this article

  Site Map | What's new | Copyright and Disclaimer
  Online since 1st April '07
  © 2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow