Immunotherapy Drugs 🛡️
Quick reference for immunotherapy drugs: checkpoint inhibitors, monoclonal antibodies, side effects, and monitoring requirements for NCHDs.
⚠️ Important Safety Notes
- Immunotherapy can cause immune-related adverse events (irAEs) - monitor closely
- Side effects can occur weeks to months after treatment - long-term monitoring required
- Many side effects are reversible with early recognition and treatment
- Always consult oncology team for any suspected immune-related toxicity
- Steroids are often first-line treatment for moderate-severe irAEs
🔬 How Immunotherapy Works
- Checkpoint inhibitors block proteins that prevent immune system from attacking cancer cells
- PD-1/PD-L1 inhibitors: Block interaction between cancer cells and T-cells
- CTLA-4 inhibitors: Enhance T-cell activation and proliferation
- Monoclonal antibodies: Target specific proteins on cancer cells
- CAR-T therapy: Genetically modified T-cells to recognize cancer antigens
Common Immune-Related Adverse Events (irAEs)
- Skin: Rash, pruritus, vitiligo, Stevens-Johnson syndrome
- GI: Diarrhea, colitis, hepatitis, pancreatitis
- Endocrine: Thyroid dysfunction, diabetes, adrenal insufficiency
- Pulmonary: Pneumonitis, interstitial lung disease
- Neurological: Neuropathy, encephalitis, myasthenia gravis
- Cardiac: Myocarditis, pericarditis, arrhythmias
- Renal: Nephritis, acute kidney injury
Monitoring Requirements
- Baseline: FBC, U&E, LFTs, TFTs, cortisol, glucose, CXR
- During treatment: FBC, U&E, LFTs every 2-4 weeks
- TFTs every 6-8 weeks (more frequent if symptoms)
- Chest imaging if respiratory symptoms develop
- Cardiac monitoring if cardiac symptoms
- Skin examination at each visit
Emergency Management
- Severe diarrhea (>6 stools/day): Stop immunotherapy, start high-dose steroids
- Pneumonitis: Stop immunotherapy, high-dose steroids, consider antibiotics
- Hepatitis (ALT >3x ULN): Stop immunotherapy, high-dose steroids
- Myocarditis: Stop immunotherapy, cardiology review, high-dose steroids
- Stevens-Johnson syndrome: Stop immunotherapy, dermatology review, high-dose steroids
- Adrenal crisis: Hydrocortisone 100mg IV, endocrinology review
Pre-treatment Assessment
- Full blood count, renal and liver function
- Thyroid function tests and cortisol levels
- Baseline chest X-ray or CT
- ECG and echo if cardiac risk factors
- Autoimmune disease history (relative contraindication)
- Performance status assessment
- Baseline skin examination
🔗 Related Topics
🛡️Immunotherapy Drugs Reference
| Drug | Target | Indication | Dose | Key Side Effects | Monitoring |
|---|---|---|---|---|---|
| Pembrolizumab | PD-1 | Melanoma, NSCLC, HNSCC, RCC, MSI-H cancers | 200mg IV every 3 weeks | Fatigue, rash, diarrhea, pneumonitis, thyroid dysfunction | FBC, U&E, LFTs, TFTs, CXR |
| Nivolumab | PD-1 | Melanoma, NSCLC, RCC, HNSCC, HCC | 240mg IV every 2 weeks | Fatigue, rash, diarrhea, pneumonitis, thyroid dysfunction | FBC, U&E, LFTs, TFTs, CXR |
| Atezolizumab | PD-L1 | NSCLC, SCLC, urothelial carcinoma, triple-negative breast cancer | 840mg IV every 2 weeks | Fatigue, rash, diarrhea, pneumonitis, thyroid dysfunction | FBC, U&E, LFTs, TFTs, CXR |
| Durvalumab | PD-L1 | NSCLC, urothelial carcinoma | 10mg/kg IV every 2 weeks | Fatigue, rash, diarrhea, pneumonitis, thyroid dysfunction | FBC, U&E, LFTs, TFTs, CXR |
| Ipilimumab | CTLA-4 | Melanoma, RCC (in combination) | 3mg/kg IV every 3 weeks | Diarrhea, colitis, hepatitis, rash, hypophysitis | FBC, U&E, LFTs, TFTs, cortisol |
Pembrolizumab
PD-1Dose:200mg IV every 3 weeks
Indication:Melanoma, NSCLC, HNSCC, RCC, MSI-H cancers
Side Effects: Fatigue, rash, diarrhea, pneumonitis, thyroid dysfunction
Monitoring: FBC, U&E, LFTs, TFTs, CXR
Nivolumab
PD-1Dose:240mg IV every 2 weeks
Indication:Melanoma, NSCLC, RCC, HNSCC, HCC
Side Effects: Fatigue, rash, diarrhea, pneumonitis, thyroid dysfunction
Monitoring: FBC, U&E, LFTs, TFTs, CXR
Atezolizumab
PD-L1Dose:840mg IV every 2 weeks
Indication:NSCLC, SCLC, urothelial carcinoma, triple-negative breast cancer
Side Effects: Fatigue, rash, diarrhea, pneumonitis, thyroid dysfunction
Monitoring: FBC, U&E, LFTs, TFTs, CXR
Durvalumab
PD-L1Dose:10mg/kg IV every 2 weeks
Indication:NSCLC, urothelial carcinoma
Side Effects: Fatigue, rash, diarrhea, pneumonitis, thyroid dysfunction
Monitoring: FBC, U&E, LFTs, TFTs, CXR
Ipilimumab
CTLA-4Dose:3mg/kg IV every 3 weeks
Indication:Melanoma, RCC (in combination)
Side Effects: Diarrhea, colitis, hepatitis, rash, hypophysitis
Monitoring: FBC, U&E, LFTs, TFTs, cortisol
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Important Safety Notes
Immunotherapy can cause immune-related adverse events (irAEs) that may occur weeks to months after treatment. Early recognition and treatment are crucial. Always consult the oncology team for any suspected immune-related toxicity.