Immune-related adverse events (IRAE)

•  Checkpoint inhibitor immunotherapy is now widely used in the treatment of many different cancers. Side-effects of checkpoint inhibitor immunotherapy agents occur when the immune system is stimulated to attack healthy cells and tissues in the body. These immune-related adverse events (IRAEs) are increasingly being recognized as oncological emergencies. 

Clinical features 

• Almost any body system may be affected, 
• Inflammation of the colon, endocrine organs (thyroid, adrenal and pituitary glands) lungs, liver, skin and nervous system are most frequently seen (see p. 129). 

Investigations and management 

• Investigation and management of IRAEs requires a multidisciplinary approach including oncologists and relevant system specialists. 
• Specialist investigations may be required depending on the body system affected. 

Treatet: 

• The focus of treatment is on dampening the immune response by

• • high-dose steroids
  • immunosuppressant therapies 
• In the case of endocrine organ inflammation, replacement of deficient hormones 
• In severe IRAEs, checkpoint inhibitor immunotherapy treatment discontinued permanently